Folate Issue

[casualobserver]

What would folate inbalance be indicative of? No other meds and reasonable diet, maybe stress recently a cause?

Something that would rectify itself by a daily folic acid tablet and maybe curbing beers?

Folate in RBC - 207ng/ML - Reference range 221 - 1113

Folate in Serum - 43ng/ML - Reference range 5 - 24

Went to a doctor last week when feeling more fatigued than usual, their basic blood tests came back okay and sent me on my way feeling like a bit of a paranoid idiot.

Not feeling particular great I dediced to get iron, b12 and folate tested at my own expense a day or two later, forgot about it as felt a little better a few days later and then got folate back today, seems a little high on the later..

Would a doc lose face if I went back with these results? Or best walk into another hospital and see another doc, not exactly difficult here?

[Sheryl]

It is not clear that you have a folate imbalance. RBC folate testing is really not indicated in the absence of anemia (which you apparently do not have, since you say the basic tests were normal -- though it would help to see the actual CBC report) and with normal serum folate levels . Your serum folate is if anything high . Are you by any chance taking a multivitamin supplement? Or eating a lot of something that is fortified with folic acid? If so and if you started this recently then it is possible that this is skewing the serum results and that the RBC level is low from prior folate deficiency.

As you also tested for B12 and do not mention the result I assume it was normal?

Regardless, the mechanism through which low RBC folate causes fatigue is anemia so if you are not anemic, hard to see how this could explain your fatigue. But please do show the actual CBC report, all of it. If the doctor you saw was just a GP could have missed something.

Did you have your thyroid checked? As that would also be a major thing to exclude - need full thyroid panel.

As to your original questions, you can go back to the same doctor with the test result but unless that doctor is a hematologist s/he is not likely to be able to make sense of it. Do not take a folic acid supplement as from your serum level you are already getting plenty of folate. If you really want to pursue this angle, see a hematologist, but if your CBC is totally normal (not just the hemoglobin/hematocrit and cell counts but also the RBC morphology etc) expect it to be brushed off as insignificant.

[casualobserver]

Yes since new year I take a centrium multivitamin and a B complex daily with about 80% discipline so say five times a week. Cereal a few times a week but not fortified from what I can see.

B12 sreum was high at 998 with a reference range of 197 to 771. Iron all looked comfortably within the ranges with serum at 90 ug/DL and TIBC 333 and saturation 29%.

I think I follow so if I understand this correctly serum is the whole blood, and RBC are cells within that, so with high serum and low in rbc one would expect eventually to increase vitamin in rbc as it slowly absorbs and balance out. High serum could simply be caused by amount being in a centrium tablet and then maybe also in a B complex tablet too?

Attached is blood work nothing stands out to me just eGFR which they said little over or under no problem

Thank you

Edited March 31, 2016 by casualobserver

[Sheryl]

Yes, that is correct. Both the centrum and the B complex contain folate and B12 so you are getting more than enough, in fact taking both is overkill. You likely had a folate feficiency before you started these and it is now gradually correcting. If you want to be sure, recheck the RBC folate in another month or two , should have come up.

Question remains why low folate originally. Alcohol is a common culprit.

[casualobserver]

Will re-check end of April, drop the extra B tablet, and lay off the beer as much as possible during April.

A quick search says that alcohol affects the absorption, that would be from serum to rbc correct? Is that during time alcohol is in the bloodstream? So a few beers every night could potentially mean several hours of mal-absorption? And there is no B12 in RBC only serum?

Thanks again

Edited March 31, 2016 by casualobserver

[Sheryl]

There is B12 in RBCs but not common to measure this and no need.

Alcohol does not only interfere with folate absorption, it also interferes with its transfer into body tissues. In addition, alcohol lowers B1w2 levels and B12 is required for folate to get into RBCs.

Continuing with the Centrum and ehalth ydiet and reducing alcohol should resolve the nutritional issues. If despite that the fatigue persists, other causes you might want to investigate would be (1) low testosterone (see endocrinologist) and (2) sleep disorder