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I was hoping someone would be able to give me some advice. I would be really grateful as I am unsure what to do next and do not know any doctors who have lots of experience in this specific area.

I had a blood test done because I have been feeling unwell lately (very long list of symptoms, notably fatigue, mood changes, anxiety, depression, insomnia, pain in my hand below my ring finger, tingling in my lips).

I am concerned about my B12 and Ferritin status:
B12 = 370 pg/mL (273 pmol/L, normal > 180 pmol/L).
Ferritin = 37 ng/ml (range 10 - 120 ng/ml)

From the research I have done, optimal B12 should be above 800 pg/mL (below 500 pg/mL is regarded as deficient in some countries) and optimal Ferritin should be 70 to 90 ng/ml.

I would like to understand whether there is a valid cause for concern and if so, it is important for me to investigate the cause of this. I have a very healthy lifestyle - no drugs/alcohol, no processed/junk food, I cook everything at home and my diet is based on quality whole foods. It seems strange to me that my blood test results would be less than optimal and so I am trying to understand what could be causing this.

I have considered the following options:
1) Eliminate gluten from my diet and monitor results in a few weeks/months . I do not have any digestive issues when I eat gluten, however I read that many people can be sensitive to gluten and that this may inhibit the body from absorbing nutrients. I thought that I could try eliminating gluten for a period of time and check whether my B12 and Ferritin levels are higher then.

2) Supplement B12 only. If so, I would look at sublingual B12 (both active forms) plus a b-complex. I thought that maybe if I had higher B12, my body might be able to absorb and store more iron (this may be completely inaccurate, it is just an idea).

3) Supplement B12 plus iron. I am a bit nervous about supplementing iron because I have read that it may cause an imbalance with other minerals (such as zinc and copper) so I would make sure I take those minerals also in recommended ratios. This is my least preferred option because I am worried about throwing my natural balance out and prefer to get nutrients from food. I am less concerned about supplementing with B vitamins because they are water soluble.

4) Investigate possibility of hypothyroidism/hashimioto's thryoidosis. While my thyroid results are all in a desirable range, I seem to have a lot of symptoms that suggest hypothyroidism (i haven't listed everything above) and so I am considering testing for the TGA and TPO-Ab antibodies. I am not sure whether this is an over reaction when my TSH, FT3 and FT4 are all good. I would like some advice about whether this is necessary/advisable.

5) Investigate B12 deficiency further by testing urinary methylmalonic acid (MMA), homocysteine and maybe holotranscobalamin. I am not sure whether this is advisable.

6) Determine whether I have pernicious anemia by doing a blood test for Intrinsic Factor Abs and Parietal Cell Abs. Is this unnecessary?

7) Doing a blood test for celiac. I am reluctant because I don't have digestive issues with gluten and the blood test is not entirely accurate anyway so I don't want to waste anyone's time (e.g. the doctor, lab technicians etc).

In case it is relevant, here are some other results:
Iron = 20.2 umol/L or 113 mcg/dL
Saturation = 32% (range 13 - 51)
Folate (red cell) 806 ng/ml (1826 nmol/L , normal > 450)
HB = 130 g/L (range 115 - 165)
TSH = 1.89 mIU/L (range 0.35 - 5.5)
Free T3 = 5 pmol/L (range 3.5 - 6.5)
Free T4 = 15 pmol/L (range 9 - 25)
Blood pressure = 100/60

The supplements that I currently take include:
Whole food multivitamin (includes 18 mg iron and 800 mcg folate, hence the high folate blood result)
Omega 3 + D capsules
Magnesium 400 mg

Thank you in advance. I would really like to hear advice from people about whether my levels are a cause for concern and if so, what I should do next.





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