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Q. What are the ways to improve vitamin levels in the body through diet and supplements?

Answered by
Dr. Basuki Nath Bhagat
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 23, 2022

Hello doctor,

I have had gastritis and IBS-D for the past three months. Also, I have grade 1 fatty liver, sinus tachycardia, and an enlarged prostate. Currently, I am taking tablet Propranol 10 mg twice daily, capsule Famotidine 20 mg twice daily, capsule Vitamin D 60000 IU, and capsule Vitamin A to Z. I have undergone endoscopy for erosive gastritis, CT scan of the abdomen, and ultrasound scan.

My query is about using the right multivitamin. My vitamin and mineral levels are in ng/ml - A-716, E-20939.1, K-0.72, B1-1.43, B2-37.31, B3-0.58, B5-137.84, B6-30.17, B7-0.44, B9-0.79, B12-226, copper-125.65 ug/dL, magnesium-2.26 mg/dL, zinc-202.54 ug/dL, selenium-120.59 ug/dL, manganese-13.51 ug/dL. My vitamin E levels are also higher than the normal range. Can you please suggest a suitable multivitamin for me?

Kindly advise.

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#

Hello,

Welcome to icliniq.com.

I have read your query and also seen the test results that you have attached (attachments removed to protect the patient's identity). Your vitamin B panel test values are within the normal limits. Vitamin B1, B3, B9, and B12 values are in the lower half of the reference range. Most people get enough B vitamins through their diet. For deficiency of a particular vitamin, supplements can be given in the form of capsules to restore the vitamin level. I suggest you to use capsule Becosules (vitamin B complex and vitamin C) once a day for one month and take a healthy, nutritional diet to maintain normal vitamin levels in the body. Vitamin B12 is found only in foods of animal origin. A Vitamin B-rich diet includes green leafy vegetables, milk, and dairy products like yogurt, cheese, non-vegetarian foods like fish and red meat, whole grains, cereals, nuts, and fruits. A diet rich in vitamin B will help maintain an adequate level without the need for supplements.

Also, I have gone through the laboratory results that you have attached. All laboratory parameters like diabetic status, kidney function tests, liver function tests, thyroid profile, minerals, and hormones are normal. High sensitivity C-reactive protein is just above 3 mg/L. As you can read in the interpretation, HS-CRP, along with other risk factors of an acute coronary syndrome (ACS), is an essential clinical laboratory parameter for the assessment. HS-CRP becomes important when other risk factors of ACS are present like diabetes, hypertension, dyslipidemia, obesity, history of smoking, and family history. Your LDL (low-density lipoprotein) cholesterol is high and total cholesterol is just above the normal upper reference value. I suggest you control the intake of a fat-rich diet and do daily exercise to reduce the values; I also suggest you consult a doctor who knows your past medical history and can give necessary suggestions to lower these values.

I hope this helps.

Kindly revert in case of further questions.

Thank you.

Hello doctor,

Thank you for the response.

My gastroenterologist has suggested me to stop capsule Vitamin A to Z as Vitamin E is very high. Though the report shows that the lower limit for B9 is at 0.2 ng/ml, I have read on the internet that 2 ng/ml is the lower limit. The cause of my severe gastritis and IBS is unknown; however, it started when I used tablet Omeprazole. I have also read online that PPI usage can lead to a B12 or folic acid deficiency. Most of my symptoms coincide with a folic acid deficiency. I would like to know if there are other parameters such as hemoglobin, MCV, reticulocyte, MMA, and homocysteine that can lead to folic acid deficiency? Also, does a value of 0.79 ng/ml constitute a deficiency?

Also, I am looking for a multivitamin tablet without vitamin E.

Kindly suggest.

#

Hello,

Welcome back to icliniq.com.

The reference range of serum folate is 2.5-20 ng/ml. Therefore, in most cases, serum folate testing is sufficient for assessing folate status. In folate deficiency, the main presentation is megaloblastic anemia, where MCV (mean corpuscular volume) is high in the routine CBC (complete blood count).

The following are the causes of folate deficiency:

  • Diet.
  • Malabsorption.
  • Excess utilization or loss.
  • Antifolate medicines.

The cause has to be ruled out or confirmed through the patient's medical history, and relevant investigation is needed. As far as PPI (proton-pump inhibitors) are concerned, they can cause vitamin B12 deficiency rarely when taken for a long duration. As the report suggests, low serum folate needs further investigations to identify the cause and treat it with folic acid supplementation. Also, the underlying cause has to be managed. I suggest you consult your gastroenterologist regarding folate deficiency.

I hope this helps.

Kindly revert in case of further questions.

Thank you.


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