Hi ,

Fortunately, she shared her lab results with you! Since I only know her labs, I will only discuss some numbers and what they could indicate. Meanwhile, could you share a bit more about this person? For example, do you know:
• If she has any health complaints. And in particular, • do you also know if she has cold hands & feet, is feeling low on energy and do you know if she is having some cognitive issues for example problems with focusing or dizziness?
• Is she short of breath? Does she experience headaches? Possible ringing in the ears? Or pains in her legs?
• was she feeling sick at the moment of drawing blood?
• does she have gut-related complaints? (feeling bloated, constipation/diarrhoea, IBS or other complaints)
• How is her diet? Is she struggling for example with eating healthy?
• How would you assess her stress levels?
• How would she describe her menstrual flow? Is there a lot of blood loss?

So let’s discuss some of the ‘easy’ numbers!

Vitamin D
Optimal numbers for vitamin D are around 120 nmol/l or 50 ng/ml. Having a vitamin D3 supplement (and not a vitamin D2!) can be an easy way to bring her levels up. If she lives in a sunny area, some sun exposure can help her as well of course. Just remember that people with dark skin can need up to 6x longer sun exposure to raise vitamin D levels compared to people with light skin.

Iron
A lot of markers point to an iron deficiency. For example: her hemoglobin is clinically low and hemoglobin can drop when iron is insufficient.

Her ‘volume globulaire moyen’ is clinically low. This means that the average size of her red blood cells is too small. This can happen when there isn’t enough hemoglobin in the red blood cells present.

And on top of everything, her storage form of iron ‘ferritin’ is almost clinically low.

Based on these numbers I would say she is experiencing iron deficiency anemia.

Thyroid
Also, we see hints of a starting hypothyroid state on her thyroid panel. TSH is clinically elevated, but free T3 and free T4 are still in range. TSH is the hormone from the pituitary telling (or in this case perhaps screaming is the better word)to the thyroid to make thyroid hormones T3 & T4. The thyroid is still reacting, but in her situation, I wouldn’t be surprised as this will start to change. These elevations could also be caused by an iron deficiency since iron is needed for optimal thyroid hormone balance.

Prolactin
Prolactin is elevated and this can be caused by a low thyroid state. But be aware that small elevations of prolactin can also mean other things. It could be an indication of a prolactinoma as well, so this does deserve special attention from her doctor in my opinion.

Vitamin B6
Her liver enzymes are in the reference range (which is good), but really low. Especially the value of ALAT is so low like the body is struggling with producing the enzymes. This is a picture we often see when there is a lack of vitamin B6. A lack of vitamin B6 can cause anemia as well and can cause worsening of the already playing anemia.

Vitamin B12
Her vitamin B12 is on the lower end of the range. Ideally, we want B12 on the high end of the reference range.

White blood cells
Something seems to be going on there. It looks like an infection dynamic. This could also make her C reactive protein (a marker for inflammation) go up. But assessing white blood cells purely on numbers isn’t going to give us the complete picture. It would be better to know if there were any symptoms.

What to do first?
I would definitely support her with iron but only if she isn’t experiencing infections! This is why having more details is important. Infections can get worse on iron supplements. 

If she had an acute infection, let her recover from this first before working with iron supplements (which I will discuss in a moment)

Support also means thinking about why she is iron deficient in the first place:
• Is iron in her diet? Is she vegan? Or is she struggling with healthy food choices?
• Is she experiencing absorption problems? Does she have low stomach acid? IBS? SIBO? Crohn’s disease? Celiac disease? Has she surgically removed parts of her GI tract?
• Is she experiencing a lot of blood loss? For example, does she have a heavy menstrual flow? Did she donate blood recently? Or maybe she had an accident?
• Pregnancy sometimes can cause iron deficiency as well.

Supporting iron
In most scenario’s supporting her with iron is a good idea. Either through healthy food choices (which are hard with an iron deficiency because people experience a lot of fatigue often) or through the use of a liquid iron formula from pure encapsulations for example (click here)

It will take a while (at least 3 months) before all her red blood cells died off and are replaced with healthy ones. Having a regular workout routine can speed up the process, although again, because of fatigue, this can be hard.

Be aware, sometimes supplementing with iron can cause constipation. Make sure when you start supplementing iron she is not constipated, because you won’t be able to tell if her iron supplement is causing a worsening of the dynamic.

Support her with the right multivitamin
Giving her a good quality multivitamin with the b vitamins in the methylated form would give her nutrients that support thyroid health as well. A healthy thyroid hormone balance depends for example also on iodine, selenium, zinc, and vitamin A & D. Supporting her for example with an iron-free multivitamin like vita-prime iron free from Klaire Labs (click here) will make it easier with dosing the right amount of iron.

Because of the possible B6 deficiency, start low and slow with the multivitamin. In the Klaire Labs formulation is 15 mg of B6 per serving. 1 serving is 2 tablets. So you can start with 1 tablet per day or even every other day and slowly work your way to a full serving size per day. Vitamin B6 is essential for detoxification and opening detoxification pathways too fast can cause problems.

Vitamin D
The multivitamin has 15 mcg (600 IU) of vitamin D. This probably won’t be enough to raise her vitamin D levels to the optimal zone. I would recommend somewhere from 2000IU to 5000IU to start with and then retest her values after a while.

I hope this helped!

Hello  – Daniel provided an excellent summary based on the data alone. But please remember, these results represent only 1 moment in time. Without any knowledge of the person’s symptom presentation, health history, diet, lifestyle, medications, supplements, stage of life, etc it is just 1 small piece of the puzzle that makes up a unique individual.

If you can provide us with more details about who she is and what she’s experiencing/struggling with, we’ll be able to provide even more guidance.

 Needles to say that a 7 day workweek can put a lot of mental pressure on someone. And yes, that can make someone very tired.

But the iron deficiency is real. She needs to address this if she wants to feel energetic again. Iron is needed for oxygen transport.

I don’t know her gut related problems of course, but be aware that those problems can be part of the root why she can’t absorb iron.

If she has trouble eating a healthy diet, start there. Her gut symptoms might already improve. Remember that iron supplements can sometimes cause constipation. If she is constipated, start with magnesiumcitrate to stimulate her bowel movements first.

If she has a normal bowel movement you can try dosing with iron. Just remember to do this when she isn’t sick. 

Remember to give her immune system more support as well!

Good luck and let us know if you need any more help!