What are the causes of vitamin B12 deficiency?

Question

Hello doctor,

This is for my husband. He recently had a master health check-up, and a few of his values are not within the normal range. I would like to hear your opinion on these. He is 35 years old, weighs 158 pounds, and is 5.5 feet tall. The abnormal values are as follows:

Serum globulin: 4.2 gm/dL (high; normal range: 2-3.5).
T4: 11.46 µg/mL (high; normal range: 4.6-10.5) (T3 and TSH are normal).
Vitamin D: 9.65 ng/mL (low).
Serum HDL: 34.9 mg/dL (low) (Other triglyceride and LDL values are normal).
Vitamin B12: 144 pg/mL (low; normal range: 180-914).

Additionally, I have attached his ECG, which is marked as "unconfirmed." Please review it and let me know your thoughts on the results.

He is an athlete who actively participates in cycling races, running, and swimming. However, he has been out of sports for a year, which led to weight gain (from 149 pounds to 165 pounds). Over the last three months, he has managed to lose 8 pounds. Unfortunately, he is following inconsistent and unhealthy diet plans, alternating between paleo for one week, intermittent fasting the next, and balanced, normal meals the following week.

I am concerned about his health and would appreciate your advice.

Answer 1

Hello,

Welcome to icliniq.com.

I believe his low vitamin B12 levels may be linked to his paleo diet, which can be deficient in legumes and nuts, foods that are beneficial for heart health. I do not think he needs to be overly strict about his diet; vitamin B12 can be obtained from dairy products, eggs, fish, and chicken. His low vitamin D levels can typically be addressed with more outdoor activity. If needed, he can take 60,000 units of vitamin D supplements once a week for six weeks. His HDL (high-density lipoprotein) levels are low, and although his LDL (low-density lipoprotein) levels are also low, I would recommend daily exercise (about half an hour each day) to help boost his HDL levels.

The isolated high T4 levels suggest that you should check for a thyroid goiter and possibly consider a thyroid scan. It could also be linked to his elevated globulin levels. Isolated high globulin levels require further investigation, as they could indicate immune system disorders or rare conditions like multiple myeloma. It may be helpful to consult a hematologist for this.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

His ECG (electrocardiogram) is normal (attachment removed to protect patient identity). I have already mentioned exercise as a method for increasing HDL, and although Niacin tablets are also used, I have no personal experience with them.