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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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I went to the doctor recently complaining of fatigue. It had

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I went to the doctor recently complaining of fatigue. It had been affecting me a few months and seems to be getting worse. I've also noticed I'm drinking a lot of water and have an increased appetite. I have a balanced diet, am not overweight, exercise moderately and regularly, sleep very well. I smoke a little (c. 5 per day). I'm not particularly stressed or down. She did a range of blood tests incl. liver & kidney function, Coeliac, thyroid, blood glucose and full blood count. Everything has come back normal except my MCV, which she says is raised (she didn't say exactly the level). She said this could be caused by B12 or folate deficiency but when I said I take a multi-vitamin daily she didn't think that was likely. She said it could be caused by excessive alcohol consumption - I would say my alcohol consumption is a little higher than it should be (c. 4 days per week & 2 - 5 units per drinking day on average) but I'm only 31 and liver function was normal - is this enough alcohol to cause the raised MCV and would that cause the fatigue? I have some bowel symptoms but she seems quite convinced that's IBS, which she says wouldn't cause malabsorption, and she was quite dismissive of the idea that another food intolerance (soya doesn't seem to sit well with me) would cause long-term fatigue. Any ideas would be welcomed.
Anthony Bray MD : Hello!
Anthony Bray MD : i think that your serum iron and B 12 should be checked.
Anthony Bray MD : B12 deficiency occurs in 90 % of cases due to malabsorption and not due to dietary deficiency. It is the most complex absorption of any nutrient...
Anthony Bray MD : iron deficiency may occur due to subtle losses...

So I could be iron deficient even though the rest of my blood count results were normal? She said I wasn't anaemic.

Anthony Bray MD : these two seem to be the main standouts as your history and other tests seem to be in pretty good shape as far as the most common causes of fatigue...
Anthony Bray MD : Yes you may become iron deficient before you become anemic.
Anthony Bray MD : i hope this information is helpful. Let me know if you have further questions.
Anthony Bray MD : i will be happy to get back with you!

So I should ask for these tests? She didn't seem to be very bothered by the raised MCV and didn't offer me any further tests..

Anthony Bray MD : if my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be much appreciated! Thank you and best regards!
Anthony Bray MD : Anthony Bray MD
Anthony Bray MD : Smoking may cause elevated MCV as well as drinking folate deficiency and B12 deficiency....
Anthony Bray MD : So from your history the B12 and iron would be the main things that I see that would need to be checked. Sed rate and C reactive protein would be useful as sensitive markers of inflammation.
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