Brief Answer:
further line of treatment and management

Detailed Answer:
Dear
Thanks for reverting back

1. After going through the reports, now I got the clear picture, since in your previous query you have written vit. D12 [instead of B12] which created the confusion]

2. As your vitamin D is low [in insufficient range] and although B12 is normal but also insufficient thus following can be done:

i. FOR VITAMIN D DEFICIENCY

. TAKE: carrot,beet root,spinach,radish,tomato,coriander/mint,amla rasayan, soybean,cucumber,cabbage, Vitamin D fortified pineapple-yogurt-milk, banana, dry mushroom,cod liver oil,sunshine, and vitamin D tablets/injection/sachet/ syrup [depending upon your attending Physician consideration]

ii. FOR VITAMIN B12 DEFICIENCY
. Since Vit. B12 is manufactured only by bacteria thus found naturally in animal products [true vegetarians thus can suffer from the deficiency]
Take: cheese [Swiss /mozzarella], eggs,shell fish, liver [beef],fortified soy products, fortified cereals, and most importantly injectables are preferred

3. One thing which I forgot to mention in my last reply was your high hemoglobin level [even when cut off is 17], do ask your doctor and check with hematocrit [HCT]

PS. although value of 16.30 might be considered as normal, but still ask your primary care physician about what can be done [if needed]

Dr. Munish
Naimittika

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Brief Answer:
further information

Detailed Answer:
Dear
Thanks for reverting back

1. I’ll be talking about the commonest causes which have to be excluded first [without face to face interaction {history taking/physical examination} i.e. either could be due
- poor absorption from the stomach or intestines [chronic inflammation/ intestinal parasites, taking drugs for acidity],
- decreased intake [in vegetarians/malnourished people] and
- Increased requirements. [any Immunodeficient disease]

i. As said earlier that Vitamin B12 is found only in animal products thus eggs are good choice. [ one boiled egg have 0.56 micrograms of B12 so two are good]

PS. 2.4 microgram of vitamin B12 is daily intake, so the rest you can have from other supplements.

2. Vitamin B12 levels are inversely associated with serum levels of homocysteine [i.e. if B12 is low, then homocysteine levels will be high]

PS. Vitamin B12 is required to convert homocysteine back into methionine, so if it is less/ insufficient then homocysteine cannot be converted into methionine and level rises in proportion to B12.

3. Yes Hematocrit [HCT] is a blood test used to determine the percentage of red blood cells in the blood and is included under complete blood count [CBC] and with respect to your blood [16 gm] the outcome of the percentage will decide the diagnosis or treatment protocol [if needed]

PS. High hemoglobin usually thickens the blood resulting in circulatory problems like blood clots, heart problems so best management is regular blood donation

4. Choice of asking for tumor/allergy marker solely depends upon your attending Physician

5. Since when going for weight loss programme, you will be on a certain dietary regime which can deprive you of essential vitamins thus make sure to take vitamin supplement as you are already devoid of some, and monitor them monthly to see whether they are increasing or decreasing, in that way you will find out whether problem is with weight or something else [do remain under constant regular supervision of your attending Doctor]

PS. If interested I can courier you the multivitamin capsules/injections which will take care of the problem.

Dr. Munish
Naimittika

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Brief Answer:
further information

Detailed Answer:
Dear
Thanks for reverting back

1. Your BMI with respect to your age, weight, height is 28.30 which is above the value of 25 which means your weight is in the overweight category.

PS
i. Average optimum healthy weight for your height should be around 57 kg and
ii. Maximum healthy weight for your height should be 66 kg and
iii. Minimum healthy weight should be in the range 49 kg

2. To interpret the results the attending obesity health care personnel will be in better position to talk about other values.

3. Remember that BMI or any other investigation is an attempt to measure the amount of tissue mass and then categorize the person as underweight, normal, overweight, or obese so do not take any decision or judgment on your health given by the machine, and a personal consultation and discussion with your attending doctor or dietitian is what is more important.

Dr. Munish
Naimittika

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Brief Answer:
further details

Detailed Answer:
Dear
Thanks for reverting back

1. Yes, initially ideal weight management should be towards achieving goal of 66 kg.

2. The said drugs are not steroids but used in the management of obesity:

i. Zerofat next is an OTC [over the counter] capsule which contains merastin 400 mg extracted from plant extract used for reducing body weight,waist and hip size in 8 weeks [as the study says] along with walking 5 days a week and standard calorie diet [2000 cal/day]

ii. Obestat [sibutramine] is a FDA approved drug which acts as an appetite suppressant drug by controlling appetite centre in brain and regulating satiety. [Once daily before breakfast] with low calorie diet and exercise.

PS. problem with the drug is that once you discontinue the drug, your satiety centre will again get stimulated and the person will again eat more.

Dr. Munish
Naimittika

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Brief Answer:
further information

Detailed Answer:
Dear
Thanks for reverting back

1. I spoked with Mr. XXXXXXX XXXXXXX dubey [bharuch, ONDOT branch] and he told me that the courier will be delivered to you by evening [he will himself do the needful] as the courier was received in his branch yesterday only.

2. His number is 0000.

Dr. Munish
Naimittika

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Brief Answer:
further assistance

Detailed Answer:
Dear
Thanks for reverting back

1. Since there is/are lot of nutritional difference between consuming egg white and not egg yolk thus mine advice would be to 1 egg white and 1 egg yolk [or consult a dietitian in this regard]

i.Egg white is free of fats, carbohydrates, sugar, cholesterol, very less calories, but at the same time also devoid of vitamin A, vitamin B12, vitamin D and omega 3 acids, which are readily available in egg yolk.

ii. No changes in fruit department.

Dr. Munish
Naimittika

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