Level 2 General Health Screening

General Health Screening Level 2 has everything that is in Level 1

• Height
• Weight
• BMI
• Blood Pressure
• Lung Capacity Test
• Blood Glucose
• Cholesterol
• Uric Acid
• Lactate

What is in Level 2 General Health Screening?

As well as all of the basic tests in Level 1 there is a urine screen and further blood tests.

• Iron (Ferritin) Deficiency Test
• Vitamin D Deficiency Test
• Thyroid Stimulating Hormone Test
• Urine Test for 12 Parameters; Creatinine, Microalbumin, Glucose, Ketone, Bilirubin, Nitrite, Urobilinogen, Protein, pH, Blood, Specific Gravity and Leukocytes
• Report and Referral Letter for GP if Needed.

Vitamin D Deficiency

A lack of vitamin D is very common. One survey in the UK showed that about 1 in 5 adults and about 1 in 5 children in the UK have low vitamin D levels.

More people have low vitamin D levels in the winter and spring because of less exposure to sunlight.

Vitamin D deficiency means there isn’t enough vitamin D in your body. Vitamin D is an essential vitamin that your body needs for healthy bones and muscles.

Vitamin D deficiency is a common worldwide problem.

Vitamin D helps our body absorb calcium and phosphorus from the gut (bowel) and this is essential for healthy bones and to allow our muscles to function properly.

Therefore, vitamin D deficiency mainly causes problems with bones and muscles.

Vitamin D is made in the skin but this needs adequate exposure to sunlight. It can also be obtained from foods (particularly fortified foods) and vitamin D supplements.

Vitamin D has to be converted to an active form, which occurs in the liver and kidneys. This is why some types of liver and kidney disease can affect the way the body handles vitamin D, and so cause vitamin D deficiency.

Vitamin D also plays a role in your nervous system and immune system.

Why is vitamin D so important?

Getting enough vitamin D is crucial for healthy bones and teeth. In children, being deficient in vitamin D can lead to a condition called rickets, where your bones are weak and soft and can become deformed (with bow legs). In adults, low levels of vitamin D can increase your risk of osteoporosis, or thinning of the bones. This makes you much more prone to breaking a bone.

But vitamin D is important for much more than bone health. Vitamin D may play a role in:

• Improving muscle strength.
• Keeping your immune system strong, helping to fight off infections.
• Protecting you against certain cancers.
• Reducing your risk of falls.
• Helping to stave off depression and low mood.
• Keeping your energy levels up.

How much vitamin D do I need?

Vitamin D is sometimes known as the ‘sunshine vitamin’: the natural type of vitamin D is produced in your skin when you’re exposed to sunlight.

In the UK, sunshine isn’t strong enough to allow you to make your own vitamin D in winter. So it’s now recommended that everyone over 1 year old take 10 micrograms (400 International Units) a day from October to March.

Certain groups of people are at higher risk of low vitamin D. It’s advised that you take a vitamin D supplement of 10 micrograms (400 International Units) a day all year round if you:

• Are pregnant or breastfeeding.
• Are aged 1-4 years.
• Are over 65 (older adults are less efficient at producing vitamin D).
• Have little exposure to sunlight, because you:
  • Are housebound.
  • Are confined indoors for long periods.
  • Cover your skin for cultural reasons.
• Have darker skin, for example if you are of African, African-Caribbean or South Asian origin (because your body is not able to make as much vitamin D from sunlight).

In addition, your doctor may recommend that you take a supplement all year round if you have certain gut (bowel), kidney or liver diseases.

Babies from birth to 1 year old should have a supplement in the form of vitamin D drops of 8.5 to 10 micrograms a day. Babies having 500 ml or more of formula milk per day do not need supplements, as formula milk already has vitamin D added.

You can buy vitamin D dietary supplements at pharmacies or in clinic. In the UK they are also available on prescription to certain groups of people via injection.

Vitamin D deficiency symptoms

Many people have no vitamin D deficiency symptoms or may complain of only vague ones such as tiredness or general aches. Because symptoms of vitamin D deficiency are often very nonspecific or vague, the problem is often missed. The diagnosis is more easily reached in severe deficiencies with some of the classical (typical) symptoms and bone deformities.

Vitamin D deficiency symptoms in adults

• Some people complain of a general tiredness, vague aches and pains and a general sense of not being well.
• In more severe deficiency (known as osteomalacia), there may be more severe pain and also weakness. Muscle weakness may cause difficulty in climbing stairs or getting up from the floor or a low chair, or can lead to the person walking with a waddling pattern.
• Bones can feel painful to moderate pressure (often more noticeable in the ribs or shin bones). Not uncommonly, people have a hairline fracture in the bone which is causing tenderness and pain. Bone pain often also occurs in the lower back, hips, pelvis, thighs and feet.

What causes vitamin D deficiency?

A vitamin D deficiency may happen because:

• Your body has an increased need for vitamin D.
• Your body is unable to make enough vitamin D.
• You don’t have enough vitamin D in your diet.

Your body is unable to make enough vitamin D

This can occur for various reasons:

• People who get very little sunlight on their skin are at risk of vitamin D deficiency. This is more of a problem in the more northerly parts of the world (including the UK) where there is less sun. In particular:
  • People who stay inside a lot. For example, those in hospital for a long time, or housebound people.
  • People who cover up a lot of their body when outside.
  • The strict use of sunscreen may increase the risk of vitamin D deficiency, particularly if high sun protection factor (SPF) creams (factor 15 or above) are used. However, there is no evidence that the normal use of sunscreen does actually cause vitamin D deficiency in real life. Everyone, especially children, should always be protected from the harmful effect of the sun’s rays.
• Elderly people are unable to produce as much vitamin D. This leaves older people more at risk of vitamin D deficiency.
• People who have darker skin are not able to make as much vitamin D.
• Some medical conditions can affect the way the body handles vitamin D. People with Crohn’s disease, coeliac disease, and some types of liver and kidney disease, are all at risk of vitamin D deficiency.
• Rarely, some people without any other risk factors or diseases become deficient in vitamin D. It is not clear why this occurs. It may be due to a subtle metabolic problem in the way vitamin D is made or absorbed. So, even some otherwise healthy, fair-skinned people who get enough sun exposure can become deficient in vitamin D.
• Vitamin D deficiency can also occur in people taking certain medicines.

Not enough dietary vitamin D

Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.

Ferritin or Iron Deficiency Anaemia

What is iron-deficiency anaemia?

Anaemia means:

• You have fewer red blood cells than normal; or
• You have less haemoglobin than normal in each red blood cell.

In either case, a reduced amount of oxygen is carried around in the bloodstream. The most common cause of anaemia in the UK is a lack of iron. Iron is needed to make haemoglobin. Anaemia caused by a lack of iron is called iron-deficiency anaemia (IDA).

Other types of anaemia (not related to iron deficiency) include:

• Folic acid deficiency anaemia.
• Macrocytic anaemia.
• Vitamin B12 deficiency and pernicious anaemia.

What is iron and why do we need it?

Iron is a metal found widely in nature but it is also essential to a healthy body. It is used by the body to make haemoglobin, which carries oxygen around the body in red blood cells, and myoglobin which delivers oxygen to our muscles. It is also important for the healthy growth of hair, skin and nails. Experts are increasingly discovering how important iron is for the normal transmission of signals in the brain as well.

We get iron in our diet in two forms:

• Haem iron, which is found in meat and fish.
• Non-haem iron, which is found in vegetables and grains.

Symptoms of iron-deficiency anaemia

The symptoms of iron deficiency may be very vague, particularly if it isn’t bad enough to have caused you to have developed iron-deficiency anaemia as well.

Some common symptoms of iron deficiency are:

• Tiredness.
• Struggling to concentrate at work or college.
• Memory problems.
• Reduced ability to exercise.
• Hair losing its condition, and possibly hair loss.
• Nails becoming brittle and breaking or splitting easily. They may even change shape, becoming concave or spoon-shaped, or may develop ridges.
• Cuts and grazes taking a long time to heal.
• A sore tongue.
• Sores at the corners of your mouth.
• Restless legs syndrome.
• Infants with iron deficiency may not develop as quickly as normal.
• Pica syndrome: the craving or eating of substances not normally eaten, such as clay, chalk or coal.

Symptoms of anaemia:

• Tiredness.
• Shortness of breath, especially on exercise/exertion.
• Palpitations.
• Looking pale.
• Feeling dizzy/faint.

Possible complications

Complications may develop if the iron deficiency becomes severe and is not treated. For example, you can develop fragile and broken nails, hair loss and heart failure. A lack of iron can also affect the immune system so you may become more likely to develop infections.

Anaemia in pregnancy increases the risk of complications in both mother and baby. For example, there is an increased risk of having a low-birth-weight baby, preterm (premature) delivery and postnatal depression. Low iron reserves in the baby may also lead to anaemia in the newborn baby.

Causes of iron-deficiency anaemia

Iron deficiency is a common cause of anaemia, often seen in pregnancy. Low iron levels may be caused by bleeding – for example, heavy periods or from the gastrointestinal tract (gut) (stomach ulcer, bowel cancer or piles). Sometimes the gut can’t absorb enough iron – for example, in coeliac disease. Iron is absorbed from the duodenum and jejunum part of the small intestine (the part after the stomach and before the large bowel/intestine.

A normal balanced diet will usually contain enough iron for your body’s needs. A low level of iron, leading to anaemia, can result from various causes. Some are more serious than others, and include the following:

Heavy menstrual periods

Anaemia is common in women (of all ages) who have heavy periods. About 1 in 10 women will become anaemic at some point because of this. The amount of iron that you eat may not be enough to replace the iron that you lose during each period. Having heavy periods does not always lead to anaemia. Anaemia is more likely to develop if you have heavy periods and eat a diet that contains little iron.

Pregnancy

A growing baby needs iron and will take it from the mother. Anaemia is common in pregnant women. It is more likely to develop during pregnancy if you eat a diet that has little iron.

Poor absorption of iron

Some conditions of the gut (intestine) lead to poor absorption of various foods, including iron. Coeliac disease is an example.

Bleeding from the gut

Several conditions of the gut can lead to bleeding. Sometimes this is sudden – for example, after a burst duodenal ulcer. Being sick (vomiting) or passing blood is obvious then.

If you have one of these problems, you may have other gut symptoms such as stomach pains, constipation, or diarrhoea. However, in the early stages of these conditions, you may not have any symptoms and anaemia may be the first thing that is noticed. For example, iron-deficiency anaemia in an older person may be the first indication that bowel cancer has developed.

Medication

Some medicines can sometimes cause bleeding into the gut without causing symptoms. The most common example is aspirin. Other anti-inflammatory painkillers such as ibuprofen, naproxen and diclofenac may also have this side-effect in some people. (Anti-inflammatory tablets may cause bleeding by irritating the stomach lining which may then lead to bleeding.)

Hookworm infection

This gut infection is the most common cause of iron-deficiency anaemia worldwide. It affects people living in (or visiting) certain tropical countries. Hookworm feeds off blood inside the gut.

Bleeding from the kidney

A small but regular trickle of blood from various diseases of the kidney or bladder may not be noticed in the urine. However, enough may be lost to cause anaemia.

Dietary factors

Not eating foods with enough iron is sometimes the cause of iron-deficiency anaemia. This is uncommon in the UK, as iron is in meat, liver, green vegetables, flour, eggs and other foods. Some people who have a poor diet with just enough iron to get by, may slip into anaemia if other factors develop. For example, a barely adequate diet combined with a growth spurt in children, or with a pregnancy or with heavy periods may lead to anaemia.

A restricted diet such as a vegan or limited vegetarian diet sometimes does not contain enough iron.

Traditional diets in some parts of the world contain a high level of chemicals such as phytates and polyphenols. For example, certain types of flatbreads (such as chapatis) may contain a high level of phytates. Tea can contain a high level of polyphenols. These chemicals interfere with the way iron is absorbed from the gut. So, if you eat a lot of these foods, it can lead to iron deficiency.