What kind of vitamin B12 with folic acid?

Starting mtx next month for RA. The 5mg folic acid tabs my rheumy prescribed to mitigate the mtx side-effects only contain folic acid. Shouldn't one take B12 at the same time, because continuous folic acid intake depletes B12? I'm going to take B12 anyway, especially as I'm a vegetarian, but I just found out there's 4 kinds - Methylcobalamin, Cyanocobalamin, Hydroxocobalamin, and Adenosylcobalamin.

Most B12 tabs from pharmacy are methylcobalamin, but the folic acid package insert says to ensure adequate hydroxocobalamin intake. it seems that hydrox.. is converted to methyl... in the body anyway. And cyano... is the synthetic version - will that work? Very confused. Anyone have any advice?

15 Replies

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  • The best thing to do is to get your B 12 levels tested and if you are deficant the GP will put you on Hydrox...injections. x

  • Thanks Gigi - I thought that the injections might be best. I'll get the test done.

  • Maybe also good to get your Vit D and calcium tested as well, many of us on the here are also prescribed supplements for bone health. Good luck. X

  • Thanks. I should have mentioned - I've already tested low for Vit D and have subclinical hypothyroidism. Already on Vit D supplements. Luckily I live in South Africa so no problem getting extra sunshine as well, even through winter, just have to strip off and get out there!

    Appreciate your knowledge and input. Never knew any of this stuff before.

  • A warm welcome by the way, you will find us a friendly bunch, always someone willing to offer advice. I have Hashimoto's as well, seems to go with a b12 deficancy, there is a forum on here for Thyroid problems if you want to take a look. All the best. G xx

  • Hi Seneca,

    Glad you brought this up. I'm vegan and have been for a good few years. I was vegetarian before that and never took B 12 supplements. When I was diagnosed they checked my B12 and it was fine.

    I thought the test must be wrong. We kept redoing it every month or so for the last year as my doctor doesn't know why it comes back normal every time. Where can I possibly be getting the B12 from?

    Have you taken B12 supplements before and are just now curious if you're taking the right ones?

    So sorry! I didn't answer your question at all but only asked one :(

  • Hi Lucy - I've never taken B12 supplements before, been lacto-vegetarian for 37 years, and always tested fine. B12 was being kept normal by the dairy products, I guess. I just wanted to take extra B12 to balance the huge amounts of folic acid. As Gigi suggested, though, maybe I should just test from time and time and take supplements when low levels manifest.

    I love that your B12 is perfect despite being vegan. Either you're eating mushrooms and/or fortified soy every day, or our bodies are better at processing a vegan diet than we think?

  • Are you going to take 5mg/1x of folic acid per week? If so is this considered a high enough dose to mess with our Vit B 12 levels? Are you injecting your MTX and at what starting dose?

    I've been taking 5 mg/1xper week for close to 18 months with 10 mg/ MTX and on occasion when I increased the dose of MTX to 15 mg I then took 5 mg/2x wk but that was short lived and returned to the lower dose of MTX and folic acid.

    It's interesting to me because as I said I don't take B12 supplements and oddly don't eat mushrooms or soy as both upset my stomach a bit and so avoid them and my B12 level is fine.

    Perhaps it's a good idea to check your levels every now and then and add as needed I wonder if your doctor will have an opinion either way.

    I have found people with RA often have low levels of both B 12 and Vitamin D. ( My vitamin D was very low and have been taking a prescribed pill of 500mg of Calcium and 800 I.E. VIT D3 for close to 18 months which helps a lot)

  • Thanks Lucy. Looks like B12 suppl won't be necessary then - or at least until it shows as a deficiency in a test. I will ask my doc to monitor. I'm starting on 10mg MTX with 5mg folic acid every day except MTX day. Yes - my vit D3 was also low, am taking a supplement for that already.

    From research, it seems that loads of autoimmune diseases are exacerbated (and perhaps created?) by this D3 deficiency. Who knew?

  • I have Pernicious Anemia and that is treated by injection with Hydroxocobalamin.

  • Thanks Medway. Gigi71 also suggested the injection, which seems the normal correction-routine for deficiency. But I think I'm jumping the gun by assuming I'll have a deficiency. From the forum advice I've got, it makes sense to rather have it tested and then take the B12. Thanks so much for your input. Hope your anemia is under control.

  • You should never jump the gun !! lol it might be painful. It was the RA consultant who tested me for it as had low B12 and D and I have RA related blood issues or it could be viewed as pale and interesting?

    It's worth knowing that any vitamin sold here is a food supplement and for instance, its 35 Vit D tablets from Holland and Barrett that would equal I of the ones prescribed, so save the money and get the consultant or GP to do a check for you and then if needed its prescribed. I only know this as asked about buying OTC and it was explained don't bother by my Haemotologist. I think there may be a placebo effect for OTC supllements but even if you do fall short the injections are not always offered.

    I'd add that they really do make a huge difference to energy levels and skin etc, it's like a magic wand but they do hurt!!

    I'm not a veggie by the way, but do know we can't make Vit B12 and deficiency is more common in veggie's but PA is an autoimmune condition.

  • That's such a good point Medway-lady!

    I never thought about OTC being at too-low levels to be of much help. Definitely, the GP/consultant route would be better. (P.S. I've had a couple of B12 injections before, so I know what you mean about the ouch-factor!)

  • Best to ask your Rheumy, or have your GP test you to see if you're deficient, only then if you are should you supplement, this applies to all supplements.

    I've been taking MTX for 9 years & only ever had the prescribed 5mg folic acid, never supplemented with B12 because it's never been necessary. I've taken folic acid initially once & then twice a week but the last 4 years I've taken it daily except the day I inject.

    Obviously it's better if we eat healthily, with a balanced diet we can get our vitamins naturally, except for Vitamin D that is! I'm of the opinion you should only supplement if a test shows you're deficient in anything. As you're vegetarian do mention it as it may make a difference.

    Hope this helps & welcome. 😊

  • Thanks nomoreheels. Will definitely raise it with my doc and ask her to monitor the B12 levels. I've been very reassured by the posts on this forum which show many people on MTX + folic acid not experiencing any B12 deficiencies at all.

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