Alternative to 5mg Folic Acid and high Ferratin dose

Hi i was diagnosed with PA in nov 7 yrs after crohns bowel surgery. My B12 level was 160 and i was suffering from fatigue, palpitations, anxiety, muscle spasms. I felt fine on the loading dose although im being re-checked due to symptoms returning. I couldnt take the 5mg daily folic acid or any iron suppliments due to the awful nausia and headaches i had. It made me unable to work or eat. Are there alternative doses? My GP wouldnt prescribe anything else.

Thank you.

8 Replies

  • 5 mg a day of folic acid is a lot - 10 times more than the recommended dose. It's a good amount to take for a short while to fix a severe deficiency, but after that 400 to 800 ug a day should be plenty. A very few people find that methylfolate (available from Amazon) works better than folic acid.

    Have you tried chelated iron? I use Solgar's Gentle Iron. This is iron bisglycinate - which is much more soluble (and, therefore, more readily absorbed) than the normal iron sulfate that doctors prescribed. That means you can take a lower dose which helps with the nasty effects.

  • Thank you so much for your reply and suggestions which I am going to try. The folate was prescribed by my IBD consultant who i wont see for 6 months hence the fact my gp was at a loss. I so appreciate your knowledge, thanks again.

  • 5mg folic acid per day is the basic treatment for folate deficiency per NICE guidelines - BCSH guidelines similar with stipulation that normally for 4 months, so possible that there may be licensing issues with different dosages.

    However, folic acid is classed as a vitamin so available over the counter without prescription.

    This is what the BCSH guidelines say on folic acid doses

    The dose of folic acid necessary for treatment depends on the cause of the deficiency. A meta-analysis showed that daily doses of 0.8 mg or more of folic acid are typically required to achieve the maximal reduction in plasma homocysteine concentrations produced by folic acid supplementation (Homocysteine Lowering Trialists’ Collaboration, 2005). Doses of 02 and 04 mg are associated with 60% and 90% respectively, of this maximal effect (Homocysteine Lowering Trialists’ Collaboration, 2005). However, more recently, a dose of 02 mg/d over at least 6 months was shown to have optimal effects (Tighe et al, 2011).

  • If you're not already taking a Vitamin B Complex tablet every day then it's worth trying.

    Please watch this short YouTube video -

    Perhaps you've already swotted up on the Vitamin B Complex, but anyone with a B12 problem needs to know about the whole Complex.

    Besides the YouTube videos there's a little booklet "

    User's Guide to the B-Complex Vitamins" that's sold on Ebay and is very helpful.

  • Thank you both for your replys. I am new to this so any links or information is very helpful.

  • Taking oral iron can amuse multiple digestive symptoms. If you have true autoimmune PA, you already have absorption difficulties. This caused me to need triple the dose of iron to bring my numbers up and caused too many side effects. Between the digestive symptoms as well as the malabsorption, my hematologist started me on IV iron infusions. This completely bypasses the digestive system and is much more efficient. I would suggest taking to your doctor about this possibility. Be careful about taking too much folate. I've been reading a lot recently regarding dosing and too much can be dangerous.

  • Hi, yes I do have absorption difficulties as I have had my terminal illium and several cm of bowel joining it removed, thus I am unable to absorb B12 through the bowel. I am interested in reading about the iv iron infusions, the doctor I saw didn't suggest anything like this and said there was nothing more I could take if I couldn't take what they prescribed, I was simply told to go home! I have been researching this and it appears it is very untrue - I am therefore seeing a different gp next week to have my levels checked and I will let them know what I have researched.

    Thank you for your reply

  • You're very welcome! I have a great GP; however, PA is such a tricky illness that you might be better off seeing a hematologist. As good as my GP is, he didn't have a clue as to what to do with me. My hematologist is the one that set me up for the iron infusions.

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