PA and low Folate

I have PA diagnosed. Levels currently in 800s just befor injection due. I have these every 8 weeks. Following tests for fatigue my Folate was found ti be 2.8 ,range 1.5-20.

When I was. Originally diagnosed with PA I also was perscribed Folic Acid. I have eaten a healthy diet ever since. I am not a heavy drinker. So my Folate levels have dropped from good to very low in 3 years. I am concerned about why this could be, what might be causing the low Folate. Any ideas please?

13 Replies

  • Hi lesley12 my understanding is that Folate gets "used up" processing the B12.

    Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body. If you are low on one or other of the three the other two exist in the body but don't get used.

    I'm not a trained medical person but have had P.A. for 45 years and personally I have taken 1 – Folic Acid 400μg as a maintenance dose for more years than I can remember and that's in addition to what is "fortified" in my every day cereals, plus I do what my mother used to shout at me across the dinner table "eat those greens"!

    If despite your low reading your doctor hasn't suggested you supplement with folic acid I think you should go to your chemist and buy what he/she recommends as it is cheap and widely available.

    I wish you well.

  • Thanks for that. All makes sence to me. Seems to be about getting the balance right.

  • folate levels in blood are much more closely related to intake from food etc than B12 as it isn't a vitamin that is stored anywhere else in the body.

    PA will affect your ability generally to absorb vitamins and minerals from your food. You were probably prescrived folic acid (in enormous doses) because you were also folate deficient when you started B12 treatment and that got your levels up. They probably dropped when you stopped supplementing but if they haven't been tested since you wouldn't have known that.

    The range for folate doesn't vary as much from individual to individual as B12 does so the normal range is much more useful as a guide, though it is still low.

    You are probably just about getting enough from food to match the amount that you are using but only just so you might want to consider supplementing with a little folic acid - 200-400mcg which you can get at the supermarket should be perfectly adequate.

    Are you okay after a maintenance shot and then the fatigue gradually builds up over time - if so it's more like that that the fatigue is actually that you have plenty of B12 sloshing around in your blood but don't have enough at the cell level - 800 is a bit on the low side for someone who is on B12 shots - and most people report needing levels of 1000 to feel okay.

    However, it's still worth trying the folic acid first.

  • Thanks ,that was a really helpful reply. My b12 of 800 was just before a shot so should go up. But im considering SI in between doctors shots.

    I will take top up Folate as you suggest but I was worried as ive ready somewhere that ovetdoing folic acid can deplete b12. I already take vit d and Magnesium vith zinc supplements. Not sure if I actually absorb though!

    Tthanks again

  • Having extra B12 in your body won't make it use up the folic acid any faster. The body will use it up at the needed rate to keep its systems running OK. That will be the same for anybody.

    Taking lots of folate doesn't use up B12 any faster, either.

    So try doing what Gambit62 says and taking folic acid pills.

  • Yup, what Eaoz said.

    Imagine you run a G&T factory that needs to make 100 G&Ts every day. For that you need 5 litres of gin, 15 litres of tonic water, 500 ice cubes and 25 limes. The factory is designed efficiently so that it only just makes 100 G&Ts. Your stock room can hold 20 days worth of stock.

    Suppose you find a deal on gin bought in bulk. So you let your tonic stocks drop to just 10 days worth and fill that empty space with cheap gin to give you 40 days worth of gin.

    Your factory won't suddenly start using the tonic (folate) up faster just because there's loads of gin (B12) available. It's already fulfilling the demand for G&Ts so making any more would just be wasteful.

  • Thanks an amusing parallel and I do love a good G n T.

    Seriously folks thanks for sharing your knowledge

  • My doctor told me that after B12 injections, the body uses up more Folate in order to process the new B12 and replace the red blood cells, so it's necessary to take extra Folic Acid to counteract this. Also, before I was diagnosed with PA, I had countless tests (as you do!) and was told my Folate levels were very high. I'd been taking strong multi-vitamins in an attempt to make myself better. After the diagnosis, doctor said the Folate level had been high because I wasn't using it, as there was little B12 in my system to 'use it up'. That made sense. I now supplement my self-injected B12 with Folic Acid, and also Magnesium, Vitamin D and a lower-level multi-vitamin. Good luck!

  • Yes. If you suffer from megaloblastic anaemia due to low B12 then there will be a sudden burst of red-cell manufacture that will require slightly more folate than usual. But that's a one-off, short-term, extra requirement.

    And it's correct that low B12 can result in high folate. It's called the 'Folate Trap' because the only way the body can convert one form of folate (MTHF) into one of the other types (THF) is via the production of methylcobalamin. If there isn't enough cobalamin in the body then the levels of MTHF will build up and the levels of other, still important, folate so will drop. But the folate blood tests measure all different types, so it will only show the overall raised level.

  • Thanks for that info, fbirder - great to have it confirmed and explained more fully. So once I get back to normal (I'm not there yet), should I cut down on the extra folic acid I'm taking at the moment? Thanks for all the really useful stuff you post here - I always find your responses particularly interesting. Thank goodness for this forum!

  • The red-cell burst shouldn't last more than 6 to 8 weeks. After that your folate requirements should be no different to anybody else's.

    I'd still take 400 to 800 ug a day, just to be sure.

  • Thank you very much for that info!

  • I learn more here than anywhere ,especially from my GP. Thanks again guys

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