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Pernicious Anaemia Society
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Many newspapers this morning report researchers are urging government to add folic acid to flour products !





"Elevated folate level and vitamin B12

How increased folate level influences neurological disorders related to vitamin B12 deficiency is a potential issue in relation to mandatory folic acid fortification. Vitamin B12 is a critical coenzyme for methionine synthase (MS), and is related to folate metabolism via the action of methionine biosynthesis. Therefore, insufficiency may interrupt the conversion of 5-CH3H4PteGlu to H4PteGlu (folate-trap) (108). Furthermore, in CNS tissue, MS dependant Hcy-methylation is the sole pathway for methionine production (no betaine is involved in the pathway in this tissue) (109).during purine and pyrimidine synthesis even with impaired MS, and folate therapy may seem to be effective in improving the symptoms of vitamin B12deficiency, while neurological lesions progress (112). For these reasons, elevated intake of folate (PteGlu) may potentially mask vitamin B12 deficiency and prevent early diagnosis of symptoms (megaloblastic anaemia), leading to a late diagnosis when neurologic sequelae have already occurred. This condition -pernicious anaemia- involves demyelinations and is irreversible (111).

A decline in cognition in the elderly is another potential issue of vitamin B12 related to mandatory folic acid fortification (113). Morris et al. (114) suggested that participants with a high intake of folate combined with low blood vitamin B12 showed faster cognitive decline, compared to a group with high folate intake and high total vitamin B12 intake. A report containing three Australian cohorts also suggested impaired cognitive performance in the elderly group with combined low serum vitamin B12 and high red cell folate (115).

10 to 15% of the elderly population (over 60 years) are not taking sufficient vitamin B12 (116), and the low level of blood vitamin possibly stems from many reasons including, lack of intrinsic factor, atrophic gastritis and other gastrointestinal issues (Crohn’s and celiac disease) as well as drug and alcohol consumption (102). The prevalence of low serum vitamin B12 in the absence of anaemia and macrocytosis has not changed since the implementation of mandatory folic acid fortification in the US (117."

9 Replies

A "bad idea" if one is susceptible to developing a B12 deficiency unless perhaps Serum B12 and B9 levels tests are also "mandatory"?

I'm not a medically trained person but have P.A.


I agree Clive - they all work together🙂 Patrick Holford, nutrition expert, asks, "what about the others?

It's also difficult enough trying to get a diagnosis with unreliable lab tests, without adding folic acid masking to the equation......


I don't know why people try to spin this as a bad thing. Folate lessens the symptoms of B12d! The problem is health professionals using megaloblastic anaemia as the main criteria to suspect B12/folate deficiency. Instead they should be using the clinical guidelines...




Although there are good reasons for people to have added folate, I have to disagree with you there. I can appreciate increasing Folate levels may help the person feel better IF their folate was low in the first place. Unfortunately, I believe higher folate can 'hide/mask' the true situation if B12 deficient, especially in view of the blood picture but, although the bloods may 'look' OK, it's still not going to have the proper efficiency. Increased levels of folate isn't going to get more B12 into the individual cells so the patient will still have the deficiency.

My folate is high, in fact out-of-range high but, until I began self-injecting (because GP refuses to believe I'm B12 def in spite of below-range results) I was feeling awful but now am feeling very much better.

Two sides to every story ... ;)


You may not have seen the film released last year, Mightydrunken about how Sally Pacholok came to write her book, "Could it be B12?" :

A short way into it, Dr Praveen Kumar (B12 expert) gives a presentation in 1995 on why he considers it unethical to add folic acid (a powerful synthetic vitamin) to food supplies in the US:

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Totally agree JMN2017 that not everyone needs extra folate, especially as it's already included in many OTC supplements, e.g. Gentle Iron, B Complex and others.

Too much of the one size fits all doesn't help anyone get to the root of their particular problem and can surely blur the picture, making it harder to diagnose the real cause. My vegetarian sister had misdiagnosed, long standing low B12 with high folate. When her health eventually deteriorated and symptoms began to include hallucinations and psychosis, her surgery used this as an excuse to stop B12 injections and treat only with antipsychotics....

So glad you're feeling better JMN2017. Like you, I decided to self inject B12 with no added folic acid (apart from occasional Gentle Iron and B complex) with huge improvements in neuro symptoms.

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mightydrunken, I agree that the real issue is the poor levels of performance by GPs (and possibily the poor levels of guidance given by testing labs) in relation to using tests in diagnosing and managing B12 deficiency ... and other conditions. Focusing too much on the presence of macrocytosis in relation to B12 deficiency isn't helping anyone.

However, I wouldn't agree that masking the symptoms of a condition is necessarily a good thing - it leads to serious conditions going undiagnosed and is as bad as filling people up with anti-depressants rather than looking for the underlying causes and treating them (whether physical or social).

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It concerns me that all neural tube deficits are being laid at the door of folic acid/folates. Even if it is the most significant cause, it does not appear to be the only one.

Deficient or inadequate maternal vitamin B(12) status is associated with a significantly increased risk for neural tube defects.


I believe that diseases/disorders go through phases. Once PA was understood to be due to B12, it seems almost to have been dismissed. The answer is obvious - supply B12. Questions about form of B12, delivery, frequency, testing, and so on were then relegated to the minor league.

(Similarly, the idea that a little white pill solves everything to do with thyroid put thyroid issues into the "beneath my great intellect" for too much of the medical establishment.)

Once folic acid is added, everyone will start to assume that the issue no longer exists. For some time, there might be more folate testing, but that will disappear. And B12 deficiency could well worsen.


Exactly Helvella.....

I believe most women have been aware for many years of the importance of folic acid during pregnancy and are usually tested for this and prescribed or advised to take vitamins and nutrients, but are they tested for B12 ? surely equally as important, especially as there are more vegetarian mothers these days.

It's bad enough that B12 deficiency is misleadingly called Pernicious Anaemia, when it's primarily neurological and psychiatric consequences caused by demylation of the spinal cord that are the main issues, resulting in vascular disease, dementia, physical disabilities, etc.

Hope this makes sense -'it's late and I'm tired and foggy 😳


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