Do you need folate/folic acid with injections?

[deepocean]

Should injections be accompanied with a folate/folic acid supplement, there seem to be many differing opinions out there.

[Nackapan]

Sounds like you should stick with what is working for you. So glad you have had such a good response. I tske 400mg daily of folic acid. Most people on here take that amount. My doctor said a safe good amount. Best thing g to do is get your blood taken to check your folate level and vitamin levels. I'm getting mine done again in March 3 Months after taking my multivitamin vits and other supplements. I've never heard of the cancer scare. Look it up yourself. I was told by a neurologist having so many injections would cause Me harm. The response from here was outrage! As no where is any evidence of this. I hope your regime continues to give your life back

[deepocean in reply to Nackapan]

Hi Nackapan, thanks for the advice!

[clivealive Forum Support]

Hi deepocean if it's any comfort to you to know I have been having cyanocobamalin B12 1mg injections every month for over 46 years and I'm still "clivealive" aged 77.

I have also taken 1 – Folic Acid 400μg tablet every day for more years than I can remember.

It would appear to me that you have an absorption problem with your digestion system hence the need for you to have the injections rather than the oral supplements.

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications, or infections such as h-pylori that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), Pancreatic insufficiency, or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Do you see yourself among any of the above "people"?

Have you ever been tested for "Intrinsic Factor Antibodies"?

I am not a medically trained person and I wish you well.

[deepocean in reply to clivealive]

Thanks Clive.

[clivealive Forum Support in reply to deepocean]

I edited and added a bit more to my original reply.

[deepocean in reply to clivealive]

Thanks.

[Plucky1976]

Hi! I hope it puts your mind to ease knowing that I SI Cyanocobalamin 3 times per week and have been for almost a year and a half. I too have tried to lessen the number of injections recently and after 2 weeks of 2 injections per week I start to feel very “off”. So I’ll just stick to what works. I take a 400 of folate very other day. I’m not sure I actually need it but I did in the beginning as the b12 was starting to do its job. Mine has a small maintenance dose of iron which also was finally able to do what it needed once the b12 was on board. I don’t like changing what seems to work. Hope this helps.

[deepocean in reply to Plucky1976]

.

[Plucky1976 in reply to deepocean]

I tried Methyl and I can’t even explain the way one dose made me feel other than I swore I would never touch the stuff again! Even on cyano my levels never go over 1330. A good dose for folate or iron?

[deepocean in reply to Plucky1976]

Thanks, that is really interesting.

[fbirder]

You almost certainly have PA. The Intrinsic Factor test gives a negative result in half of those with PA.

Your cyanocobalamin sounds like it's working well. You need to inject often enough to keep symptoms at bay.

Cyanocobalamin is perfectly safe. Yes, it does release cyanide, but incredibly tiny amounts. One of your injections releases as much hydrogen cyanide as one apple pip.

There is no evidence for B12 causing cancer. There are studies that show high levels of B12 in people with some cancers. But it is thought that the cancer causes the high B12, not the other way around.

Injecting B12 does not increase the body's requirement for folate. Not does folate mop up B12. The 400 mcg you're taking should be plenty. Ignore any advice to take stupidly high amounts of folate - there is some thought that it might be harmful.

Unless you have one specific genetic mutation (homozygous C677T on the MTHFR gene) then there is no need to take MTHF (aka methylfolate) instead of / as well as folic acid. But it can't do any harm if you do.

[deepocean in reply to fbirder]

Thanks Fbirder.

[fbirder in reply to deepocean]

You can try the IF antibody test again, but it's still 50:50 that it will be negative.

Yes, you can have PA without having macrocytic anaemia. This is a great medical article about PA - onlinelibrary.wiley.com/doi... Here's one bit...

Low cobalamin levels of

uncertain significance may occur with non-specific symptoms and no anaemia.

The doctor that spoke of a 'balance' between B12 and folate has misunderstood. In one of the reactions involving B12 one molecule of B12 (in the form of cob(II)alamin) and one molecule of folate (in the form of MTHF) are required. But after the reaction the body recycles the products to recreate the molecule of B12 and the molecule of folate. Here's a diagram - frankhollis.com/temp/B12%20... So the amounts of each you need depend on how many times the molecule can go round and round the two cycles.

Also, B12 is used in another reaction (that doesn't involve folate) and folate is used in many other reactions that don't need B12. So the amounts used in those other reactions mean that there isn't an overall 1:1 balance needed.

[deepocean in reply to fbirder]

Thanks Fbirder.

[deepocean in reply to fbirder]

.

[fbirder in reply to deepocean]

The best way to diagnose PA is -

Does the patient have the symptoms of a B12 deficiency?

If so, does the patient get symptom relief from IM B12?

If so, they have a B12 deficiency.

Does the patient have any other possible causes for the B12 deficiency? Are they vegetarian/vegan? Do they take PPIs? Do they take metformin? Do they have a fish tapeworm? Do they commonly abuse nitrous oxide?

If not, then they probably have PA.

I was diagnosed with PA by the combination of having very low serum B12, having symptomatic relief by B12 injections, having antibodies to gastric parietal cells and having metaplastic gastric atrophy (as determined by a gastroscopy).

[deepocean in reply to fbirder]

Thanks Fbirder.

[jostafford0]

Hello, I self inject out of no other option as my GP wouldn’t help me. My B12 levels were the same as yours and I’ve never felt so bad in my whole life and I’ve suffered with some crappy diseases! I injected once a week initially then once a month. I stopped for 6 months (I guess I thought I might be ok) but the symptoms came back so I self injected the other day and the horrid symptoms have gone. I’m so angry my GP never mentioned I could have vitamin deficiencies as I am hypothyroid & have ulcerative colitis and then wouldn’t help me when I felt at my worst. I feel so abandoned by our health service but relieved we have sites like this for support.

[deepocean in reply to jostafford0]

.

[deepocean]

After you have injected, how do you really know if the injection ends up being intramuscular vs subcutaneous?

[fbirder in reply to deepocean]

It depends on how much fat you have. 1/2 inch sounds a bit shallow. I have almost zero fat on the top of my thighs and I use a 1" needle - all the way in.

[deepocean in reply to fbirder]

Thanks Fbirder.

[deepocean]

.