B12 and folate relationship.

[Scipio99]

I understand that B12 and folate are both B vitamins and essential for the production of healthy blood cells but not sure of their relationship to/interaction with one another. My B12 is borderline (233 ng/L) and folate sub-threshold (3.0 ug/L). That they're both low can't be a coincidence. I presume, because my folate deficiency is not through diet or any of the other causes given , that the B12 deficiency causes the folate deficiency but I'm not sure why. Does the body have to draw on its reserves of folate in the absence of sufficient B12? I see that some posters state their B12 is low and yet their folate is normal so this seems not to be the case so maybe there's another reason. I've searched the internet for some explanation but haven't come across anytrhing helpful so far.

[Nackapan]

I would get your b12 levels up first . Then get your folate levels up. Important in that order.

Before you get too many symptoms.

As you dont mention any I hope nipped in the bud, if you act now.

I dont know the answer to your query.

If an absorbtion issue you can be low on all sorts. The most common things seem to be, b12 ,folate, ferritin and iron and vit D.

The lowest my folate went was 9ug/l so always in range

My b12 was 106ng/L

My vit d was low at 21 before other things were found

Ferritin also dropped as b12 went up??

Hope your levels are good soon.

[Scipio99 in reply to Nackapan]

Thanks Nackapan. The fact your folate was well in range seems to demonstrate that there's no obvious cause and effect relationship between B12 deficiency and folate level. Yes, I'm self-administering B12 injections at the moment (6 so far, alternate days with probably another 2 )and only then restarting folic acid supplements 5mg as Fbirder suggested in an earlier post. My only symptom so far is numbness and tingling in my left foot and very mild tingling occasionally in my left hand. All my bloods were ok apart from these two. I decided to take the bull by the horns and buy the B12 etc. as it's so difficult to get a GP appointment and I suspect I wouldn't start treatment until the New Year even with hard pushing.

[Scipio99 in reply to Scipio99]

Just to clarify. Fbirder didn't advise me to take folic acid supplements. My doctor prescribed them (incorrectly it seems as B12 should be administered first in cases of neurological symptoms) and Fbirder suggested I only take the folic acid after the B12 supplements which is the official guidance advice . Sorry about that.

[Gambit62 Administrator]

B12 deficiency does not cause folate deficiency. Folate deficiency does not cause B12 deficiency. Both B12 and folate are absorbed in the ileum so damage there - such as that which leads to a B12 absorption problem such as PA is likely to affect both B12 and folate absorption.

THe BCSH standards state that in a case of non dietary folate deficiency means that B12 deficiency should be suspected. The standards also stress that B12 deficiency should be treated first. The gap is only 24-48 hours though.

[Nackapan in reply to Gambit62]

So I expect that is why b12 is tested at the same time as folate. Which is good practice at the start so you can treat b12 first and know your folate status.

Later promlamatic if you only want folate level checked as I do . Its automatically done with b12

Just dont want the high b12 result in the wrong doctors hands that might jeopardise my b12 prescription the way things are going with everyone having reviews!!

.

[fbirder]

Low B12 cannot deplete folate. Indeed, the opposite (sort of).

There are many types of folate in the body, two of which are tetrahydrofolate (THF) and methyltetrahydrofolate (MTHF). The conversion of MTHF to THF requires B12, so if you do not have enough B12 all the folate in your body gets trapped as MTHF.

Now the folate blood test picks up all the different kinds of folate. So it can see lots and lots of folate and doesn't realise that much of it is useless MTHF. It looks as if you have lots of folate, but you have the symptoms of a folate deficiency.

This is also the reason why a B12 deficiency can affect the production of DNA. It's not that B12 is needed to make DNA, but that another form of folate, methylenetetrahydrofolate (MeTHF) is needed to make one part of DNA. If you have a B12 deficiency then you can't convert MTHF to THF. So there's not enough THF to make enough MeTHF to make enough DNA.

A B12 deficiency and a folate deficiency can have the same cause.

Pernicious Anaemia is caused by autoimmune attack of the gastric parietal cells, which make Intrinsic Factor and stomach acid. The IF is needed for absorption of B12 in the ileum (the last part of the small intestine.

Folate is primarily absorbed in the first two parts of the small intestine (duodenum and jejunum). However, folate in food comes attached to multiple molecules of glutamic acid, which have to be removed by pancreatic protease enzymes. But these enzymes need stomach acid to activate them. If you have PA then you have little stomach acid, so the enzymes aren't activated, the glutamate isn't removed and the folate cannot be absorbed.

[fbirder in reply to fbirder]

Here's a more scientific explanation. b12science.com/B12Science/D...

[Scipio99 in reply to fbirder]

Thank you all for that. It's all much clearer now. A bit tangential but it makes me wonder whether my mother, who had a neuroendocrine tumour - unlocated as is often the case but the ileum being a very common site - was possibly suffering from B12 and folate deficiency. A few years ago now but as I recall, her symptoms weren't at all dissimilar. She was never prescribed any kind of supplementation so I presume/hope the doctors checked for it in her blood tests.

[fbirder in reply to Scipio99]

Having PA does make you more prone to having gastric neuroendocrine tumours. But they are still very rare and it’s even rarer for them to metastasise and spread.

Other NETs are, as far as I can find, aren’t connected to a B12 or folate deficiency.