B12 & folate

[Agapanthus1]

What’s the relationship between B12 &folate? I am self injecting more regularly due to recent illness & I need to keep both levels optimal as I’m on antibiotics. Does more b12 impact folate levels? Thanks 😊

[Gambit62 Administrator]

The relationships are:

a) if you have a B12 absorption then you may also have a folate absorption problem because they are both absorbed in the ileum

b) many processes that require one to run efficiently require both.

Too much folate can affect the way the body uses methylcobolamin so avoid over supplementation. Generally this means dose maxima of 1000mcg a day - but preferably less than this unless under medical supervision.

Some antibiotics can affect B12

[Agapanthus1 in reply to Gambit62]

Yes Nitrofurantoin, as I learned at my peril! Couldn’t understand why I was getting peripheral neuropathy symptoms, breathlessness again etc. So I started to SI B12 again on a more regular basis. But now I’m on Trimethoprim which apparently robs the body of folate, so trying to get the balance between the 2 right. Thanks so much. 😊

[cheriton22 in reply to Gambit62]

Can amoxicillin affect B12 please?

[Gambit62 Administrator in reply to cheriton22]

I couldn't be entirely sure - might be better to ask the dispensing pharmacist - they have access to databases that tell them about interactions

[MattdL182 in reply to Gambit62]

When I took Trimethoprim, I got intense burning and tingling sensations. I didn't know I was B12 deficient at the time, which I know know can cause a functional folate deficiency... and of course, Trimethoprim impacts folate.

[tootsiedadoots in reply to Gambit62]

I heard protocol was to take 5 mcg folic acid if doing daily or every other day? I’m on hydroxo though. My folate did jump to 40 ( 20 is high cut off here in US).

[Gambit62 Administrator in reply to tootsiedadoots]

Presume you mean 5 mg rather than 5 mcg.

Unfortunately that protocol does appear to be out there - facebook seems to be a particular offender. 5mg = 5000mcg is the dose used to treat and resolve a folate deficiency, ie provide extra folate to allow damage caused by folate deficiency to be repaired. I think some people assume that if you have a B12 deficiency you also have a folate deficiency - not necessarily true. There also seems to be a misunderstanding that if you are recovering from folate deficiency then you will need additional folate - no real basis for that.

Do not take doses of 1000-5000mcg of folate daily unless you have taken medical advice.

[cloudspotting in reply to Gambit62]

Thanks, I recently discovered the PA/B12D facebook group advice suggesting 5mg Folic Acid when supplementing B12 every day or other day and 1200mcg Folic acid with B12 supplementation twice weekly, also ensuring that Folate levels are in the 75% range to be effective. I'm now questioning whether my Folate intake is adequate as I'm in the 50% range and suspect I have a Folate absorption alongside my B12 absorption issue. I'm SI 1ml Hydroxo every 4 days and have just increased my Folate from 400 to 1200mcg as a trial. Would be interested to know your thoughts on this, particularly how long to expect any beneficial effects to show.

I appreciate the complex nature of balancing B-vitamin supplementation and would like to know If there's an easy & fairly reliable way of diagnosing the symptoms of other B vitamin lack than serum testing (which my GP is reluctant to do at present).

[Gambit62 Administrator in reply to cloudspotting]

Do not take folate doses over 1000mcg without medical supervision. Doses of this level taken regularly can affect the methionine cycle and trap B12 in the wrong form leading to problems with the relevant processes in your cells.

[Agapanthus1 in reply to Gambit62]

yes, this is what I have been advised on 2 different fb groups-the PA one & a thyroid one. There is even a scale showing how much folate to take depending on how frequently one is SI. I think the theory is that you can’t utilise b12 without sufficient folate. Mine has tested a bit low. I’m thoroughly confused now. 🥴

[Gambit62 Administrator in reply to Agapanthus1]

There are too many personal factors involved for anyone to actually determine folate requirement based on frequency of B12 injections - if people are giving advice on that I'd be a bit wary of the advice. Facebook probably not the best place to get advice ... and as a reminder, this forum is for support rather than a substitute for professional medical advice.

[tootsiedadoots]

I know b12 ises folic acid/folate but I’ve seen contradictory advise on dosage. If you don’t supplement with folate b12 will use up what you have. I see below Gambit said 1,000 mcg max but I was told differently. I’m no dr or pharmacist so now I’m confused too. Folate and ferritin should be checked frequently, that’s really the only way to know if you ate depleting yours or taking enough supplentation.

[Gambit62 Administrator in reply to tootsiedadoots]

tootsiedadoots please note - B12 does NOT deplete iron or folate.

If you have been B12 deficient for a while then it is possible that having enough B12 may mean that some processes that weren't able to run properly before start running again and those processes may start using more folate or other vitamins and minerals eg iron but that is different from B12 using folate and iron. Also, needs can vary substantially from one person to another.

If you have macrocytic anaemia then it may be useful to monitor for potassium deficiency resulting from the temporary additional use of potassium in replacing macrocytic red blood cells with healthy red blood cells. Serious potassium deficiency can be life threatening. Potassium overdoses can also be life threatening.

Having a B12 absorption problems makes it more likely that you will also have a problem absorbing folate ... and it can also affect the absorption of other vitamins and minerals generally and iron tends to be a particular commonly affected mineral.

Note: a B12 deficiency should always be corrected before treating a folate deficiency to avoid the very low risk of precipitating SACD by raising folate significantly whilst a patient is B12 deficient.

It can be quite difficult to see from blood work that someone has both B12 and iron deficiencies from blood work - and it may be that treating a B12 deficiency will make an underlying iron deficiency more common.

Ferritin is a secondary measure of iron status - it is generally a very good one but it doesn't tell the whole story so should never be used as a single measure to determine iron deficiency.

There is a real danger in becoming over-reliant upon tests that individual variations are misinterpreted.

[tootsiedadoots in reply to Gambit62]

What is SACD? Subacute spinal cord degeneration?

I thought folic acid was the one cofactor necessary for b12 ?

[Gambit62 Administrator in reply to tootsiedadoots]

SACD means subacute spinal cord degeneration. There is a small risk that administering folic acid to a patient who is B12 deficient will cause SACD. However, if being treated with injections that would only mean having the injections 24 hours before the first dose of folate.

[tootsiedadoots in reply to Gambit62]

so you only need folic acid of you’re deficient? Even if on b12 injections?

[Gambit62 Administrator in reply to tootsiedadoots]

the best sources of vitamins and minerals are food, You only need to supplement if you have an absorption problem so you can't get enough of the vitamin or mineral from your food, or you have become deficient due to dietary deficiency. If the deficiency is the result of diet then ideally diet should be reviewed to correct the dietary deficiency.

[tootsiedadoots in reply to Gambit62]

I have autoimmune PA and several deficiencies, although I don’t know if PA can cause malabsorption in other vitamins/minerals besides b12? I was also b6 deficient, lower end folate and vit D. Doubled vit D to 4,000 iu and it only went up 1.4 pts. I may have autoimmune atrophic gastritis as I have major gut issues. I have sjogrens, b-cell lymphoma, and more. Cannot be in the sun due to certain meds.

[Gambit62 Administrator in reply to tootsiedadoots]

PA is an auto-immune gastritis. One auto-immune disorder makes it more likely you will develop another auto-immune disorder.

[tootsiedadoots in reply to Gambit62]

thank you. I’m getting very little guidance, even from my mayo clinic specialists. Probably because one insisted I didn’t have PA because my hemoglobin was fine so I found another dr to do the tests. They kerp telling me to go to my primary, which then tells me my specialists should handle it.

[Technoid]

This diagram shows the B12 and Folate interaction within the Folate Cycle and Methionine Cycle : ncbi.nlm.nih.gov/core/lw/2.....

You will see there are many other B-vitamins involved, especially B2, B3 and B6. But you need ADEQUATE amounts of these, not huge dosages - the presence of B12 enables the folate cycle to run, and more B12 will not make it run "faster" and use up more folate - it just enables the cycle to get back up and running - without B12 the folate cycle eventually becomes deadlocked. If the cycle becomes completely locked up you have "folate trap" , which requires synthetic folic acid to kickstart it (at least in initial treatment).

Methylcobalamin B12 is the cofactor of the methionine synthase reaction that is needed for the folate cycle to run. Adenosylcobalamin B12 is the cofactor of the methylmalonyl-CoA mutase reaction that converts methylmalonyl-CoA into succinyl-CoA, used in the Krebs cycle which is the main energy production cycle in cells. More gruesome metabolic details here : ncbi.nlm.nih.gov/books/NBK1...

I recommend a moderate dosage B-Complex supplement (surprisingly hard to find ones that deliver RDA or twice RDA rather than thousands of times that, which only gives you expensive urine). The exception there I would say is Biotin, for which, in early treatment (first couple of weeks), higher dosages from 100mcg to 300mcg daily to ensure the bodys reserves are not drained as the body uses it to create Adenosylcobalamin. b12-vitamin.com/biotin/

If you want a wider picture of where B12 sits in Metabolism, this is one of the best diagrams (I like it so much I might get it in a poster for my wall lol). It shows the nearby pathways for Choline, Betaine/TMG, Glutathione (the bodys "master antioxidant") and Taurine.mdpi.com/jcm/jcm-10-01081/a...

[Agapanthus1 in reply to Technoid]

This is brilliant, thanks so much 😊