B12 & Folate Deficiency and tolerabil... - Pernicious Anaemi...

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B12 & Folate Deficiency and tolerability of antibiotics (why I react badly to them)

Whoa182 profile image
20 Replies

I wanted to just share this in case anyone else has similar issues with reacting badly to some antibiotics (particularly Trimethoprim or Bactrim) after developing a B12 deficiency.

I think I might've figured out why I am responding so badly to antibiotics I've tried over the past few months, that I used to have no problem with at all in the past.

It seemed to me that it had to be something fundamental, and based on my history, it could easily be because of a B12 deficiency. And from my communication with others, it appears that people who have pernicious anemia or B12 deficiency from diet, or Nitrous Oxide, have less tolerance to antibiotics they also took with no problem before becoming deficient.

Obviously B12 is crucial for nerves (as is folate), DNA synthesis and cell metabolism. It also keep methylmalonic acid and homocysteine low, which both can cause toxic effects in high amounts. If there nerve cells are already experiencing a high level of oxidative stress and damage, and nerves become hyperexcitable, then adding antibiotics on top of that could push things over the edge where I'd develop worse symptoms.

Doxycycline is more confusing to me, but that has important effects on cells mitochondria by inhibiting protein synthesis. And Trimethoprim has effects on folate metabolism, through its inhibition of dihydrofolate reductase.

Interestingly, Trimethoprim can lower folate levels quite rapidly, within days. And a Vitamin B12 deficiency can cause a functional folate deficiency, as explained by the 'methyl trap hypothesis' - this is where cobalamin (B12) deficiency causes reduced methionine synthase, resulting in a 'functional' deficiency by increasing the proportion of folate as the 5-methyl-derivate.

Before I figured this out from my research, I knew that B12 deficiency could increase the risk of toxic side effects from several chemotherapy drugs, which massively increased the risk of peripheral neuropathy. For example:

"A total of 12 patients had folate deficiency, and 10 of those suffered from severe toxicity (grade 3 or more)"

"Pemetrexed (Alimta®) is a novel multi-target antifolate that inhibits several enzymes involved in DNA synthesis such as thymidylate synthase (TS), dihydrofolate reductase (DHFR), and glycinamide ribonucleotide formyltransferase (GARFT). Early studies showed a severe toxicity profile, but further studies performed in the US yielded a lower grade of toxicity. The reason for that was assumed to be folate supplementation in flour (7). Therefore Alimta is given together with folate and vitamin B12 supplementation." - PMC2852767/

That's just one study, but there are others, including case studies, where patients who were found to have a B12 deficiency developed grade 3 neuropathy, and had to stop the chemo drug. Then once the B12 deficiency was corrected and their neuropathy improved to grade 1, these patients did not progress beyond grade 1. Therefore, B12, as a fundamental vitamin to nerve function and regeneration, can alter the tolerability of neurotoxic drugs.

Based on some symptoms I had over 2022, it's probably, perhaps highly likely I had a B12 deficiency. But I cannot know for sure because I had already begun supplementing a small amount of B12 a month prior to the infection, albeit a small amount of 160 mcg, which is far too small to correct neurological functions and even haematological abnormalities, which requires at least 500 mcg. And finally, 1000-2000 mcg of methylcobalamin is required for optimal reductions in homocysteine and methylmalonic acid.

Anyway, that the hypothesis at the moment. How plausible does this sound???

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Whoa182
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20 Replies
Imaaan profile image
Imaaan

My b12 and folate knowledge is low , so I look forward to reading the responses. In meantime I'd like to ask you the name of the supplement you're taking that provides 160mcg. I've been on the hunt to find a low dose of b12.

Whoa182 profile image
Whoa182 in reply to Imaaan

Ah, that was just part of a multivitamin I was taking. Instead of the 3 capsules for the full dose, I was taking 2. Which equates to about 160 mcg. It was Now Foods Adam Multi capsules.

Imaaan profile image
Imaaan in reply to Whoa182

Thank you

Technoid profile image
Technoid in reply to Imaaan

Other low dosage B12 sources:

Solgar 100mcg dolphinfitness.co.uk/en/sol...

Veganicity 100mcg : veganicity.com/Vitamin-B12/...

Vegetology 100mcg Sublingual : vegetology.com/supplements/...

Sunday Natural 10mcg (3 Natural Forms) : sunday.de/en/b12-mh3a-formu... (Taking 3xday would be adequate for maintenance if not deficient and intrinsic factor is working). I like one at nighttime because its not enough to cause any sleep disruption issues but keeps the body processing B12 overnight "just in case" 😁

Imaaan profile image
Imaaan in reply to Technoid

Awesome of you to give me a few options and I thank you. Hopefully they're available in North America

MrsTuft profile image
MrsTuft

I think simply that nitrofuratoin lowers B12 and Trimithoprem lowers folate, so if you’re already deficient you can react badly to these drugs. That has been my experience.

Yervaud profile image
Yervaud

Fine work Whoa182. This might explain my bad reaction to Doxycycline taken before my PA was detected, so before I injected.

Whoa182 profile image
Whoa182 in reply to Yervaud

Thank you! Do you remember what kind of side effects you had? I had taken Doxycycline many times over 10 years ago for weeks or months at a time. Never had an issue. I tried again , 3 separate times from September to November 2022 and every time I got intense burning sensations and tingling.

I don't know the mechanism though... Perhaps it puts additional stress on the cell through doxycyclines effect on mitochondria and inhibiting protein synthesis. Not sure really...

I have to try Amoxcillin + Clavulanic acid (Augmentin) soon. I hope I'll be okay with that one :|

Yervaud profile image
Yervaud in reply to Whoa182

I was taking it during an omicron infection for a throat so sore I literally could not locate my swallowing ability and a bad chest which I had not had with Alpha covid. So it was hard to separate the effect of the doxycycline from the Covid attack.

But it did seem that it doubled my misery with nausea and splitting headache and when I stopped it, my symptoms calmed down. I may have taken enough of it to help with any bacterial issues. I’ll never know.

I do know drugs and me don’t tend to get on very well.

Pasjc profile image
Pasjc

Thank uou for your research its a lot to take in I'll have to read it several times to take a fraction in. I've been telling doctors for many years I can't take antibiotics (I'm PA) I've even been accused of being obstructive in my treatment. But it's a lot more complex than my wee issue x

Whoa182 profile image
Whoa182 in reply to Pasjc

Have you been able to tolerate any antibiotics since treating PA? If so, which ones?

Cherylclaire profile image
CherylclaireForum Support

I have had the same bad reaction to Metronidazole (twice) and Doxycycline (once) after B12 deficiency treatment started. Both caused vertigo and constant headache.

I did not have a bad reaction to antibiotics prior to B12 deficiency.

There are lists - about vitamin B12 drug interactions (drugs.com/drug-interactions) and Drugs that deplete vitamin B12 (umm.edu/health) - from University of Maryland medical center.

Whoa182 profile image
Whoa182 in reply to Cherylclaire

Yah, it doesn't seem too uncommon. But Flagyl (met) is quite a heavy drug to be honest.

I had a bad reaction to doxy, but it was only nerve pains. I say only, but it was unbearable. I had taken doxy many times years ago without an issue...

I'm hoping 3rd time lucky, when I try Amoxicillin + Clavulanic Acid soon.

Saoirse2016 profile image
Saoirse2016

I was diagnosed T2 diabetes in 2008, in 2027~8 I had a UTI that did not respond to antibiotics, and one of them (can't remember the name of it) nearly killed me.

I had to use alternate methods of treating the UTI since the doctor wasn't being helpful and blaming my high blood sugars on my diet. No, they're high because I have a UTI that's not responding to treatment.

Took a year to get shot of the UTI and my blood sugars returned to acceptable levels.

I can't remember when I was first given B12 injections, but I do know my health was bad before I got that UTI, and it wasn't diabetes related, it was my life long condition; which I now think is PA

Whoa182 profile image
Whoa182 in reply to Saoirse2016

I've had a UTI/chronic prostatitis now since September. It's miserable. Your post makes me hopeful that I can get better eventually!

I need to try Amoxicillin + clavulanic acid (augmentin). Hoping it will go okay this time and I don't get the nerve pains. :/

Frogit profile image
Frogit

Sounds very plausible. I cannot take Trimethoprine and Notrofuratin just makes me feel worse, now I have an inkling of why. Thank You. I also have ongoing UTI problems which the GP has linked to love estranged and given me stuff to stick where the sun don’ t shine….thanks Doc! THey help in some ways but have done nothing to stop the UTIs which inevitably happen after gut disturbance . I have a question mark diagnosis of Crohn’s because it is not “Textbook” probably because whatever it is is PA or B12 related. When can we have a specialist B12 doc for all of us? I feel another letter to the MP coming on…

Whoa182 profile image
Whoa182 in reply to Frogit

What kind of reaction do you get with Trimethoprim?

Sea-blue profile image
Sea-blue

Hi Whoa, read your post with huge interest. I had Trimethoprin years ago for the first time and I was so ill after taking it, with various horrible symptoms and have got it as a contraindicated drug on my GP notes. I didn’t realise I had PA at the time. Your research is great . I’ve had to have prophylactic antibiotics for years because of congenital heat disease so I’m sure this contributed to my PA. My stomach and bowel flora completely gone haywire. We weren’t told about probiotics etc years ago . I’ve been trying to mend my gut for years.

Whoa182 profile image
Whoa182 in reply to Sea-blue

Thank you :)

What were your symptoms with Trimethoprim, do you remember?

Sea-blue profile image
Sea-blue in reply to Whoa182

Hi Whoa, my Trimethoprim symptoms were, bowel probs and IBS for years after, extreme fatigue, severe anxiety, palps, loss of appetite . That’s as much as I can remember to be honest as it was over 30 years ago now. Hope this helps. Reason I swore I’d never have it again was the fact many of them persisted for quite a while. I prob had low folate and B12 and hadn’t realised at the time as they were never tested.

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