Folate and B12

[HealthStarDust]

May I just ask what are the consequences of treating folate before B12? Is it case of results being skewed or symptoms worsening?

[wedgewood]

If you take folic acid before the B12 deficiency has been addressed , the B12 deficiency can be masked . Then does not appear on blood test results , so will not be treated . So yes the test results will be skewed .

[Regenallotment in reply to wedgewood]

Ah interesting, this describes my situation.

[HealthStarDust in reply to wedgewood]

Ah. Thank you!!!! I thought it was test thing and not a symptom thing.

[EyesWideNow in reply to HealthStarDust]

Hello, yes, I think it stops your red blood cells from going overly large and so hides your B12 deficiency. Sometimes you get a B12 deficiency diagnosis even on a standard blood test that doesn’t test for B12 as the lab tech can see the massively enlarged cells on a slide? My daughter had this thankfully-otherwise I wonder how long it would have taken to find the cause of her postural hypotension? She ended up having 3 serious concussions due to fainting and being unconscious for 10 minutes with one of them! They just said because she was so tall as she grew that her body needed time to adjust and regulate her blood pressure?!?! 😵‍💫

[HealthStarDust in reply to EyesWideNow]

Gosh! That’s sounds horrific and typical.

[Noelnoel in reply to wedgewood]

Have just bought MMA tests for my family from Medichecks on the recommendation of a PA specialist. The website states abstinence from B12 for two weeks before the test but no mention of folate. Does anyone know anything about this?

Before buying the test I spoke to a Medichecks rep and was told that both homocysteine and mma tests are conclusive for PA. This isn’t true so I’m not sure it’d be worthwhile speaking to them to ask about the folate thing

[FlipperTD]

Scientist, not medic.

I remember being taught that folate treatment before B12 replacement could result in the patient's remaining B12 stores being used up quickly, exacerbating the symptoms and damage. This may well be a fallacy, but it did seem to make sense at the time.

[Technoid in reply to FlipperTD]

"Regarding dose-response, it is also noteworthy that >95% of the 155 cases in which folic acid supplementation was reported to precipitate neurologic manifestations occurred before 1963, during which time the FDA recommended dosage was 5–20 mg folic acid/d"

from

"Knowledge gaps in understanding the metabolic and clinical effects of excess folates/folic acid: a summary, and perspectives, from an NIH workshop" 2020

sciencedirect.com/science/a...

There are several papers suggesting (but not proving certainly), that high dose folic acid in low b12 states may further impair B12 status. For all these reasons I've never been a fan of the 5mg daily folic acid ideas that float around.

Folate dietary insufficiency and folic acid supplementation similarly impair metabolism and compromise hematopoiesis

haematologica.org/article/v...

Excessive Folic Acid Mimics Folate Deficiency in Human Lymphocytes

mdpi.com/1467-3045/44/4/97

Perspective: The High-Folate-Low-Vitamin B-12 Interaction Is a Novel Cause of Vitamin B-12 Depletion with a Specific Etiology-A Hypothesis

pubmed.ncbi.nlm.nih.gov/346...

[WIZARD6787 in reply to Technoid]

Good science that!

[HealthStarDust in reply to Technoid]

Gosh! Thats pretty scary. It’s something I wondered when I was treated with folic acid. At the time my B12 was in its 200s but still in range, so low. And, during that period I believe my mental health symptoms worsened.

[Sleepybunny]

Hi,

Should be something useful in links below.

BNF Folic Acid

bnf.nice.org.uk/drugs/folic...

See Cautions section in above link.

NICE CKS (Clinical Knowledge Summary) B12 deficiency and Folate deficiency

cks.nice.org.uk/topics/anae...

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

I'm not a health professional.

[HealthStarDust in reply to Sleepybunny]

Thank you.

[Sleepybunny in reply to HealthStarDust]

There's other useful info in pinned post "Various PA/B12D Resources".

Pinned posts are on right hand side of screen if on computer.

If you have the time and energy, I suggest tracking down the local B12 deficiency guidelines and folate deficiency guidelines for your ICB (Integrated Care Board - England) or Health Board - Wales/Scotland.