my husband has been feeling unwell/cognitively impaired. He had some blood tests and his folate was abnormally low but his b12 was in the middle of the range. I’m just wondering if it is diet related wouldn’t his b12 be low too? I looked up a list of folate rich foods and we eat most of them. Not sure if this is the right place for this question but his doctor just sent him a text saying there was a prescription waiting for him so he didn’t get a chance to speak to him. Here are his results:
16 Nov 2023
Serum folate
Result
2.6 ug/L
Normal range
2.9 - 50
Abnormal
Written by
Artemis2
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Has your husband been prescribed folic acid by any chance ? Do you know if they checked his B12 ? If not request that they do so.
I was prescribed folic acid which masked my low B12. I became very lathargic, lost my balance and much of my cognitve function. Others will answer your post and offer information.
yes he has been prescribed 5mg of folic acid a day for three months. His b12 was tested and is in the middle of the range. I’m confused because if his deficiency was to do with his diet wouldn’t his b12 be low too?
He has been getting his words mixed up and is very tired and finding work mentally difficult (he is 52).
Hi Artemis.Sorry to hear what you're husband is going through.
Am in the same boat M54
And over the last few months have been experiencing memory and cognitive issues. Very frightening.
I two have low folate levels and am going to start supplementing today.
My b12 levels came back really high near the beginning of August 1399.
Going to be investigating this more fully.
However recent tests 23th November came back normal it was a Vitamin Active test. From medichecks.
There is evidence that your b12 levels even if normal or high can actually be a b12 deficiency in some cases due to absorption issues.
B12 deficiency can most definitely result in neurology issues i.e memory loss, confusion and cognitive decline. And if this is due to your B12 needs urgent attention.
Am hoping that this might be true in my case. And I am going to see a private GP tomorrow to investigate my memory problems. Whether getting more blood done, memory tests. Cat Scan whatever it takes to find out what is happening. I also have thyroid issues which could be the culprit.
Please ask more knowledgeable members of the forum about when a normal b12 result can actually be a deficiency especially SlowDragon as she has been most helpful.
Know it is a mindfield trying to figure everything out but hang in there, plenty of good people in the forum that can help.
Please if you think that what is happening with your husband could be in anyway related to what I am going through don't hesitate to pm me.
Thanks Gerry and good luck with the supplementation.
My husband looks healthier even though he has only been taking folic acid for a few days (although it could be a coincidence). He has been prescribed three months worth. If he doesn’t feel better in a couple of months he’s said he’ll go back to the GP.
The cognitive issues are scary - hopefully they’ll improve with the supplementation
Folate is found in fruity veg. B12 is found in animal products - meat, fish, dairy egs - so dietary sources are very different, so having a dietary deficiency in one doesn't mean you should be deficiency in the other.
Your body doesn't really hold stores of folate whereas it does store quite a lot of B12. This means that a dietary deficiency in folate will manifest quite quickly but for B12 it can take years or even decades.
B12 deficiency is quite difficult to identify from a single point test using serum B12. Levels tend to be quite steady in an individual at some point in the range but will start to drop if there is an absorption problem.
If you really don't think the deficiency is dietary but an absorption problem then that increases the likelihood that he also has a B12 absorption problem - as they are both absorbed in the ileum but the mechanisms of absorption are quite different.
Has your husband ever had gastric surgery affecting the ileum or gallbladder?
Thanks for the replies. He has never had surgery. He had a lot of stomach problems (I thought maybe he had IBS) when he was a teenager and in his 20s but he says it’s improved a lot.
I’m surprised he has a deficiency because we eat a lot of food containing folate (but maybe not enough as my folate is low too). He hardly ever eats fortified food eg bread or cereal.
I’m not sure how low 2.6 ug/L is - ie are most people clumped together at the low end of the range or is there an even spread?
He was tested a couple of years ago because of tiredness. His folate was low then (I think 4ish) but no action was taken. I think the GP put his tiredness down to his thyroid which was/is borderline.
He has only been taking the folate for a few days but the colour in his face looks a lot healthier (he has been looking really ill).
I’m wondering if there’s more to it than his diet. I’m also worried that he might have the beginnings of dementia or that something else might be going on with his brain. He had concussion a few times as a child.
surgery can damage the ileum which is why I asked.
As you get older stomach acidity tends to reduce which can also affect your ability to absorb micronutrients, including folate.
If his colour is coming back that is good. It suggests that the problem probably was folate - it can affect blood and it can also affect memory, mood etc. Hope he feels improved soon.
That’s reminded me - his blood tests have always come back abnormal for years but the GP says that it’s normal for him so no action is required.
I think his red blood cell count is consistently low and haemaglobin too. He has been feeling tired for years but it was only when he started mixing up his words that he got really worried. Maybe a lot of these things are related.
folate deficiency would have resulted in larger rounder red blood cells - smaller is consistent with iron deficiency but being low in range or even just below the range may not always mean there is a problem
He was tested a couple of years ago because of tiredness. His folate was low then (I think 4ish) but no action was taken. I think the GP put his tiredness down to his thyroid which was/is borderline.Has his thyroid been tested again recently?
Might be worth looking into Functional B12 deficiency. This is where there is plenty of B12 in the blood but it's not getting to where it's needed so person develops deficiency symptoms.
MMA, Homocysteine and Active B12 (holotranscobalamin) may help to diagnose functional B12 deficiency.
In someone who has both B12 and folate deficiencies, B12 treatment would be started first. Starting folate treatment without treating a co-existing B12 deficiency may lead to neurological problems.
See Cautions section in above link which says that folic acid should never be given on its own for PA (Pernicious Anaemia) or other megaloblastic anaemias caused by Vit B12 deficiency as this may lead to SACD, subacute combined degeneration of the spinal cord.
Coeliac disease
Has he been tested?
Guidelines below suggest anyone with unexplained B12, folate or iron deficiency should be tested.
I urge UK forum members to track down the local B12 deficiency guideline used by their ICB (Integrated Care Board) or Health Board in Wales/Scotland and compare them to NICE CKS link.
Two useful B12 books
"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper
Martyn Hooper is the former chair of PAS (Pernicious Anaemia Society).
"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (US authors)
Very comprehensive with lots of case studies.
Wrong ideas about B12 deficiency
Many of us have met health professionals with poor understanding of B12 deficiency.
Misconceptions about a B12 deficiency
(From Dutch B12 website - units, ref ranges, treatment patterns may vary from UK)
I had severe B12 deficiency symptoms including dementia type symptoms, spinal symptoms and many neurological symptoms with most serum B12 results between 300 - 500ng/L.
If he has the symptoms, my understanding of NICE CKS link and BSH Cobalamin and Folate guideline is that he should be treated.
NICE CKS link states
"Note: clinical features of vitamin B12 deficiency can occur without anaemia and without low serum levels of vitamin B12."
BSH Cobalamin and Folate guideline summary states
"In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment"
So your levels looked ok going by the blood tests but the deficiency was masked somehow?
Did your symptoms go away after you took b12? (Sorry for all the questions. I have a hard time persuading my husband to go to the GP when he’s not feeling well so just want to make sure I understand).
Did your GP prescribe the b12 or did you buy some yourself?
Is the idea that if you take folic acid you should always take b12 too?
How would you find out that you’re deficient in b12 if the blood test is normal? Could his cognitive problems just be down to his abnormally low folate levels?
Might be good to take several days to read this so it's not so overwhelming.
I'm not a health professional so I can't give medical advice. I sometimes suggest people read articles that I found helpful or interesting.
Some links might have upsetting details.
I did have a previous serum B12 result that was well under range.
I was only given 5 or 6 loading injection then nothing else. I think they stopped giving them partly because my serum b12 had risen to about 300 ng/L and I suspect they thought everything was okay as B12 serum levels had risen.
At the time I had dementia symptoms, spinal symptoms, neurological symptoms, mental health symptoms, mouth symptoms etc etc...all typical of B12 deficiency.
At the time I trusted my GPs knew what they were doing....that was nearly my undoing.
It was only after spending many hours researching info online that I realised I had not been treated correctly and that practically every symptom I had could be explained by B12 deficiency. Folate and iron were I think within normal range but not that far up the range.
I was refused further B12 treatment on several occasions and raised the issue with every specialist I saw, they weren't much better apart from one neurologist who at least thought B12 deficiency was a possibility.
After realising I was going to end up in a home with dementia and paralysis due to spinal damage if I didn't do something, I chose to treat myself. I did eventually get some NHS treatment.
It took weeks even months to see improvement because I had been left untreated for so long.
"How would you find out that you’re deficient in b12 if the blood test is normal"
If serum B12 test is normal range then following tests might help to diagnose Functional B12 deficiency.
This PAS page discusses diagnosis of PA and B12 deficiency. It states
"The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status since there is no ‘gold standard’ test to define deficiency."
It suggests that doctors should consider continuing B12 injections in someone who has responded to the injections (improvement in symptoms) even if tests such as MMA, homocysteine, Active B12 are "normal" range.
"Is the idea that if you take folic acid you should always take b12 too?"
That's not how I understand it...I'm not medically trained.
My understanding is that if you have both folate deficiency and B12 deficiency, B12 treatment should be started first. Treating folate deficiency without treating a co-existing B12 deficiency could lead to neurological problems.
This next link states in section "Is there anything else I should know"
"If a patient is deficient in both vitamin B12 and folate, but only takes folic acid supplements, the vitamin B12 deficiency may be masked. The anaemia associated with both may be resolved, but the underlying neuropathy (nerve damage) will persist and may deteriorate."
Have a good look at his Full Blood Count. There can be clues on this.
High MCV result is suggestive of possible macrocytic/megaloblastic anaemia. In this type of anaemia, red blood cells are larger than normal.
Macrocytosis
B12 deficiency can lead to enlarged red blood cells (macrocytosis) - so can folate deficiency.
Iron deficiency can lead to small red blood cells.
In a person who has both B12 deficiency (and/or folate deficiency) with iron deficiency, they may appear to have normal size red blood cells on FBC (Full Blood Count) because the effects of iron deficiency can mask the effects of B12 deficiency/folate deficiency.
Things can get complex in someone who has deficiencies in B12, folate and iron at the same time.
The reason I end up posting so much info is mainly the lack of understanding of B12 deficiency and folate deficiency that some health professionals have ...even specialist doctors...
See articles I posted about misconceptions and wrong ideas when you have the time so you're prepared in case you meet health professionals who lack understanding.
I spent a couple of years educating myself...my brain was so foggy that I could only take in small amounts of information.
Apologies if I haven't answered all your questions.
Might be useful info in pinned post "various B12D/PA resources.
Thanks. I’ve ordered some B12 vitamins for him to take along with the folic acid. His folate levels are abnormal. Folate can also cause cognitive issues
I’m puzzled about how much folate rich food you would have to eat to get to the mid range or even healthy range. I looked at a list of the top 15 foods and I eat all of them apart from two and my husband eats a lot of them.
That’s why I was wondering if most people have a lowish number for folate.
Our (grown up) daughter eats vegetarian food most of the time and her level was 4.6 ug/l but her GP uses a different range:
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