What is folic acid used for?

[helvella]

For other reasons, nothing to do with Pernicious Anaemia, I was checking the Patient Information Leaflet for a UK folic acid product. And I noticed this bit:

Ennogen Pharma Limited

Folic Acid Tablets 5mg

1. WHAT FOLIC ACID TABLETS ARE AND

WHAT THEY ARE USED FOR

Folic acid belongs to the vitamin B group.

Folic Acid Tablets are useful for:

! The treatment and prevention of certain types

of anaemia, including pernicious anaemia

! The treatment and prevention of folic acid

deficiency (for example caused by the

administration of phenytoin for epilepsy).

mhraproducts4853.blob.core....

And I sat open-mouthed at this The treatment and prevention of certain types of anaemia, including pernicious anaemia.

Does a single member here believe that folic acid can PREVENT Pernicious Anaemia? Yet I couldn't read it as not saying that - without playing ducks and drakes with word order and grammar. Indeed, in someone with adequate/good folate levels, nor would it have any role in treating Pernicious Anaemia.

If anyone else feels (as I do) that this is grossly misleading, please consider complaining to the MHRA. (I'll not be doing so as I already have some issues open with them! And Pernicious Anaemia is not my focus.)

[deniseinmilden]

It beggars belief, doesn't it.I wonder if it was generated by AI or just a living being who is equally ignorant?

I suspect that this sort of thing will become increasingly worse as time goes on.

[helvella in reply to deniseinmilden]

This leaflet was last revised in April 2019.

So I would say, definitely NOT AI as we have come to understand it. And every word, every jot and tittle in PILs has to be approved by the MHRA.

[deniseinmilden in reply to helvella]

I'm That's true, thank you - I hadn't quite grasped what it was and therefore the full implications of it.(Had an insanely busy week - which has been very good but I'm feeling it!).

It's just dreadful!

But adds to my confidence when talking to medics, because I can be confident that the information they are going on can be extremely flawed and therefore my information may be more correct.

[Narwhal10]

Yes helvella because vitamin B12 is exactly the same as B9.

Somebody obviously does not know their 3 times table. 🙄 They need to go back to school.

[helvella in reply to Narwhal10]

What's worse, more than one person! At the very least someone at manufacturer and someone else within MHRA.

[ACritical in reply to Narwhal10]

Vitamin B12 is the same as vitamin B9?!

I was under the impression that they are two different B vitamins who work together.

I read…

Folate (also known as Vitamin B9) and vitamin B12 (cobalamin) are essential water-soluble compounds that are part of the one-carbon metabolism cycle. They play an essential role in DNA production, amino acid homeostasis, antioxidant activities and epigenetic regulation (Lyon et al., 2020).

Acting in synergy, folate and vitamin B12 play an essential role in DNA metabolism and the conversion of methionine/S-adenosyl methionine, as they can regulate gene expression and chromosome conformation (Fenech, 2012).

Furthermore, optimal levels of folate and vitamin B12 are required to maintain adequate erythropoiesis (red blood cell formation) and also to prevent the risk of anaemia and hyperhomocysteinemia (Fenech, 2012). Iron, folate and vitamin B12 have an impact on the production of red blood cells (erythroblasts). Consequently, deficiency in one of these micronutrients, in particular folate and vitamin B12, may result in an impairment of DNA synthesis and a decrease of red blood cells, which can eventually lead to anaemia (Koury and Ponka, 2004).

So I am confused reading your remark that B9 and B12 are the same. Yes, they come under the umbrella of vitamin B complex however they individually are important , they all work together to the benefit of our health?

Please explain to some one like me, just reading articles to comprehend….

[helvella in reply to ACritical]

I read Narwhal10’s reply as being towards being facetious. (Generally, not directed at an individual.)

“OF COURSE B12 is not the same as B9”

[ACritical in reply to helvella]

I am too serious for my liking.😬 However still getting a grip of all of this, not being trained in biology then grammar level. And that was long ago.

[Narwhal10 in reply to ACritical]

Apologies ACritical,

I am on occasions, extremely sarcastic. The next line is reference to simple Math(s) because :-

3 x 3 = 9

3 x 4 = 12.

Nine months ago, I posted this and people were asking where is B9 ? It is in a different metabolic cycle.

healthunlocked.com/pasoc/po....

Great referencing by the way. 👍🏻

[Technoid]

I think it is true that folic acid tablets are often prescribed IN ADDITION to B12 to help resolve a B12 deficiency. I'm not a big believer in the 5mg dose (unless a severe folate deficiency is present, and then only for short periods) as I've mentioned here at length and I think other folate forms have some metabolic advantages and less concerns, especially at high doses.

Whether supplemental folate is even required is in my opinion, very individual, and depends on folate levels and the usual folate content of the persons diet and if absorption issues are affecting that. I have never found the frequent reflexive 5mg prescription to be convincingly evidence-based.

They are phrasing it extremely poorly as even if the folic acid temporarily corrects the megaloblastic anaemia, it does not and cannot (of course), "prevent" pernicious anaemia, which is an auto-immune disease, which provision of folate, or indeed B12, does not prevent or cure.

They may be using the phrase "pernicious anaemia" here to mean "megaloblastic anaemia secondary to B12 deficiency, secondary to PA", which is a mouthful but I think more correct but FlipperTD can correct me if I'm grossly distorting haematology here 😊

Regards the folic acid effect on anaemia, just a little snippet from a paper for newer members:

"In B12 deficiency, there is disruption of normal folate cycling for regeneration of methylene-tetrahydrofolate, the form required to sustain synthesis of thymidine for DNA replication. Folate becomes effectively “trapped” as methylfolate, because B12 is required for its conversion to tetrahydrofolate in the methionine synthase reaction. Trapping of methylfolate creates a state of functional folate deficiency. Supply of folic acid to a B12-deficient patient can intermittently bypass this block through reduction of folic acid to dihydrofolate and then tetrahydrofolate, thereby partially or temporarily alleviating the anemia. Alleviation of the anemia masks the underlying B12 deficiency and allows the neurological damage from B12 deprivation to continue unabated. "

from ashpublications.org/blood/a...

I am a bit annoyed that many sources are still talking about folic acid "masking" a B12 deficiency when it has been known for a long time that B12 deficiency can often present without anaemia. GP's should not be deciding on a B12 deficiency based solely on a lack of anaemia and if they are still doing that they need to be retrained.

[helvella in reply to Technoid]

My morning eyes read that last word as "restrained".

Still, it fits.

[JHEW0836 in reply to Technoid]

So when there is a functional folate deficiency, is your folate level elevated? And if so, is that excess folate methyl folate? And I thought folic acid and folate are not the same, even though the terms are used interchangeably? It is all so confusing. My folate has always been high since discovering my B12 deficiency, and it has not come down much, even with injections.

[Technoid in reply to JHEW0836]

My understanding is that, in folate trap, yes, overall folates can be elevated but most of that folate is trapped methylfolate (5-methyl THF) and signifies a dysfunctional folate cycle rather than a true excess of folate. With adequate B12, overall folate might be expected to come down but the proportion of folates in each form would have a more normal distribution. I'm not a professional biochemist or medically trained, this is just what I can recall from what I've read and studied in my nutrition training.

I highly doubt any folate blood test you get from (or referred by) a GP will measure the proportions of folate in each form from the folate cycle (as shown below). It might be possible to get this from a private lab but I'm not convinced it would be worth the cost or bother unless there is a very strong suspicion of unexplained folate cycle dysfunction.. There is for sure more than one reason for high folate levels so I wouldn't necessarily put it down to folate cycle dysfunction if both B12 and natural folates are adequately supplied.

"Folate" is the generic term for all types of folate but there are many different forms. Folic Acid is a synthetic form. It needs to be converted to DHF before use. Prepare for some unpleasant biochemistry. The folate forms found in the folate cycle are:

Dihydrofolate (DHF)

Tetrahydrofolate (THF)

5-formimino THF

10-formyl THF

5,10 methylene THF

5,10 methenyl THF

5-methyl THF (methylfolate)

The natural forms of folate found in foods are usually 5-methyl THF (methylfolate), 5-formyl THF (folinic acid) and 10-formyl THF but there can be others. Methylfolate and Folinic Acid are both available as supplements.

Folate Trap is explained here : firstclassmed.com/articles/...

[Technoid in reply to Technoid]

Oh and please ignore this line of nonsense in the article:

"Now one of the chemical forms of Vitamin B12 is Methylcobalamin (The other one being the synthetic cyanocobalamin)."

The rest is good. 😁

[Gambit62 Administrator]

unfortunately the term pernicious anemia isn't used consistently and is often confused with the macrocytic anaemia that is a symptom of the autoimmune disorder that it is used for on this forum. Folate deficiency will also lead to macrocytic anaemia.

[FlipperTD]

This is another case of “When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean – neither more nor less."

The erroneous situation whereby 'Pernicious Anaemia' and 'Megaloblastic Anaemia' terms are used interchangeably leads to confusion, and then some berk writes a pack insert like this.

I could imagine simple re-wording that would remove the confusion. Megaloblastic Anaemia assumes two things: Anaemia [low Hb] and the presence of Megaloblasts [found in the bone marrow.] If you don't have both then I wouldn't use the term.

Pernicious Anaemia is a glorious old fashioned term, and is best confined to history.

I despair, but I can't say I'm surprised. Presumably, Humpty Dumpty is employed to write these pack inserts. I hope he doesn't fall off that wall.

[Narwhal10 in reply to FlipperTD]

Crackin’