What is the folate trap? Am I in it? - Pernicious Anaemi...

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What is the folate trap? Am I in it?

Laverdista profile image
14 Replies

Just watched the Cytoplan video with Dr David Morris and he mentioned the folate trap, which I've seen mentioned on here

When I was first diagnosed with B12D and extremely low folate, I was told to take 5mg of folic acid for 6 days before starting the B12, because my folate was so low.

Would this have affected my chances of absorbing B12 in any way? Can someone explain the folate trap in layman's terms? I'm probably overthinking but worried I've scuppered my recovery in some way.

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Laverdista
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14 Replies
Regenallotment profile image
Regenallotment

They do say to start with B12 first and introduce folate later over on the thyroid forum. I was also recommended to have Methylfolate and not folic acid, which is I believe more bioavailable. (I have the MTHFR genetic mutation that means I don’t methylate correctly so makes sense for me). Sorry I find the science a bit brain bending so this so my generalist take on things. I don’t suppose it matters if you stop and restart, I took folic acid 20 and 22 years ago for both pregnancies as recommended at the time. Hope that helps 🙏

Laverdista profile image
Laverdista in reply to Regenallotment

Thanks. I've seen a lot of people mention the MTHFR gene. How did you discover you had the mutation?

Regenallotment profile image
Regenallotment in reply to Laverdista

Weirdly it was through doing ancestry which hubby bought for Christmas a few years ago. I discovered you could download your dna in a txt file, then find the ‘alleles’ and RS number associated with MTHFR and hey presto there it was, the mutation can’t remember which way round it was now but I have it written down somewhere. I have a few, I found DIO1 and DIO2 and also the BRCA2. I was referred to Birmingham genetics unit for something else and when I mentioned the ancestry DNA they said ‘can you send the txt file we are also interested’ 🤣

Tanitha profile image
Tanitha in reply to Regenallotment

I believe this has come about due to the fact if folate deficiency is treated before testing for b12 taking folate/folic acid may mask b12 deficiency. There is also much debate about the MTHFR gene, so much so 23andMe no longer report on it in in their dna reporting although they state "Some very rare variants in MTHFR can cause a severe condition called homocystinuria, which affects fewer than 1 in 200,000 people in most ethnicities." blog.23andme.com/articles/o...

However from what I have read, being homogeneous for both rs1801133 and rs1801131 would possibly be detrimental. I am G/T (minus allele hence A/C) for rs1801131 only which SNPedia suggests may possibly cause impaired folate metabolism.

Regenallotment profile image
Regenallotment in reply to Tanitha

Wow that’s impressive - good work sleuthing that out. Isn’t it amazing what we can learn 👏

Tanitha profile image
Tanitha

I study little else! Be interesting to compare notes.

Technoid profile image
Technoid

Once you start B12 replacement, you would quickly be out of folate trap unless something quite unusual like a functional deficiency is involved.

More people have an MTHFR variant than do not and the presence of the common MTHFR variants does not mean you need to avoid folic acid. They metabolise somewhat differently but folate recycles through various different forms in the folate cycle so taking one form instead of another doesn't make as much difference as one might expect by just glancing at a one carbon metabolism chart.

This is one of the better explanations of folate trap I've read:

firstclassmed.com/articles/...

Extremely high doses of folic acid have been theorized to possibly cause functional folate trap but this has not really been properly tested.

Starting with B12 first and then folate is less to do with folate trap but mostly because of a concern from some very old case studies about aggravating neurological damage. It's a longer discussion but I think this fear is unfounded and based on a fairly small evidence base from when B12 deficiency was not recognized at all and was treated with mega dose folic acid (like even more than 5mg) WITHOUT accompanying B12 replacement.

23andMe don't report on MTHFR because experts in MTHFR agree that, outside of serious MTHFR disorders usually seen in infancy, MTHFR testing provides nothing more useful than a serum folate test would provide so its generally a waste of time and money.

Laverdista profile image
Laverdista in reply to Technoid

Thanks for the concise, yet detailed explanation! 🙂

B12again profile image
B12again

The “folate trap” is a situation in the body where a lack of vitamin B12 causes folate (or folic acid) to get “stuck” in a form that cannot be used properly.

Folate and vitamin B12 work closely together to help make red blood cells and support healthy nerves. Without enough B12, folate can’t do its job properly, and even if you have plenty of folate, it can’t be used by the body the way it should. This leads to a problem where, despite having enough folate, you can still end up with symptoms of a deficiency, such as tiredness or anaemia.

So, the folate trap is essentially caused by a B12 deficiency, which prevents folate from being used effectively. It highlights how important it is to have enough of both B12 and folate for your body to function well.

For Example:

For pregnant women, the “folate trap” can be particularly concerning because both folate and vitamin B12 are crucial for the healthy development of the baby, especially in the early stages when the brain and spinal cord are forming.

Folate, in its usable form, helps prevent neural tube defects, which are serious birth defects affecting the baby’s brain and spine, like spina bifida. Pregnant women are often advised to take folic acid supplements for this reason. However, if a woman is deficient in vitamin B12, the folate might get “trapped” and not work properly, even if she is taking enough folic acid.

This means that B12 deficiency during pregnancy can indirectly affect how folate works, potentially increasing the risk of complications like neural tube defects or anaemia. It’s important for pregnant women to have enough of both B12 and folate to support their health and the baby’s development.

That’s why some health care providers may check both B12 and folate levels during pregnancy and may recommend supplements if needed.

JHEW0836 profile image
JHEW0836 in reply to B12again

Thank you for this detailed explanation! I have been really confused about folate in relation to B12 deficiency, especially since my folate level was off the charts when I discovered that my B12 was low.

Laverdista profile image
Laverdista

Thanks. All makes sense now! 🙂

WIZARD6787 profile image
WIZARD6787

The genetic abnormality resulting in methylation issues is real. It is not the same as the one that is rare and shows up in infancy. The methylation issue is 1 to 2% and NOT rare. DR Morriss is correct and those that contradict that science are incorrect although confident. There are other experts that actually promote healing that do not follow only information applicable to those that choose a vegetarian diet and have to supplement to keep from being ill on that diet.

Methylfolate (Methyl B9 and not other forms of B9 ARE required by some of us to heal regardless of how confident others are.

just as an encouragement about folate - I’ve only been taking 500mcg on injection days (EOD) for about 3 months now and my folate just measured at 54 pmol/l which is more than adequate.

I know everyone is different but if you find you aren’t tolerating the 5mg folate, and your levels are now stabilised, you could probably get by on a smaller dose.

Laverdista profile image
Laverdista in reply to PlatypusProfit8077

Thanks. My folate levels were really low (2.6pmo/l) when I started self-injecting 5 weeks ago. I'm interested to see my latest blood test results this week!

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