Is it ok to supplement with folic as I am led to believe it affects B12 in some way?

[bflare]

I have read that folic supplements can cause some issues with B12. My folate is quite low at 1.5ug/L. Is it ok to start supplementing while i await my biopsy results and IFAB blood test?

[Rexz]

Too much folic acid (folate) can reduce Holo TC which your body needs for B12 metabolism. You need a proper balance of Folate and B12. So with you being low in Folate it should be O K to supplement now. This will have no impact on biopsy or IFAB test results that have already been taken. The other thing you may have read is that high levels of folate can mask a B12 deficiency. In your case, I think you are beyond this? In other words you're already diagnosed as B12 def.

That's my take anyway.

[bflare in reply to Rexz]

Thanks Rexz. I am yet to have the IFAB test. That is next next Wednesday. Yes, i have read that it can mask B12 deficiency symptoms. My B12 is currently 275 ng/L and my Serum folate level 1.2 ug/L. I am concerned that the folate level is very low but I am worried if i take the folate how will i know if i am experiencing any symptoms to report to my GP if the folate masks them? Also, according to my GP my B12 levels are normal. Thanks.

[Rexz in reply to bflare]

Depending on the Lab you are using the 275 ng/mL could be considered borderline. My opinion is it is on the low side. Folate will only mask B12 def of it is "high" I'm not sure of the value, but above normal anyway. I think it'd be OK to supplement folate now to bring it up a bit

[KBird01 in reply to Rexz]

Hoping you don't mind me asking a question on your post bflare but this is an area of interest to me and something I've found difficult to get to the bottom of. My folate levels have always been consistently over range, even when I haven't supplemented, whilst my B12 levels have been in range at levels no lower than yours.

When you say 'masking' B12 symptoms, could you clarify what you mean?

[bflare in reply to KBird01]

I’m no expert on this but from an NHS website:

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal.

This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.

If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

Not sure if this helps.

[KBird01 in reply to bflare]

Ah ok. Thank you. The thing is I wasn't supplementing, I've just always had consistently over range folate results. Ah well, another mystery! 🤷‍♀️

[Rexz in reply to KBird01]

Having high levels of folate is common, at least here in US as our foodstuffs, breakfast cereals, bread, etc. contain folate supplement as an additive. I'm not sure this is done in UK or elsewhere? They do not contain B12 though, curious...

[KBird01 in reply to Rexz]

Thanks Rexz . Yes, we also have foodstuffs supplemented with Folate, but I don't really eat much of those foods. Yet another of my personal health journey mysteries I guess... 🤷‍♀️

[Rexz in reply to KBird01]

Yeah, I supplement folate now also as I've pretty much stopped eating refined foods. More gluten, dairy, sugar free and natural nutrient dense foods now. 🐷🐖🙂

[Rexz in reply to KBird01]

Hi KBird, sorry your question got lost in the mix here. Masking of symptoms....When a person goes for physical or say your not feeling well and you go see your doc/GP. They'll order the standard CBC blood tests. These do not include B12. However for most, not all with B12 def your MCV would come back elevated and show Megaloblastic Anemia from this result your doctor would order other tests the first being serum B12 which would show deficient. This would start you on B12 replacement therapy and hopefully other tests to confirm PA. The masking of symptoms occurs when you have severely low B12 but high normal or over normal folate. High levels of folate will correct megaloblastic anemia, the telltale sign of B12 def. So here you are B12 deficient and all the neurological and peripheral nerve damage is occurring away but the big red flag of megaloblastic anemia is missing because high levels of folate is correcting that. Your doctor/GP may be none the wiser, not check your B12, and send you home with a couple of useless aspirin. Some GPs are keen to this, they are few though, most are not.

Just a note that severely low levels of folate in the absence of B12;def, can also cause megaloblastic anemia.

Hope that answers OK. If not please ask again...or DM me.

Best wishes, Rexz

[KBird01 in reply to Rexz]

Thanks Rexz that's very helpful indeed. This would answer a lot, seeing as my MCV has always been right at the top of range, but not over.

My folate has always been over range, even without supplementing.

I discovered last year my ferritin was low and had been for years (GP said was OK in low 20s). This of course would have been reducing my MCV and also masking effects of potential B12D.

Your info is reassuring to know a) there was a lot more going on with my bloods than at first sight.

b) I wasn't crazy/neurotic etc, etc and my current supplement regime was correct and has got me well despite no diagnosis from GPs.

Thanks again. You're such an asset to this forum. 😊

[bflare in reply to Rexz]

The PA blood test that I’m due to have on Wednesday checks MCV.

From the PAS website…..

Also, be aware that taking folic acid will prevent your red blood cells becoming enlarged so be sure to tell your doctor if you are taking any form of folic acid.

So folic acid could affect the result of the MCV test which looks at the size of the red blood cells.

[Rexz in reply to bflare]

bflare , you're exactly correct, both low folate and B12 'can" cause megaloblastic anemia which shows a raised level of MCV. This is one of the PA symptoms being masked or similar that I mentioned. So, now let's assume your MCV is raised, they look at it, and it shows megaloblastic anemia? Is it caused by low folate or low B12? You already know your folate is very low so it would be no surprise if MCV were raised. Although both low B12 and folate do not always result in elevated MCV and megaloblastic anemia. At this point MCV is really of no use. Normally you would have B12 and folate checked as a result of high MCV to diagnose or peel the onion back to find the cause, then lead to IFAB and PCAB testing if those are positive then gastroscopy. Although a negative IFAB does not rule out PA as well as a positive PCAB does not confirm PA. There are two instances that are diagnostic for PA/AIG. Positive IFAB or a positive PCAB along with High serum Gastrin. But with no symptoms and your age my "guess" is that Gastrin will be normal. The only current 100% affirmative test for PA/autoimmune gastritis is a gastroscopy and biopsy of oxyntic mucosa with pathologist confirming damage to Parietal cells. Taking folate now if your PA cascade testing is Wednesday will have no impact on those tests. My suggestion if you're in doubt is to ring your GP .

I notice your bio says you have celiac disease...just a note, celiac d can also cause B12 deficiency amongst other things such as being a strict vegan, having had gastric surgery...

Hope this is helpful.

[bflare in reply to Rexz]

Ah right I understand thanks! Basically I’ve already had the gold standard diagnostic method for PA so any blood tests I have will not show anything more than the biopsies can. So, taking folic now cannot really impact anything.

The guideline defines the diagnosis of AIG as a positive gastric autoantibody (PCA and/or IFA), adding to endoscopic manifestations and/or histopathologic manifestations fulfilling the features of AIG

Yes I have celiac and thinking back my diet has been extremely poor lacking in veg and much meat. Basically I’ve been eating a lot of bread, rice and confectionery 😬

[Rexz in reply to bflare]

Well, sort of yes 😳. Depends on if they did the biopsies correctly... e.g. they biopsied your oxyntic mucosa. Biopsy specimens are placed in jars labeled for regions of stomach and pathologist was given instructions to look for it. Back to my original response... If you can, get a copy of your pathology report.

If pathology biopsy of upper body/cardis or fundus (this is upper part of stomach where oxyntic mucosa is located) and it says something like "atrophic gastritis consistent with autoimmune gastritis". That's PA. If the gastritis is confined to the antrum (lost part of stomach) that is most likely H-Pylori bacterial infection or in lessor cases too much alcohol or smoking.

That said I would still go ahead with your testing you've scheduled for Wednesday.

B12 is found in meat, beef, chicken, eggs, etc. if you're low B12 it could be PA, your diet of breads rice and confectionary, there's no B12 there, or Celiac disease.

Rexz

[bflare in reply to Rexz]

Gotcha! Well fingers crossed that they did follow the Sydney protocol as my endoscopy report says they did. The pathology report will confirm I guess once I receive that which should hopefully be in the next couple of weeks.

The Sydney protocol for gastric biopsy sampling includes two biopsies from the oxyntic mucosa:

Biopsy sites: The Sydney protocol recommends taking two biopsies from the oxyntic mucosa, in addition to three biopsies from the mucosecreting area:

Oxyntic mucosa: Two biopsies from the oxyntic mucosa

Mucosecreting area: Three biopsies from the mucosecreting area, including two from the antrum and one from the incisura angularis

Biopsy placement: Biopsies should be placed in separate jars.

[WIZARD6787]

My study has led me to take Methyl Folate.

[GoneWithTheWind1972]

A good quality B complex with methyl folate should help you. Be sure to thoroughly investigate the B complex to contain all the B’s in recommended doses. Amazon has many options available.

[Tanitha]

I agree with Rexz in that as your b12 has been tested you should be fine to take folate as I've never heard of it interfering with an IFAB test. The only thing I am aware of is a b12 injection close to a test may cause a false positive result. It is also worth being aware a negative IFAB isn't conclusive in proving PA as it is only positive in 50% of patients with PA - that's not to discredit the test, just to highlight its limitations. You haven't given the range for folate but you must be feeling pretty rough at a level of 1.5.

[bflare in reply to Tanitha]

Thank you. I understand that folate can mask the symptoms of B12 deficiency. However, I have no symptoms of either B12 deficiency or folate.

[Tanitha]

That's amazing. My folate was 5.9 early December (usually above 18) and I felt quite rough which is why I replied. I know they check B12 and folate when you have coeliac so probably why you were tested. Perhaps your levels have dropped sharply but at that level I would think you will start to become symptomatic if you don't supplement. I can't see any reason not to.

[Bellabab]

Providing all your tests for B12 deficiency have been completed it is essential to supplement with folic acid because it is needed for B12 to function - they work hand in hand. I take a 5mg folic acid tablet every other day.

[bflare in reply to Bellabab]

I have a PA blood test this coming Wednesday which has 20 bio markers. Should I wait until then?

[Bellabab in reply to bflare]

It would be wise to do so.

[helvella in reply to bflare]

The same question, more or less, was on Thyroid UK earlier. My reply, somewhat lacking context:

There are many, many reports of biotin interference. (And oodles of other things!)

But I have searched and trawled and, just now prompted by you, also used an AI source.

The only issues I can find for folic acid, methylfolate or folinic acid are the totally obvious folate, and the fairly likely/obvious B12, the probable homocysteine, and (I would add from caution) methylmalonic acid. Plus any MTHFR gene test.

It did take some time for biotin to be accepted as an interferant, and even longer for action to be taken. Even now, the desirable action of making tests that are not susceptible to biotin has not been achieved. Therefore, I am absolutely open to the possibility. But it does seem odd that, from the evidence so far, one GP is saying this and no-one else.

And this is the context:

healthunlocked.com/thyroidu...

[Katherine1234]

If it was me bflare I would wait until all my testing was over, results in and you have seen consultant. It is hard jogging along with low folate it makes you so fatigued. Once everything is in you can bring your folate up pretty quickly with high dose folate. I cannot take folic acid.

How is your tummy, low acid conditions in the tummy make it hard to absorb B12 and folate, along with iron, protein and amino acids.

[bflare in reply to Katherine1234]

Yes I’m going to wait until the testing is in. I’m just concerned that I could be causing damage to myself running on low folate. However, I feel absolutely fine in myself apart from all this bringing on my health anxiety!

My tummy is ok apart from a lot of churning. My stools are still light brown which isn’t usual for me. They do not float now though which I believe can indicate a problem with fat absorption. I do suspect that I’m on low stomach acid though which is another thing I’m not sure what to do about.

[Katherine1234 in reply to bflare]

I personally would wait. It will be ok, but once you have had tests and consults get it up to near top of range. Low tummy acid has so much to do with it. If you look up Dr Berg and repairing low tummy acid, there is another doctor too on there, cannot think of his name. I am sure this is the root of our troubles. I take HCL, digestive enzymes, copper, zinc, iodine, bile salts, probiotics, and lots of unrefined gray sea salt to build up my tummy acid to allow me to start absorbing vitamins and minerals.

[bflare in reply to Katherine1234]

Did you find which enzymes to take yourself or was it your GP / consultant? That’s another thing that baffles me is where do I start with that stuff? I haven’t got a clue.

[Katherine1234 in reply to bflare]

I think you will have to gen up on all the nutrition articles or see a nutritionalist. I use Thorne Biocare enzymes. Dr Sarah Myhill has a lot about this on her website.

[scnuke]

Are you planning to SI B12 and how often? Most sources agree that you should maintain folate levels in the upper third of the range. Once your blood tests are over you should consider taking a 5 mg folic acid for a short time, 1 - 2 weeks, and then a daily 400 - 800 mcg dose daily. I inject Hydroxo twice daily and take 800 mcg folic acid. I'm in the USA so my B12 levels are serum only and meaningless. My folate is always >30. I am afraid that you will have to get the most useful advice on this forum, but you will hear all sorts of histories of what works. Stay away from the Facebook groups. But the most important things is for you to take charge of what works best for you. Keep a log book of symptoms and routines. There are a lot of knowledgeable people here, so don't be afraid to visit often and hear from different people and what they did in their B12 journey. Good luck!

[bflare in reply to scnuke]

I will SI if I don’t feel I’m getting the right help off of my GP / consultants. Once I have my biopsy results back and the results from a PA blood test that I have next week I’m hoping I’ll know more and have some idea what to do next. But I’m definitely prepared to SI if I do have PA and I don’t receive the appropriate help.

[B12phd]

B12 and folate work together. If you supplement 1 you should supplement the other also!

[bflare]

From the PAS website…..

Also, be aware that taking folic acid will prevent your red blood cells becoming enlarged so be sure to tell your doctor if you are taking any form of folic acid.

So folic acid could affect the result of the MCV test which looks at the size of the red blood cells.