Help please with folic acid

[Missfolic63]

I've asked a few questions before but really struggling i was given foilc acid as a touch low I've taken the tablets for nearly 3 weeks no improvement really dizzy I feel like a car battery that just loses energy then spins has to lay down .I can't even go out as the feeling I'm going tp faint my folic was 4 5 b12 258 doctors are saying it's not these causing these symptoms. Anyine had these symptoms. I'm over thinking so much now

[MindfulSquirrel]

Sorry, was your latest/reported folate readings 4, 5 or 45? And are you also on b12 injections?

[Missfolic63 in reply to MindfulSquirrel]

4 point 5 no b12 injections doctors say 258 is a good level ..my symptoms say that isn't true

[MindfulSquirrel in reply to Missfolic63]

My understanding is that increasing your folate will also lower your B12 - there’s even a bog standard NHS webpage advising against just using folic acid if B12 deficiency is a potential problem because of the potential of masking B12 deficiency.* And if you aren’t deficient for dietary reasons (ie veggie or vegan), it’s an absorption issue and you’ll need B12 injections.

Low folate can artificially increase B12 in your blood too - it did with me but a MMA test confirmed B12 deficiency.

Can you get another B12 test? Not that my understanding is that you should need one, but it might help convince doctors.

*e2a: which  DevH ’s post below includes

[Technoid in reply to MindfulSquirrel]

> "My understanding is that increasing your folate will also lower your B12"

No, increasing folate intake will not lower your B12. Folate is said to mask the anaemia of B12 deficiency, but anaemia isnt even that common in PA or B12 deficiency. The "masking" is only relevant if you want to get a B12 deficiency or PA diagnosis and you doctor is clueless enough to think that a B12 deficiency always presents with anaemia.

[MindfulSquirrel in reply to Technoid]

My bad, I must have been thinking specifically of active B12, and from reviewing the paper again, seems it’s only suggested as caused by high dose folic acid rather than increased folate per se. Which tbf is still relevant to the OP, who might find it useful to look further into. My folate shot up from the borderline of deficient to over the cut off in just two weeks of high dose folic acid.

”In vitamin B-12 deficiency, elevated folate is associated with serum depletion of active vitamin B-12 (holoTC)

Observational study

HoloTC is referred to as the active form of serum vitamin B-12 because of its role in the transport of the vitamin to all tissues of the body (49). It is also a sensitive and early indicator of vitamin B-12 depletion. HoloTC typically represents 20–30% of total serum vitamin B-12 …. Specifically, elevated folate among the vitamin B-12–deficient participants was associated with a >50% lower holoTC concentration compared with vitamin B-12–deficient participants with nonelevated folate (Figure 8A). Importantly, in vitamin B-12 deficiency, high folate was associated with 16% lower total vitamin B-12 concentration than the state of vitamin B-12 deficiency with nonelevated folate status. This lower concentration of total vitamin B-12 can be totally accounted for by a high-folate–associated decrease in holoTC concentration.”

”Intervention studies

…

For the first 6 mo (period 1), patients were each given biweekly intramuscular injections of 30 μg crystalline vitamin B-12 or purified liver extract containing 20 μg vitamin B-12. (The specific cobalamin forms of vitamin B-12 used in this study were not specified.) In the next 6 mo (period 2), patients received the same biweekly intramuscular injections of vitamin B-12 plus daily oral doses of 5 mg folic acid. The data show (Figure 9) that, after the first period, serum vitamin B-12 increased significantly from a mean of 190 pg/mL … to a mean of 449 pg/mL ... Importantly, the inclusion of daily 5-mg oral doses of folic acid with the biweekly intramuscular injections of vitamin B-12 (period 2) resulted in dramatic decreases in serum vitamin B-12 to a mean of 277 pg/mL (95% CI: 221, 334 pg/mL; 204 pmol/L; 95% CI: 180, 246 pmol/L; P < 0.02), a concentration that is only slightly higher than that observed at baseline. “

Also more stuff about proposed functional deficiency as a result of high folate, all from here:

pmc.ncbi.nlm.nih.gov/articl...

[DevH]

Ah sorry to hear about your issues.

B12 deficiency - initial tests check:

* lower level of haemoglobin (a substance that transports oxygen) than normal

* red blood cells are larger than normal - MCV on standard blood test

* the level of vitamin B12 in your blood

* the level of folate in your blood - it’s not clear on your post what the folate level is. Can you confirm

Also

-what’s your diet are you vegan or vegetarian?

- did GP check iron or ferritin levels

Your b12 levels are low considering you are fainting. What are your other symptoms

Sadly none of the b12 tests are reliable, identifying b12 deficiency is complex so GP should go on clinical symptoms.

New NICE guidelines 6th March 2024 - get a copy to your GP - Highlight section 1.2 Recognising b12 deficiency

nice.org.uk/guidance/ng239

I fainted twice in 2020 and it took some weeks for GP to try me on b12 injections but I had so many symptoms including neurological and had these for 6-8 months plus before I fainted which promoted me go to GP.

Re Folate deficiency see comment from 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.

nhs.uk/conditions/vitamin-b...

Suggest you start to list ALL your symptoms with indication of severity and speak your GP.

Tracy Witty - b12d symptoms

b12info.com/signs-and-sympt...

Help with Writing to your GP

b12info.com/writing-to-your...

DO NOT DELAY as if you are b12 deficient quick action is best to avoid permanent damage.