Should folic acid supplements be taken when having B12 injections?

My GP has just agreed to my Endo's request that I be given a series of B12 injections. I mentioned to him that my niece, who has ME, is currently having B12 injections and that her ME specialist had recommended that she take folic acid while having the injections, My GP said that he had not heard of the need to take folic acid at the same time and that as my blood tests show that my folic acid level is fine he did not think that would be a good idea because if I start to improve we won't know whether it's the B12 that's helping or the folic acid. Has anyone else been told to take folic acid at the same time as B12 injections?


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12 Replies

  • Yes! There are studies regarding this. B12 and Folate work hand in hand. Thus if you have a B12 depletion or deficiency you may also have a folic acid deficiency. If you supplement B12, it may be a good idea to also supplement with folic acid.

    Silky x

  • Thanks SilkyJ. My folate level last Nov was 11.1 ug/L (4.6-18.7) so it was well within the reference range while my B12 was towards the low end of the reference range at 219 ng/L (197-866) so my Endo felt that a course on injections might help.

  • You may find that your B12 injections will deplete your folate so supplementation is advisable.

    I take daily B12 injections too and also supplement with 400 mcg Folate p/d and my latest folate serum results were in the middle of the reference range, which means I could supplement more.

    There is a HUGE study on this which is too much to read here x

  • B12 and folate certainly work together as advised, especially as the hydrocobalamin (injection in UK) needs to be methylised by folate or B12 useless to body, just excreted. Who said levels "fine"? Doc? Entitled to copy test, check for self folate is optimal, at least 3/4 up range. If decide self-supplement folate, supplement is called folic acid, usually taking max 800 units daily OK. Do NOT take folic acid in isolation, can mask effects B12 deficiency, be careful.

  • Agree.

    For those with less of a deficiency 5000mcg daily of Methylcobalamin (sub-lingual) might be a better route.

    Cheapest I can find currently at Health Monthly, although they are not the fastest or most reliable retailer!

  • Thanks so much everyone for your responses to my question. I emailed my Endo about this and she said that folic acid is taken to support the formation of lots of new red cells, which may occur when depleted B12 is replenished. She didn't think it was really necessary for me to take folic acid as my level was ok (11.1ug/L, ref: 4.6-18.7) but that it might help and wouldn't do any harm to take a low dose supplement for a short while. She disagreed with my GP who had told me he didn't want me to take both as then if I began to feel better we wouldn't know which was causing that. The Endo said taking some folic acid wouldn't make me feel better but the B12 supplementation should make a difference as stores were low previously. So I'm taking a low dose of folic acid while having the injections. Thanks again.

  • Hi,

    I have been prescribed 6 injections of hydroxocobalamin initially over 3 weeks for nerve pains as my b12 is slightly low 137 (range 145 - 569). My folate level is 7.7 (range 4.6-18.7).

    My endo says I should take 5mg of folic acid every day but my GP has not prescribed it. 5 mg folic acid is available OTC online. Do you think I should take it.

    Thank you

  • I know that this is an old thread but someone needs to set the record straight. If you have a deficiency (B12 less than 500) then you should be treated. If it is severe due to malabsorption then you should have injections versus pills. There are retrospective studies of experiments on people with PA and neurological involvement who were given high levels of folic acid for treatment. In some cases their nervous systems spontaneously degenerate. The rapidity of the response has led researchers to conclude that this was an unexplained effect of the folic acid rather than an effect from not being treated with B12. At the same time, folate is a required coenzyme with B12 in the methylation cycle. If you supplement with folic acid, I would not take high amounts. If you have neurological involvement, perhaps a better approach would be to initially get folate from food given the unknown consequences of high doses of folic acid with a severe B12 deficiency. After the deficiency is resolved and neurological issues begin to clear, perhaps folic acid is fine. However, in any case, one can get their folate levels tested to provide more information.

  • That's very helpful. So are you saying that it's not necessary to supplement folic acid when taking b12 supplements? We should get enough folate from our diet?

    Sorry to ask for clarification.

    My last levels of B12 serum were 240 which isn't very good. But when I take my B12 supplements 1000. I feel very wizzy? Bit hyper? Is that a good thing?

  • I don't think it is clear, but I think b12-PhD is saying that a person with low B12 should take folate rather than folic acid.

    For help with B12 you would be better to join the Pernicious Anaemia Society community on HU.

  • I take folic acid with b 12 as iam on chemo at the moment i was wondring why. I seem to have far too much acid now so can. Anyone help me please

  • I understood that the b12 jabs use folate in the methylation process, b12 may use your reserves. B12 is useless without folate.I have PA and keep my folate topped up with Thornes basic b. 11 may be well within the reference range but it's not optimal I'd like it to be 14/16.

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