Low folate - what causes it and what does it affect?

[London3891]

Hello,

I recently had some private blood tests and my folate level was low:

Vit D: 100 nmol/L (50 - 175)

Folate (serum): 9.15 nmol/L (8.83 - 60.8)

Ferritin: 100 ug/L (13 - 150)

Active B12: 131 pmol/L (37.5 - 188)

I was surprised with the low folate because my diet includes plenty of folate-rich foods and I have been supplementing with BetterYou B-Complex for a while. I’m confused about how the level can be low if I’m using an oral spray (endocrinologist didn’t know how it was possible either, but didn’t think it was a very interesting conversation).

Please can someone help me understand what might cause the low level, and what the effect of it being low might be?

In the last year I've had a couple of over-range / high in range results that I think could suggest potential folate-deficiency, but I don’t know enough about the link or whether these are anything to worry about. No doctor has ever discussed them with me.

MCH 34.2 pg (27.5 - 33.1)

MCHC 347 g/L (315 - 345)

MCV 98.6 fL (83.5 - 99.5)

For completeness, my latest thyroid levels are below - but I’m not too worried about these as I had just come off T3 after a trial and reverted to levothyroxine only. Since these results, I've increased my dose and am hoping levels will normalise soon.

TSH: 3.69 mU/L (0.27 - 4.2)

T4: 13.9 pmol/L (12 - 22)

T3: 3.39 pmol/L (3.1 - 6.8)

Many thanks for any guidance here!

[SlowDragon Administrator]

Many hashimoto’s patients have MTHFR gene variation

So it’s best to take vitamin B complex with folate in, not folic acid

Eg Thorne B complex

Or Jarrow B right

Remember to stop taking vitamin B complex a week before ALL BLOOD TESTS as contains biotin. Biotin can falsely test results

Being under medicated for thyroid will result in low vitamins

[London3891 in reply to SlowDragon]

Thanks SlowDragon, I’ll switch my B vitamin to one of the ones you suggest.

(I did stop taking it a week before blood tests to avoid biotin issue).

[radd]

London3891,

Folate is commonly seen as deficient in hypothyroidism, but adequate supplies are essential for the making of RBC’s (so preventing anemia).. There are several barriers that will inhibit methylation needed to activate folate such as poor gut health, acid blockers, high oestrogen, HRT, and the MTHFR gene impairments commonly seen in Hashi sufferers.

Just supplement folate (not folic acid) because you need to keep the level in line with VitB12 for both to work most effectively. You will need to retest because once supplies have been replenished unless you can identify and eliminate the cause (& sometimes we just can’t) ongoing supplementation may be required. Ensure other Vit B's are kept inline with VitB12 & folate.

[London3891 in reply to radd]

That’s interesting - thanks radd. I take the contraceptive pill so high oestrogen definitely applies. I also have gut issues but thought that using an oral spray would avoid any malabsorption problem.

When you say to just supplement folate to bring levels in line with B12, do you mean I should drop the B complex for a while to rebalance, or keep up the B complex but switch to one with folate rather than folic acid?

[radd in reply to London3891]

London3891,

I can't suggest as don't know what your other B levels are but either way will be good as long as levels are kept in line and you are avoiding folic acid which will build up if methylation is poor.

You can also get methylfolate + methylcobalamin (VitB12) combos. I try taking as few pills as poss so combos are good for me 😁

.

[London3891 in reply to radd]

ok, thank you - I've ordered some new B complexes with methylfolate + methylcobalamin

One thing I'm never sure of is which supplements to keep up indefinitely, and which to stop or reduce to maintain levels. It's expensive and pretty difficult to get all vitamins tested, so often feels like guesswork... thanks for your help with this - really appreciate you sharing the benefit of your research.

[Hedgeree]

Hi London3891,

When you mention you have gut issues have you been checked for coeliac disease or asked your gp about Pernicious Anaemia? Both are also autoimmune conditions and could eventually affect your ability to absorb nutrients in your bowel.

As in a previous post at the beginning of the year, Bookish says it could be helpful to get your gp to do an MMA and a Homocysteine blood test. If your gp is useful (as I know many are not!) and with you having neurological symptoms it could be a good idea to try to get these tests done (if you haven't already) to check for Pernicious Anaemia. (Though from my understanding there are no actual conclusive tests for PA.)

It may also be useful to have a look at functional B12 deficiency which is when you could appear to have normal or higher levels of B12 in your blood but there is a problem with the transport of the B12 between the cells.

I'm just another member of the forum and have no medical or science qualifications so these are just suggestions and I'm certainly not saying that you have these conditions!

It might be helpful to have a read around on the forum or find reputable sources on the internet for more detailed information.

Best wishes.

[London3891]

Hi Hedgeree, thanks for all your suggestions!

Yes, I've been checked several times for coeliac disease, and I also had the methylmalonic acid test earlier in the year - both came back normal. This plus fairly decent levels of B12 in blood tests make me think I can't have pernicious anaemia because, as I understand it, that relates to B12 deficiency only?

I've seen a neuro-gastroenterologist who thinks my GI issues are enteric dysmotility (he described it to me as the communication having broken down between the brain and the gut) which he is sure was caused by hypothyroidism before I was diagnosed and medicated. As a result of the dysmotility, I also have SIBO. I'm working on these issues and part of the reason for using oral spray supplements was to avoid absorption issues.

I don't think I've had a Homocysteine blood test though. It seems like this test would confirm low folate, but does it tell you more than the folate test itself does (since I already know my levels are low)?

Thanks again!