Folate deficiency

[Pinkisland]

Please can you give me some advice as to what supplement should be take for a folate deficiency. Is it folic acid tablets or folate tablets? I am somewhat confused. Also what is the optimal folate level for a person with Hashimotos? Thanks in advance

[SlowDragon Administrator]

What are your most recent folate and B12 results

These work together so it’s important both are tested BEFORE starting any folic acid or vitamin B complex

If folate is deficient GP will prescribe folic acid

If folate is low, or if you prefer not to get prescription supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid explained here

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

What are vitamin D and ferritin levels?

[Pinkisland in reply to SlowDragon]

Thank you...these are my results:

Serum vitamin B12

262 pmol/L

Range 145 - 569

Serum folate

7.9 nmol/L

Range 8.8 - 60.8

[SlowDragon Administrator in reply to Pinkisland]

With folate deficiency you should really see GP for prescription for folic acid

B12 is far too low ….but as is within range GP unlikely to do anything

Do you have any Low B12 symptoms 

If you do discuss further testing with GP before starting on B12 supplements

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex……once you finish prescription from GP for folic acid

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

Low folate

Once you finish folic acid prescription from GP

Consider supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help maintain B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

currently cheapest on eBay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

[Pinkisland in reply to SlowDragon]

Thank you

[helvella Administrator]

It is often claimed that one form is better than another. Or that it doesn't matter!

First, folate from ordinary foods has never been shown to cause any problems even with high intake.

Second, excess folic acid can make people feel terrible. Sometimes people are prescribed 5 milligrams and carry of taking it for a long time. That sort of dose should be short-term (two or three months) unless there are particular reasons that the person needs that much.

Third, it appears most people can take modest doses of folic acid, such as 200 to 400, maybe 800 micrograms a day, without any obvious issues.

Fourth, some people seem to prefer one of the folate options.

Do you have test results?

[Pinkisland in reply to helvella]

Thank you...these are my results:

Serum vitamin B12

262 pmol/L

Range 145 - 569

Serum folate

7.9 nmol/L

Range 8.8 - 60.8

[SeasideSusie Remembering]

Is it actually folate deficiency (<3ug/L) or low folate? If folate deficiency your GP should prescribe and monitor your level.

[Pinkisland in reply to SeasideSusie]

Thank you...these are my results:

Serum vitamin B12

262 pmol/L

Range 145 - 569

Serum folate

7.9 nmol/L

Range 8.8 - 60.8

[SlowDragon Administrator]

So B12 is also too low as below 400-500

Both low folate and low B12 extremely common with Hashimoto’s/hypothyroidism

pubmed.ncbi.nlm.nih.gov/186...

Do you have symptoms of Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

If you do …..you should request testing for Pernicious Anaemia before starting on replacement B12 and separate vitamin B complex

You might need B12 injections

If you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels between injections too

If you don’t get prescribed B12 injections……

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

A week or so after starting B12

Starting supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will also help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

[Pinkisland in reply to SlowDragon]

Thank you for all your advice. My endocrinologist did a gene test and this is what the feedback report stated:

The results of the genetic tests have highlighted multiple polymorphisms affecting folate, B12 pathways and she has a compound homozygous polymorphism of SOD which can be associated with impaired recycling of the energy currency. Is this the same as what you were referring to when you wrote the following: Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

I have been prescribed folic acid tablets but should I rather be taking folate tablets or/and a Vitamin B complex as you suggested above? I am struggling to get my head around everything. Thanks in advance

[SlowDragon Administrator in reply to Pinkisland]

Take the folic acid prescription

Add separate B12 supplement 10-14 days after starting folic acid

When you finish folic acid prescription…..then start on daily vitamin B complex

Alternatively buy your own methyl folate

Eg Jarrow methyl folate 400mcg

If don’t want to take folic acid

You won’t need folate/folic acid AND vitamin B complex

Take one or the other

In week before blood test, when need to stop vitamin B complex……during that week …take separate methyl folate

Retest thyroid levels and all four vitamins at least once a year

What are your most recent thyroid results

TSH, Ft4 and Ft3

[Pinkisland in reply to SlowDragon]

Thank you. My TSH is 1.8

[SlowDragon Administrator in reply to Pinkisland]

Just testing TSH is completely inadequate

You need TSH, Ft4 and Ft3 tested together

Plus thyroid antibodies tested at least once

Vitamin D and ferritin too

How much levothyroxine are you currently taking

How long on this dose

Do you always get same brand levothyroxine at each prescription

all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

[Pinkisland in reply to SlowDragon]

I am planning to use Medichecks to test Ft3 and Ft4. I was on 150 and 125 alternating every day but I am now on 150 to try and get my level below 1 (It's when I feel my best).

[Pinkisland in reply to SlowDragon]

Sorry I'm still a bit confused. When you say take one or the other are you saying I should either take folic acid or folate and once I have finished a course of either folic acid or folate. I should then start a Vitamin B complex.

[SlowDragon Administrator in reply to Pinkisland]

NHS only prescribes Folic acid for low folate

If you want to take folate instead you ideally would take vitamin B complex

[Pinkisland in reply to SlowDragon]

Thank you

[Pinkisland in reply to SlowDragon]

Which do you think is better?

[Pinkisland in reply to SlowDragon]

Which do you think is better?

[bookish in reply to Pinkisland]

Hopefully you have a full report of which polymorphisms are involved so that you can do a bit more research about where your issues might be and what you might be able to do to assist those processes. There are an awful lot of possibilities. Methylfolate (I use a small amount of methyltetrahydrofolate liquid) made a huge difference to me, but it doesn't for everyone. Genefood can be useful mygenefood.com/genes/

[purejoynow]

Before anyone can give you guidance, they would need to know if you have a mthfr 677t mutation. because it can reveal if you can even USE folic acid. Most Drs. won't say anything about that to you. Even mine, who submitted my blood for a test of mthfr mutations, still prescribes me folic acid. I throw it out. I have to remind him not to, and I don't always remember. To let it sink in, best to use those keywords to google and read a few good sites to start to understand what difference it makes.

[Pinkisland in reply to purejoynow]

Please can you explain what a mthfr 677t is? Thanks

[humanbean in reply to purejoynow]

Before anyone can give you guidance, they would need to know if you have a mthfr 677t mutation.

I would disagree. If someone has an MTHFR problem they would need to take methylfolate rather than folic acid.

If someone has no problems with MTHFR then they can cope with either folic acid or methylfolate.

So, in my opinion, for most people methylfolate is a safe option to raise folate.

takecareof.com/articles/ben...

chriskresser.com/folate-vs-...

[Pinkisland in reply to humanbean]

Is methylfolate natural folate tablets you would buy in a health shop as oposed to folic acid tablets prescribed by a doctor?

[humanbean in reply to Pinkisland]

Some manufacturers seem to purposely make their description of their products confusing. I would NOT buy this one, for example, because even the maker seems to think that folic acid and methylfolate are the same, which they definitely aren't :

smile.amazon.co.uk/L-Methyl...

I haven't researched all of these, but superficially at least , they appear to be fine :

smile.amazon.co.uk/L-5-MTHF...

*** smile.amazon.co.uk/L-5-MTHF...

smile.amazon.co.uk/Methyl-F...

I wouldn't take methylfolate which is higher than 1000 mcg per dose.

And I've never studied any products called Natural Folate, so don't know what is being sold. I would always insist on reading the label on any products to see what they are actually selling.

The link I've marked with three stars is the one that I take when my level won't stay up from just taking a B Complex. I will continue to take a B Complex then will take one of the starred ones about 2 - 5 times a week for a few weeks, depending on how low my folate result is.

[purejoynow in reply to humanbean]

Thank you for offering your opinion. I have heard from some with the mutation who say only folinic acid works for them I have to believe them, and I do. But I don't recommend supplements to anyone else because I am not a qualified health practitioner. It was nice of you to put up the links to the articles.