folate vs folic acid

[bikebabe]

I’ve been searching for a post that says not to take folic acid if your folate level is low. My daughter’s folate level is 2.95 (side effect of netformin)and her b12 is only 283. Hee GP has given her folic acid and will only repeat after 1 yr! Madness. Her tsh is 0.9 and they didn’t test t4 or t3.

[greygoose]

Folic acid is the synthetic form of inactive folate. Not always well absorbed or used by the body. Better to take methylfolate. But, actually, she should be dealing with her B12 before starting folate.

With that low B12, has he tested for Pernicious Anemia? He really ought to, and best not to start folate supplementation before that.

I'm afraid doctors know nothing about nutrients and have to be pushed to do the testing. And then, they have no idea what to prescribe and go for the cheapest options, if anything.

[Eliotf in reply to greygoose]

Grey goose,

You seem knowledgeable and well informed. I have a few questions for you and the group. First background information: I am in the USA. My diet/eating habits probably won’t change. My blood is drawn all the time cbc, wbc, etc and every 6 months my complete thyroid panel is drawn. I have hashimotos, CLL and they are well controlled and /or stable It’s the dermatomyositis and a few other disorders that seems to flare up. I will be going to a naturalpath & nutritionist/dietitian. My questions are: what nutrition blood panels & or specific tests can I run for a more fuller picture and to see the less common nutrients? Are those freezes dried ‘super greens supplements’ any good ? And of course I am also looking for micronutrients and finally the magic ingredient/pill.

[greygoose in reply to Eliotf]

I think it would be better if you put those questions in a new thread rather than tagging them on to someone else's thread, because that then gets complicated. Also, more people will see them that way.

[Eliotf in reply to Eliotf]

OK, Thank you

[SlowDragon Administrator]

Metformin lowers B12 as well as folate

gov.uk/drug-safety-update/m...

Metformin also lowers TSH

cureus.com/articles/50564-e...

How long is the prescription of folic acid for

Starting on B12 first then adding folic acid

After prescription for folic acid finishes start daily vitamin B complex with folate instead

Low B12 symptoms

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

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

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

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

healthline.com/nutrition/fo...

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)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Schilddruse in reply to SlowDragon]

Do you know of any sublingual methylfolate supplement? I can only find one with folic acid.

[SlowDragon Administrator in reply to Schilddruse]

There’s this one

revital.co.uk/products/bioc...?

Or this one more expensive but has both types of B12 included

metabolics.com/b-complex-li...

[Schilddruse in reply to SlowDragon]

Thanks. I'd seen these liquid drops you add to water, but haven't come across any sublingual formulation. I always worry that, given the lack of regulation, I may be buying a supplement that doesn't contain what it purports to. It's a shame that an independently tested brand such as Thorne doesn't do sublingual supplements.

[helvella Administrator Thyroid UK in reply to Schilddruse]

Is it possible that sublingual forms of methylfolate provide little or no benefit?

It is unlike the supplements industry to leave a gap if there is a body of opinion that filling it would in turn fill their coffers.

[samaja in reply to helvella]

When there is a confirmed or even suspected malabsorption resulting in B12 deficiency there is no point in taking any oral, sublingual or transdermal forms of this vitamin because only around 1% of them will be used while the only effective way of raising B12 levels AND making sure it's actually going where it's needed is by injection. It might be similar with folatewhich can be injected too but most people are fine with folic or folinic acid tablets.

[helvella Administrator Thyroid UK in reply to samaja]

I was referring back to this reply:

Do you know of any sublingual methylfolate supplement?

Not B12.

Will edit my reply to make that clear.

[Schilddruse in reply to helvella]

I wondered that myself...

[bookish in reply to Schilddruse]

I don't I'm afraid but I do use Metabolics liquids as mentioned by SlowDragon - their methyltetrahydrofolate made a huge difference for me (I had been supplementing B12 for some years, and taking a small amount of folic until finding methylfolate)

metabolics.com/methyltetrah...

and I use the methylcobalamin too

metabolics.com/vitamin-b12-...

(I also use subliguals from Cytoplan but they only do B12s, not B9, as sublingual)

Metabolics are good, but don't let them freeze - I accidentally froze a folate and it loses potency by some considerable amount, noticeable by symptoms. Cheers

[Schilddruse in reply to bookish]

Thanks - that's good to know.

[Schilddruse in reply to bookish]

Can I just ask what dose of methylfolate you'd suggest taking please? I'm concerned not to take too much, and I keep seeing conflicting recommendations of 400mcg vs 1000mcg.

I'm actually asking on behalf of two people, one with a serum folate level of 2.8 mcg/l and the other with a level of 6 mcg/l (the range is >2.9 mcg/l in both cases).

[bookish in reply to Schilddruse]

What I did myself, which is all I have any experience of, is start very low and build up. I did this partly because I didn't know how much would be a good dose and partly because I was reacting to ingredients in most things. So I bought a good quality, clean, grain-free methylfolate (Metabolics liquid in my case) and started with one drop daily. 1000mcg is 13 drops so I was on approx 77mcg. I built up to about 9 drops daily before reading that 400mcg was considered a good maintainance level, so I dropped a bit. I also started to divide the dose into three, so I take a couple of drops three times daily. It made a big difference to my symptoms. My serum folate was actually high in range before I started the methylfolate (had been using a multi with a teeny bit of folic in it, plus folate from food of course) and reduced to mid range with the higher dose of the different form, which can be the case with functional deficiencies of other B vits as well as B9. Some are above top of range with no supplementation at all. But as others have said, if there is a B12 deficiency, and it is very difficult indeed to be certain that there isn't, supplementing folate in any form first might exacerbate the problem, even severely. So check the B12, as thoroughly as possible, and if in any doubt at all, supplement B12 first then add the folate after a couple of weeks. Gently does it. Also mentioned here is that some cannot cope with additional methyl groups at all, getting anxious, panicky, out of control, whereas some do better (like me) with more methyl. Another reason to only change one thing at a time and always start slowly, making a note of what you've done and how you feel. If it feels wrong, stop. You can always try a different form of B12 and/or folate.

[Schilddruse in reply to bookish]

Thanks! That's incredibly helpful.

[mstp]

The link to info about biotin has given me food for thought. Last time I had a blood test my ferritin and B12 were over range. I hadn't been taking supplements for a while so this was surprising. I've been doing the Zoe Personal Nutrition Programme and wondered if it could be down to all the good food I'd been eating. One of the links mentioned that biotin is found in seeds and nuts. As I now eat lots of these on a daily basis could that be responsible for skewing my test results?

[samaja]

It is absultely fine to take folic acid and actually it should be taken at 5 mcg immediately for at least 4 months and then retested to support B12 injections becuase that's what your daugther is needing at this level of B12 and B12 wont's work anyway when folate is that low. Methyl folate is more expensive and known to cause anxiety in some patients.

She should be tested for Pernicious Anaemia and investigated for poor absorption. Testing for PA requires 2 weeks of any B12 if she was taking any and folate at least 3-4 days off folic acid. A positive result on IF antibodies test confirms PA but a negative one does not exlude it because they are only 40-60% accurate and then more testing should be done.

Please join the Pernicious anameia/B12 Deficiency FB group for the info you need and the protocol for treatment becuase chances are you will need to consider self-treating given the current stance of the medical profession on limiting or even withdrawing necessary tratment for people with B12 deficiency.

Tablets or any oral and transdermal forms of supplementing will only elevate the serum results but will not address the cell deficiency!

[galathea in reply to samaja]

Its not always fine to take folic acid. I have a problem with both copies of the mthfrc677t gene, which means i cannot break down the folic acid into folate….

[samaja in reply to galathea]

I didn't say it's always fine but for most people it is. There's been a lot of hype that folic acid is somehow bad for almost everyone while as with any suplement it's the question of what suits the individual depending on their unique body and history. Methyl folate is not always better if you don't have MTHF problems.

[CoeliacMum1]

Look on for advice on

bda.uk.com/

For helping with areas with deficiencies, both how to include more in diet and what can result in deficiencies from conditions, cooking things too much and alcohol and drugs one like you mentioned, is Metformin, it is a known one for depleting B12 levels along with some obvious gastrointestinal conditions that can result in these problems.

Others have mentioned the folic acid v the active form will which we mostly use better, which is Methylfolate. unfortunately it will possibly fall on deaf ears re Dietitian or GP unless they have delved deeper in to this … a nutritionist however will point this out to you but do find a reputable one, not one that has done a random short online course and now say they’re “qualified” unfortunately this isn’t a regulated area, as with a dietitian but the latter are out of the same med school and guided by NICE which isn’t always the latest information regardless of it’s updated content.

However as others mentioned the B12 situation needs addressing first.

cks.nice.org.uk/topics/anae...

Your GP should be following these if not ask why.

It does state this re thyroid but not sure if it applies in this situation.

Severe thyroid deficiency — anaemia caused by hypothyroidism is often macrocytic. However, MCV falls once thyroxine treatment is started.

Regarding Pernicious Anemia (PA) you don’t always have to have positive antibodies results to have PA, but as mentioned again it should be done.

I have PA and mine were negative… I have 5 family members including my sister on my mums side with PA we all have B12 injections… I have periodically had to have folic acid 2020 the last time but going forward I will buy my own Methylfolate I clearly have genetic methylation problems…and no they don’t often bother testing again as they assume your levels whilst supplementing are going to be ok along with that will do for now attitude, same goes often with Vitamin D.🤦🏻‍♀️ agree madness !

[humanbean]

The Pernicious Anaemia forum on Healthunlocked can be found here :

healthunlocked.com/pasoc

...

You might find some of the info in this thread of interest :

healthunlocked.com/thyroidu...

It is a bit of a brain dump, and isn't well written, but hopefully it might have some useful info.

[Star13]

This article has a good explanation about the different types of “folate”. It explains why Folic Acid is not the best supplement to be taking. The one I suggested is a L- Methylfolate which I have found to work well plus’s the tablets are not huge!

seekinghealth.com/blogs/edu...