low folic acid

[Blackberrymoo]

Hi all, I’ve been prescribed 5mg of folic acid for 3 months, i have Graves disease and am on Carb 20mg a day. My b12 was 536 pg/mL on last test but doctor didn’t say how low folic acid was! She also said my cortisol level was above range but only slightly but couldn’t advise as was down to the Endo doc to discuss.( not sure if cushings related or not)I’m not seeing her till end of December though. I’ve read a lot about not taking folic acid without checking b12 but mine were showing as fine! What should I do next? Should I get some b12 vitamins as well? Xx

[HealthStarDust]

Simple answer. Do not start folic acid until at least B12 is tested. With that said, you have to appreciate there limitations to B12 testing. For example, someone can have a B12 deficiency even with excellent levels on multiple types of tests. So, in this way, it’s a risk either way.

To get around the risk, I would probably start B12 supplements first followed by folic acid once B12 is tested.

I can share that I was practiced Folic Acid for 6 months (possible due to GP error) and B13 was tested in the same sample. It was within range but a bit on the low side. My health did deteriorate but it’s not possible for me to know if this was related to the folic acid or underlying thyroid issue, or both.

[bookish]

A good answer from HealthStarDust and I would agree - even though your serum B12 was ok, you can have a deficiency at any serum level, so it is not enough to rule one out. Some will be fine at that level, but not all, and as your folic is low and you are going to be taking a large dose (which may be too large and may also be the wrong type of folate for you, as some of us do better with the alternatives) I think taking at least a basic B12 supplement, starting a couple of weeks before beginning the folic, a good idea. The two work so closely together that you are usually going to be having a metabolism issue with both.Try to find out the level of your serum folate as otherwise you won't know how it improves - and you do not want to stay on a high dose for any longer than necessary. Ideally you would have homocysteine tested and methylmalonic acid but little chance of getting them done. If you have any neurological symptoms or any family history of B12 deficiency or pernicious anaemia then you need better testing before starting any B vits. Best wishes

[samaja]

First of all find out what the level was. They have to give you all your results as they are legally yours. You cannot overdose on folic acid so you are ok to take it for the three months and if your doctor actuallly prescibed it to you at 5 mcg at all I guess you were deficient. It's best to take it with food and see how you are doing on it.

With very low folic acid your B12 is higher in the blood possibly masking a B12 deficiency because they need each other to work correctly but taking any B12 in this situation will only make it more difficult for you to be diagnosed with a possible B12 deficiency because supplementing will raise your blood levels without neccessarily having any effect on the celluar level but pushing the numbers within the range. You could take the folic acid for a month and test privately both folate and active B12 to see where you are and how B12 is being used, or start taking B12 with folic acid but being aware that any B12 supplements, B12 fortified foods or drinks within 4 months before testing will also elevate B12 in the blood.

With folic acid rising your B12 will be dropping and the question is how much it will drop and whether the cause of malabsorption of both/either should be investigated first.

High cortisol might be a sign of stress in the body (like being deficient in vitamins for example) but doing a 4 point saliva cortisol might give you a better picture than just blood. They don't always match.