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Are Folate supplements necessary to take with B12 if Red Cell Folate levels are high?

Discussion in 'Detox: Methylation; B12; Glutathione; Chelation' started by axx, Apr 24, 2012.

  1. axx

    axx

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    My recent blood test results showed:
    B12 = 370 pg/mL (273 pmol/L, normal > 180 pmol/L).
    Folate (red cell) 806 ng/ml (1826 nmol/L , normal > 450).

    I am planning to start taking B12 supplements, but am concerned about my high folate levels and am considering stopping my current folate supplementation (i currently take 800 mcg per day in a whole food formula).

    I have read on other threads that folate/metafolin supplements are necessary to be taken with B12, but how about if folate blood levels are high?

    I am also wondering whether my high folate result may be due to lack of absorption. Should I get tested for the MTHFR gene? Could I have a folate deficiency with the following results:
    mcv = 92 fL (80-99)
    rdw = 13.3 (11.0 - 15.0)%

    Thank you.
     
  2. hixxy

    hixxy Woof woof

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    The high folate levels can be indicative of folate trap mechanism and functional b12 deficiency. Rich would probably recommend you get the HDRI Methylation Panel done to confirm this.

    It would be likely you would need to supplement methylfolate and hydroxob12 or methylb12 depending on the results. Likewise, supplementing folic acid will block the absorption of the methylfolate.

    Hopefully Rich will be around to confirm this for you!!

    If you're feeling brave, there's plenty of other reading about this in the stickies at the top of this forum.

    hixxy
     
  3. axx

    axx

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    Thank you Hixxy.

    Yes, I think I will probably stop taking my current whole-food multivitamin that contains folate and start taking methylfolate instead. I saw a comment from Fredd that the whole-food vitamin folate was not able to be absorbed by him and it makes me wonder about what form it really is - I think they may feed folic acid to yeast so maybe the output is not truly food based folate, but is more folic acid like (i hope that makes sense).

    I have seen a type called "quatrefolic" that contains MTHF 400 mcg (as 800 mcg S-MTHF acid, glucosamine salt (vegetarian source)). Is this type of folate advisable?

    Regarding B12 supplementation, from what i have read I think I should take 1000 mcg methyl b12 per day. I am wondering whether I should take adeno B12 as well or if this is only for people with particular symptoms?

    Before I take B12 supplements, I was considering the following tests - are these necessary?:
    serum methylmalonic acid (MMA),
    homocysteine test,
    active B12,
    Intrinsic Factor Abs,
    Parietal Cell Abs

    I really want to understand the underlying cause before I start treatment because otherwise I might just be masking the problem.

    Regarding the methylation panel test, I have read the various stickies and am a bit confused about it. Because I am in Australia, I would need to send my samples overseas and so I am wondering whether this test is necessary or whether I should just start supplementing anyway. If I start supplementing now and take this test later on, would the supplements impact the results?

    One other question, I have done alot of research but can't find an answer on whether red blood folate shows how much folate is absorbed by the body (vs serum folate which just shows how much folic acid is in the blood stream). If my red blood cell folate is high, does this mean that I don't have absorption issues?

    In case it is of interest to others with the same problem, I wanted to share an article I found explaining some concerning risks associated with high red blood folate levels:
    http://www.sciencedaily.com/releases/2010/12/101222173103.htm
     
  4. axx

    axx

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    I think I understand the concept of folate trap now.

    If this is what I have, then does it make sense to start taking B12 for a while before taking metafolin so that my existing stores of MTHF that are currently trapped can be released before I start adding more to the storage?
     
  5. hixxy

    hixxy Woof woof

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    The tests you have listed aren't really going to be very helpful. As you're in Australia and the Methylation Panel is hard to get, you could just give the protocol a go.

    There are B Complexes out there that contain methylfolate such as:

    Thorne Research, Basic B Complex, 60 Veggie Caps

    If all goes well with that, then you can go an add additional separate methylfolate and hydroxob12 and methylb12 on top.

    Startup on methylation sups has been known to exacerbate magnesium and potassium deficiencies, so watch out for these. There's is plenty of threads on this in the forum.

    For MethylB12 the following is good:

    Jarrow Formulas, Methyl B-12, 1000 mcg, 100 Lozenges

    For HydroxoB12 the following is good:

    Perque Activated B-12 Guard 100 Lozenges

    You can get HydroxoB12 injections from the pharmacy without prescrption in Australia.

    For methylfolate the following are good:

    Solgar, Folate Metafolin Folic Acid, 800 mcg, 100 Tablets

    Thorne Research, 5-MTHF, 1 mg, 60 Veggie Caps

    hixxy
     
  6. axx

    axx

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    Thanks for your advice. To give you an idea of my thinking process, I was considering taking those tests as they may be helpful to a) confirm if I have a b12 deficiency b) give me a baseline to measure progress other than B12 serum, which can be unreliable and c) determine whether there is an underlying cause of my low B12. If I am indeed experiencing a folate trap due to insufficient B12, then I would like to understand why my B12 is low (when my diet should provide more than adequate supply of this). Depending on the underlying cause, I may or may not need to take B12 supplements forever so I would like to ascertain this upfront.

    Thanks for recommending those supplements. I think the thorne b complex you suggested looks good but my key concerns are that it contains Calcium Folinate as well as methylfolate (whereas I prefer just methylfolate), the b6 is lower than I would like it to be and the b3 is higher than I want. Pure Encapsulations b complex plus also looks quite good too.

    The best b complex formula I have found is by Swanson's activated b complex http://www.swansonvitamins.com/SWU533/ItemDetail but unfortunately this costs about $45 to get sent to Australia so I need to look elsewhere.

    Thank you for the other recommendations, I will probably go with the Jarrow methyl b12 1000 mcg and either the solgar metafolin or the quatrefolic i mentioned earlier.
     
  7. hixxy

    hixxy Woof woof

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    Thorne has a bunch of other B Complexes with different balances. I was actually trying to find the ?Douglas Labs B Complex on iherb, but it doesn't appear to be there. It contains methylfolate only.

    http://www.douglaslabs.com/pdf/pds/200765.pdf

    I'm sure there are some other quality B Complexes with just methylfolate that others can bring to your attention.

    Methylmalonate is so unreliable for diagnosing b12 deficiency because other deficiencies can cause false negatives. Have a look at the discussion here:

    http://forums.phoenixrising.me/showthread.php?188-B-12-The-Hidden-Story&p=242568&viewfull=1#post242568

    Homocysteine may or may not be useful either. It's hard to say.

    hixxy
     
  8. axx

    axx

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    Thanks. You have been really helpful.

    My outstanding questions at this stage are:
    1) I have seen a type called "quatrefolic" that contains MTHF 400 mcg (as 800 mcg S-MTHF acid, glucosamine salt (vegetarian source)). How does this type of folate compare with metafolin branded folate?
    2) Should a combination of methyl b12 and adeno B12 be taken by everyone with B12 deficiencies or just people with particular symptoms or genes? Can other people take just methyl b12 successfully?
    3) If my red blood cell folate is high, does this mean that I don't have folate tissue absorption issues?
    4) If I am in a folate cycle block, then does it make sense to start taking B12 for a while before taking metafolin so that my existing stores of MTHF that are currently trapped can be released before I start adding more to the storage?

    Is anyone able to assist with these queries? I have tried searching for this information but can't find any answers.
     
  9. hixxy

    hixxy Woof woof

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    1. I asked this very same question on another thread today already. As far as I'm aware at the moment you can treat Metafolin and Quatrefolic as being equally effective.

    2. That depends on which "take" on treating methylation you are following. Fredds or Rich's. To start with, adenosylb12 is probably not that necessary even on Fredd's protocol. Rich's procotol doesn't use it at all. As for genes. MethylB12 can be intolerable for some people with COMT gene mutations. This is where hydroxob12 is necessary. This has nothing to do with adenosylb12.

    3. Functional B12 deficiency / folate trape mechanism that causes this is much better explained by Rich here: http://forums.phoenixrising.me/showthread.php?17466-Revised-Glutathione-Depletion-Methylation-Cycle-Block-Hypothesis-for-ME-CFS

    4. This doesn't seem to be necessary.

    I just tried to find a clear and concise description of both Fredds and Rich's protocols, but I agree with you. It can be really difficult to find what you're looking for on here at times.

    hixxy
     
  10. axx

    axx

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    I am so grateful for your help!!

    1. great minds!
    2. this is the answer I was looking for (and what I suspected)
    3. thanks for the link.
    4. that's good to know, i won't take a break from folate when I start b12.
     
  11. adreno

    adreno 3% neanderthal

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    Douglas Labs products have been discontinued on iHerb. I only managed to get one bottle of their B complex, before they discontinued it.

    I've found this product, which contain methylfolate exclusively:

    http://www.iherb.com/Metabolic-Maintenance-B-Complex-100-Capsules/37558

    Another option I have been considering lately, is simply to take all the Bs separately, in active forms. So I would take:

    Benfotiamine
    FMN
    NAD
    P5P
    Pantethine
    Biotin
    Methylfolate
    Methylcobalamin/hydroxocobalamin

    Then I wouldn't have to worry about conversion, and also wouldn't have to pay the ATP "fee". I'm starting to think that it would be an advantage to avoid inactive forms completely, and those are always found in B complexes.
     
  12. hixxy

    hixxy Woof woof

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    What about the active/coenzyme forms that you miss? A lot of B vitamins have multiple coenzyme forms and some of these coenzymes can't exactly be converted over to another coenzyme on need basis

    I'm fairly sure this is why you will often see multiple forms of the same b vitamin in some of the activated b complexes.

    I could be wrong tho, maybe I'll do some research. :D

    hixxy
     
  13. adreno

    adreno 3% neanderthal

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    Good question. I know methylcobalamin can be converted to adenosylcobalamin. Methylfolate is an end product, but seem to be all that is needed. I am not sure about the others.

    Since they are dephosphorylated before entering cells, and rephosphorylated inside the cells, I tend to believe that they can convert to any form they need, intracellularly.
     
  14. hixxy

    hixxy Woof woof

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    R5P will be able to convert to FAD and FNM, I doubt the other 2 can convert between themselves?
     
  15. adreno

    adreno 3% neanderthal

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    R5P and FMN are the same.
     
  16. hixxy

    hixxy Woof woof

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    Some NAD+ is also converted into nicotinamide adenine dinucleotide phosphate (NADP+); the chemistry of this related coenzyme is similar to that of NAD+, but it has different roles in metabolism.
     
  17. hixxy

    hixxy Woof woof

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    Not sure about Benfotiamine!
     
  18. axx

    axx

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    Adreno, that b complex product looks really good! I haven't seen that one before. The main thing stands out for me though is that the b3 is quite high. Also, I wonder what percentage of the b6 is actually Pyridoxal 5' Phosphate because it doesn't state that (and it is the more expensive of the 2 b6 ingredients listed so I expect it is a small percentage). Otherwise, I think it is a really good candidate!

    I have been thinking about whether b complex supplements that are so much higher than the RDIs are really needed, espcially when most of it get excreted anyway (with some exceptions).

    At the moment, I am considering taking a basic whole food b complex like this one: http://www.iherb.com/MegaFood-DailyFoods-Balanced-B-Complex-90-Tablets/3992, which only has much smaller quantities of each b vitamin and then on top of that taking extra folate (either metafolin or quatrefolic). The megafood product contains food based folate (from brocolli) so won't be suitable for people who have the folate paradox. Is this going to be sufficient or should I be taking a more potent b complex like the metabolic maintenance one that you suggested above?

    Ideally, I would like to not take a b complex at all and rely on my diet for b vitamins, however I have read that it is important to take b complex together with B12. In addition, I have recently eliminated gluten to see whether that helps with my absorption of b12 and ferritin and grains are supposedly a big source of b vitamins so I want to make sure I don't miss out on anything.

    I am also wondering whether inositol is needed together with the b complex (in order to maintain balance).
     
  19. axx

    axx

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    Adreno, have you considered the Swanson product http://www.swansonvitamins.com/SWU533/ItemDetail ? This contains bioactive forms of all the b vitamins it contains. If you live in Europe, I think you can have it shipped from the UK (but I'm not 100% certain).
     
  20. hixxy

    hixxy Woof woof

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    That Metabolic Maintenance B Complex is a winner!

    Swanson one looks better again. Hate buying direct from manufacturer though.
     

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