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Active B12 Protocol Basics

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Hi everyone ... I'm new here and have become very impressed with the level of medical/nutritional knowledge that I am seeing here. It's obvious that many of you have experienced baffling and debilitating health problems and have done extensive research in trying to achieve some healing. I would like to ask you to consider my own mysterious and baffling symptoms in the hopes that you may have some insight into my situation.

I have attributed many of my symptoms to Candida >> that is because I seem to have the most problems when I don't eat enough for a while (once or twice a day) and when I cheat and consume too much sugar. When I relapse these are my symptoms:

Feeling of extreme malaise
back and chest pain
premature ventricular contractions

These symptoms disappear within an hour after eating beef >> other meats like chicken or pork do not seem to be nearly as effective in easing the symptoms. If I eat the beef at the first pangs of hunger >> the symptoms do not occur.

Reading about the incidence of B12 deficiency has made wonder about this as a possible reason that beef seems to help me. I always simply assumed that for some reason the beef had something in it that helped my liver to remove the candida toxins.

The following is a recap of my struggles with candida and how this strange beef syndrome began:

My life experiences with Candida Albicans

I first became aware of Candida after reading some books about nutrition and one book in particular >>
"The Yeast Connection" by William G. Crook, M.D.

The information led me to understand that I had a small problem with Candida overgrowth ... in order to address the problem I began taking vitamins and a natural anti-fungal nutrient "Caprylic acid" which seemed to help with my mild symptoms, but I had no idea at the time just how serious my Candida problem would eventually become. I was therefore quite unconcerned and not especially serious about self-treatment or about any strict dietary regimen for controlling it. I was probably around 20 years old at the time.

The first time Candida tried to kill me ... I had no idea what was wrong with me. This was around 20 years ago when I was about 37 years old. It all started when I caught the Flu ... there were 2 different strains circulating that year > and I caught both of them within 3 weeks. In addition to this while trying to recover ... I also contracted a severe case of food poisoning. All this occurred within the period of about one month. After this I was very weak ... felt very ill and did not seem to be able to recover my full health.

One puzzling symptom was revealed ... If I ate lean hamburger I would feel much better for a while. But I had to do this every four hours or else I would feel very ill again, I even had to set the alarm and wake up after 4 hours and eat the beef or else I would wake up extremely ill.

I went to several doctors explaining my unusual symptoms with no successful diagnosis >> my blood tests were all normal. Eventually by taking mega doses of vitamins and eating two hamburger patties every four hours >> I regained my strength and health. I now realize that the Flu and food poisoning had destroyed the natural intestinal flora and resulted in a Candida overgrowth. It wasn't until much later that I would do the research that would finally explain all of this. For some reason no other protein sources seemed to be effective in relieving my symptoms.

The second time Candida tried to kill me ... I had regained my health and strength and abandoned my regimen of vitamins and beef that had restored me. I had also began eating too much sugar and nutritionally "empty" foods. I then began having serious symptoms that I did not relate to my previous episode of illness >> recurring sinus and respiratory infections, joint pains, skin eruptions, anxiety, headaches, mental confusion, chest and back pain, exhaustion and malaise. It even got to the point where I was experiencing heart symptoms like PVC's (premature ventricular contractions) and symptoms of toxic shock. Once again doctors could not provide an answer >> but by returning to my regimen of vitamins and beef I began to recover. This is when I began my research into what was causing my illness. I still had not associated these symptoms to Candida overgrowth.

I began my search by investing in medical books concerning diagnosis of diseases ... I was able to eliminate many causes of illnesses. However no 'one' disease seemed to explain all of my symptoms >> even the sections on Candidiasis did not seem to include all of my symptoms. I had also recently invested in a computer and learned to use it >> when I researched Candidiasis online >> a more complete description of the systemic candida syndrome was revealed to me.

I used that information to establish a more complete and comprehensive regimen of nutrition which included the following:

The elimination of sugar and replacement with Stevia

The addition of Whey protein to alkalize the intestine

The use of probiotics

The addition of certain vitamin, amino acids and mineral supplements

The use of herbal anti-fungals ("Fungal Defense" - consisting of Oregano and Olive leaf extracts)

In my research I found out that Candida causes a deficiency in aspartic acid ... I also learned that some individuals who have a genetically caused difficulty with the absorption of magnesium are also immuno-compromised in such a way that they are predisposed to candida and systemic overgrowth, prompting me to begin supplementing my diet with magnesium aspartate.

By doing these things and eating the beef >> I once again regained my health and became completely asymptomatic ... the recurring sinus and respiratory infections stopped .... the PVC's stopped .... no more joint pain ... I still have the skin eruptions but I have found that chlotrimizole heals them within 1 or 2 days.

It seems clear to me now that the beef has something in it that helps my liver to eliminate the candida toxins ... this is why it makes me feel better and helps me to recover.

Even knowing all this >> I still sometimes stray from my regimen ... partially because I become complacent and partly because I cannot always afford to follow it to the letter. This is the case now as I realize that some of my symptoms have returned and that I need to once again endeavor to eliminate sugar and return to a more healthy diet >> I am finding it neccesary to once again eat the beef regularly until I get my systemic candidiasis under control once more.

It seems now that some of the symptoms that I am experiencing now >> which I have been attributing to high blood pressure >> are actually due to a candida relapse.

Unfortunately, sometimes I have difficulty in remembering, recognizing and relating the symptoms as being caused by candida >> because of the anxiety and mental fog that accompanies the condition. This causes me additional stress and anxiety until I realize the problem and understand that I need to return to my nutritional regimen as I am trying to do now. Already today ... the symptoms of chest and back pain and malaise have been alleviated simply by eating some beef and taking some vitamins. I am going to once again eliminate sugar for a while and increase my dosage of "Fungal Defense".

Fungal Defense has herbal anti-fungals like Syrian Oregano and Olive leaf extract as well as protease and cellulase.

It seems to me that this is why sugar has been shown to be detrimental to the immune system ... because candida suppresses the immune system .... and sugar feeds candida. One good dose of sugar can effectively double the number of candida organisms in the system if the good flora are not intact to prevent this. I would not be suprised if this syndrome is directly involved in the proliferation of cancer and diabetes. The introdution of sugar and refined empty foods into the diet is very dangerous especially for those who are genetically predisposed to systemic candida overgrowth. Also the imbalance in the natural flora of the intestines caused by antibiotics and sugar as well as the imbalance that can be caused by flu virus and food poisoning are a serious concern and the symptoms of the resulting candida overgrowth are not always recognized in the medical community.
 
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I'm now of the opinion that this is a potassium problem because it took about three days for the diuretic (first time using) to bring me back into the "beef syndrome" with back pain and PVC's. An hour after a dose of beef the PVC's and back pain went away again >> plus getting better since I quit the diuretic (Hydroclorothiazide) I must not be able to hold on to potassium well .... or else I get really depleted when I do not eat enough "real" meals.
 
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SYMPTOMS, SIGNS, CHARACTERISTICS OF METHYB12, ADENOSYLB12, METHYLFOLATE and limited cofactors, CNS and body deficiencies
Version 2.0 01/21/2012

mouth sensitive to hot and cold
sore burning tongue
beef-red tongue, possibly smoother than normal
sore mouth, no infection or apparant reason
teeth sensitive to hot and cold
canker sores
dry mouth
excessive thirst
burning bladder (no UTI)
painful urgency (no UTI)
burning urethra (no UTI)

burning muscle pain
accumulating muscle pains following exertion
sore muscles throughout body
lack of muscle recovery after exercise
exercise does not build muscle
extremely sore neck muscles reversing normal curvature of neck
exercise deblitates for up to a week, making things much worse
painfully tight, stiff muscles, especially legs and arms
frequent muscle spasms anywhere in body
muscle pain especially around attachment points to bones
Eighteen severely tender muscle spots of FMS
Widespread muscle pain responding to NSAID
Bursitis
Joint pain
Pain in weight bearing joints
morning joint stiffness


sick stomach
nausea
stomach not emptying
bloating
frequent vomiting
acid regurgitation
dyspepsia
flatulence
altered bowel habits
abdominal pain
loss of appetite for meat, fish, eggs, dairy, the only b12 contining foods, nutrient specific anorexia
intermittent constipation
intermittant diarrhea
irritable bowel syndrome
Crohns disease (direction of causality if any not established)
Celiac disease (direction of causality if any not established) - gluten sensitivity
Dairy sensitivity - beyond lactose intolerance
sores, ulcers and lesions along entire GI tract or any part
anorexia
Bullimia
weight loss
weight gain

reduced libido - loss of sexual desire
loss of orgasmic intensity
unsatisfying orgasms
inability to orgasm
loss and/or change of genital sensations
burning genital skin sensation
unable to feel aroused
numb genital skin
low sex hormones

MEN
low testosterone
erectile disfunction
low sperm count
poor sperm motility
Poor sperm quality
no sperm


WOMEN
low testosterone
low estrogen
post partum depression
post partum psychosis
False positive pap smears
menstrual symptoms
Frequent miscarriage
PMS
Chronic yeast infections
onset of menopause - unexpected

paleness
rapid heart rate
heart arythymias
shortness of breath
heart palpitations
weak pulse
congestive heart failure
arteriosclerosis

Widespread pain throughout body
Hypothyroid (direction of causality if any not established)
Hasimoto's Thyroiditis, affected during active phase, appears to be deficiency result

High homocysteine
High urinary MMA

dizziness - even unable to walk
vertigo

Confusion
Disorientation
Difficulty in word finding
irritable
depression
SAD - Seasonal Affective Disorder
mental slowing
personality changes
chronic malaise
poor concentration
Difficulty assimilating new information
Reduced task completion
moodiness
tiredness
mood swings
memory loss
listlessness
impaired connection to others
mentally fuzzy, foggy, brainfog
inappropriate anger
rage
psychosis, including many of the most florid psychosis seen in literature, megoblastic madness
Alzheimer's
delirium
dementia
paranoia
delusions
hallucinations - multisensory
anxiety or tension
nervousness
mania
panic attacks
Hypersensitivity to touch
Hypersensitivity to odors
Hypersensitivity to tastes
Hypersensitivity to clothing texture
Hypersensitivity to chemicals
Hypersensitivity to body malfunctions, symtoms
Hypersensitivity to sounds and noises
Hypersensitivity to light and visual stimuli
Hypersensitivity to blood sugar changes
Hypersensitivity to internal metabolic changes
Hypersensitivity to temperature changes



mild to extremely severe fatigue
continuous extremely severe fatigue
easy fatiguability
severe abnormal muscle fatigue up to and including apparent paralysis leading to death
weakness


sleep disorders
non restorative sleep
lack of dreaming
Night terrors
Prolonged hypnogogic state transitioning to sleep
Sleep paralysis

alteration of touch all over body, normal touch can be unpleasant and painful
alterations and loss of taste
taste hallucinations
smell hallucinations
sound hallucinations
visual hallucinations
metallic taste
alterations and loss of smell
loss of smell and taste of strawberries specifically
loss or alteration of smell and taste of potato chips specifically
roughening and increased raspiness of voice, mb12 can smooth in mid word
blurring of vision - can be sudden onset and sudden return
dimmed vision - usually not noticed going into it because change can be very slow or present for life
Visual impairment can be seen; ophthalmological exam may show bilateral visual loss
optic atophy
centrocecal scotomata
hypersensitivity/intolerance to bright light
Slow to adapt to night vision
Night blindness
tearing
redness of eyes
Age Related Macular Degneration
Optic neuritis
diminished hearing - gradual onset or present for life, sudden return possible
tinnitus - ringing in ears
always feeling cold
low body temperature
intolerance to loud sounds
intolerance to multiple sounds

Brainstem or cerebellar signs or even reversible (with mb12) coma may occur
neural tube defect
mother of child with neural tube defect
demyelinated areas on nerves
subacute combined degeneration
axonial degeneration of spinal cord
unsteadiness of gait
ataxic gait, particularly in dark
positive Romberg
positive Lhermittes

neuropathies, many types
progressive bilateral neuropathies
demyelination of nerves - white spots on nerves on MRIs
loss of detail and sensual aspects of touch all over body
paresthesias anywhere in body - tingling, pins and needles, etc
paresthesias in one left foot only
paresthesias in one right foot only
paresthesias in one left leg only
paresthesias in one right leg only
paresthesias in one left hand only
paresthesias in one right hand only
paresthesias in one left arm only
paresthesias in one right arm only
paresthesias in both feet - cobwebs, hairs etc
paresthesias in both feet - burning, cold, wet, etc
paresthesias in both feet - tingling,painnful tingling, etc
paresthesias in both feet - pain - mild to seveere or acute, shallow to deep, etc
paresthesias in both feet - numbness in skin, etc
paresthesias in both feet - numbness in muscles, etc
paresthesias in both legs - cobwebs, hairs etc
paresthesias in both legs- burning, cold, wet, etc
paresthesias in both legs - tingling,painnful tingling, etc
paresthesias in both feet - pain - mild to seveere or acute, shallow to deep, etc
paresthesias in both legs- numbness in skin, etc
paresthesias in both legs - numbness in muscles, etc
paresthesias in both legs - burning, tingling, cobwebs, wet, hair, pain, numbness, etc
paresthesias in both hands - burning, tingling, cobwebs, wet, hairs, pain, numbness, etc
paresthesias in both arms - burning, tingling, cobwebs, wet, hairs, pain, numbness, etc
Loss of position sense is 1 of 2 most common abnormality (or vibration sense)
Loss of vibration sense is 1 of 2 most common abnormality (or position sense)
Loss of motor control over some or all of toes
Loss of motor control over part or all of feet
Loss of sense of joint position
hands feel gloved with loss of sensitivity - glove anesthesia
feet feel socked by loss of sensitivity - stocking anesthesia
glove and stocking anesthesia
trembling
neuropathic bladder
unable to release bladder, mild to severe
unable to fully empty the bladder
urinary incontenance - occasionally to frequently
fecal incontinance - occasionally to frequently
sudden electric like shocks/pains shooting down arms, body, legs shooting down from neck movement
sudden "ice pick" pain
standing with eyes closed, a slight nudge or bump causes loss of balance
most patients have signs of both spinal cord and peripheral nerve involvement

The effect on reflexes is quite variable
Motor impairment may range from only mild clumsiness to a spastic paraplegia
clumsiness
slowed nerve impulses
decreased reflexes
difficulty swallowing
brisk reflexes
decreased deep tendon reflex
toes turn up instead of down in reflex to sole stimulation
Positive bilateral Babinski reflex
Foot Drop
tripping over toes
injuring toes catching top of toes on floor
general feeling of weakness
drowsy

suspicious
apathetic
rapid and unpredictable emotional changes
limbs feel stiff


impaired white blood cell response
poor resistance to infections
easy bruising
pronounced anemia
macrocytic anemia
megablastic anemia
pernicious anemia
decreased blood clotting
low hematocrit
MCV > 93 first warning,
MCV > 97 alert
MCV > 100 outright macrocytosis
MCV > 105 urgently needs treatment, severe problem






elevated MCH (Mean Corpuscular Hemoglobin)
elevated LDH
big fat red cells (when said this way usually with happy or healthy modifying it completely misinterpreting results of MCV
platelet disfunction, low count
white cell changes, low count
hypersegmented neutrophils

headaches
inflamed epithelial tissues - mucous membranes, skin, GI, vaginal, lungs
inflamed endothelial tissues - lining of veins and arteries
mucous becomes thick, jellied and sticky
asthma
chronic cough that mimics asthma but isn't
chronic sinus congestion
dermatitis herpetiformis, chronic intensely burning itching rash
frequent infected follicles or acne type lesions all over body
chronic infections, many varieties possible
Seborrheic dermatitis
dandruff
eczema
dermatitis
skin on face, hands, feet, turns brown or yellow if anemia occurs
poor hair condition
thin nails
transverse ridges on nails, can happen as healing starts
splits/sores at corners of mouth -angular cheilitis
Hyperhidrosis - excessive sweating

Bariatric surgery
Dilantin and some other medications
Relatives, grandparant, parent, sibling, child, grandchild ever needing b12 shots or supplement
coma
seizures
brain atrophy with ileal tuberculosis preventing b12 absorbtion
Intestinal parasites
Intestinal bacterial overgrowrth
Low CSF cobalamin
Elevated CSF MMA
Elevated CSF Hcy
Low blood serum level
Elevated uMMA
Elevated blood serum Hcy


Starting AS INFANT OR CHILD

delayed myelination
failure to thrive
autism
delayed speech
depression
frequent or continuous toncilitis
frequent strep
frequent pneumonia
frequent longlasting supposed viral illnesses that linger and linger and linger
everything goes to the lungs for extended periods
headaches
growing pains
skin problems
dandruff
allergies
asthma
continuous swolen glands in neck
low grade fever for years
Night terrors
Prolonged hypnopompic state transitioning from sleep
Prolonged hypnagogic state transitioning to sleep
Sleep paralysis
seizures
coma
nosebleeds
FREQUENT DIAGNOSES OR OTHER PROVIDER BEHAVIOR

FMS
CFS
ME
ED
IBS
Sub-acute combined degeneration
Low Testosterone
Fertility Problems, male and female
Sleep Disorders
Neural Tube Defects
Peripheral Neuropathy
Polyneuropathy
Autonomic neuropathy
Conversion Disorder
Hypochondria
"TOO many symptoms to be believable"
Liar
Alcoholic - non-drinker or genuine light drinker
Removed from Practice for knowing to much
Its All In Your Head - IAIYH
Removed from practice for insisting that there is REALLY something wrong instead of IAIYH
Alzheimer's
Hello,
I am relatively new to this forum. I have spent MANY hours studying posts. I finally started up on Fred's recommended protocol. I'd like to know which form of active B12 assists most in the lowering of homocysteine?? My level is now 11.2. I am diagnosed w FMS and also have much fatigue-- for many years. I have NON-stop tinnitus. I am now taking, and allowing to dissolve slowly in my mouth, folate and mb12, and adb12. I also discussed w a friend this forum(she also has FMS) and she wonders if Fred's /Freddd's recommendation to NOT take whey also applies to raw, unpasteurized whey? thanks, Michael
 

Lotus97

Senior Member
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I agree with some his points. Namely that taking glutathione exogenously is a fad and a waste of money.
By exogenously you mean taking something like reduced Glutathione or Acetyl Glutathione? I noticed that Rich doesn't have Glutathione supplementation in his most recent methylation protocol and Fredd seems to have an even stronger opinion about it.
 
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Hello


I would like to join this conversation about B12. I have been dealing with so many symptoms over years, including fatigue, insomnia, memory loss, difficulty concentrating etc that I have not paid a lot of attention to this gradually growing and spreading pain that sounds like a B12 deficiency neuropathy. It started with burning in the bottoms of my feet at night, now it is feet, hands, calves and other parts of my body, migrating around my body. As someone who once practiced yoga diligently and who loves to dance and move, this is devastating. If I try to stretch it gets worse. I am glad I am getting closer to understanding it, but this is my dilemma.:
I tested homozygous for 677t. That is the only SNP I have tested for and frankly, it just gets too overwhelming to get more information. I did Rich's modified protocol for a year and my levels of b vitamins did not go up. I got my test results back two weeks before Rich died last fall so I never got to ask him about them. I was so discouraged about the test results and deeply saddened by his unexpectied loss that I quit the protocol and left the forum. I am just coming back now to restart.
I tested my levels w Geneva's Metabolic Analysis before starting the protocol to get a baseline. They actually all went DOWN slightly afterwards. I used the sublingual B12 drops from Lasko. The Enzymatic Therapy ones make me feel weird and a little anxious. Does that mean they are working, or might I be sensitive to some of the fillers? What does that indicate? Methyl B12 shots don't seem to do much for me. Maybe I should try them again. I am trying to tease it all apart and figure out why my levels of B12 would not increase w sublingual. I know I need some gut healing so that explains why the other B's including methylfolate did not go up. RIght now I am on a low dose SSRI that seems to reduce the pain about 80% so I hope I will notice when the methyl B's start working.
I want to address this B12/methylfolate thing because I believe it will make a difference. How to start absorbing B12 and how will i know? Where to start given my seeming sensitivity to it in some sublingual forms. The Lasko drops did not bother me but they did not seem to do much either.


thank you,
Lucy
 
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Location
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I think I would take breaks, then try it again. The effect was almost instantaneous, like w my food sensitivities so Iwonder if that would be methylation happening so quickly. I just tried it again today after a long break and had a similar response.
BTW I love your quote. It is so necessary to keep all of this in perspective and I appreciate that thought.
 

Lotus97

Senior Member
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I think I would take breaks, then try it again. The effect was almost instantaneous, like w my food sensitivities so Iwonder if that would be methylation happening so quickly. I just tried it again today after a long break and had a similar response.
BTW I love your quote. It is so necessary to keep all of this in perspective and I appreciate that thought.
Thanks :) Are you taking methylfolate with the B12? If so you might want try lowering the dose of methylfolate and/or lowering the dose of methyl B12. Some people need to start at a lower dose than others.
 

Xara

Senior Member
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I have read somewhere over here (I believe it was Freddd himself) that it is important not to take methylfolate with vitamin C or iron supplements, they make each other inactive (they bond together, or what's it called in English).
I reckoned that if iron supplements are no good, iron in food would be no different.
So I take methylfolate on an empty stomach. Or if that's not possible I let it melt beneath my tongue. (or crush it and massage it in under my tongue).
 
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Hi Topaz,


Q1: Why do you not include Metagenics Folapro as a source of methylfolate? This question is a bit academic as I have ordered Solgar Metafolin but wonder why that brand is not suggested despite that it contains only Metafolin?

I was not aware of it at the time of the original post which I copied and missed bringing it up to date. Also Solgar Metafolin is literally half the price.

Q2: How long should one be on the basic protocol (methyl B12 and Metafolin) before introducing adenosylb12? Straight away or after a suggested period?

I don't have a "should" on this. I waited 9 months out of ignorance and maybe missed my chance to correct certain neurological problems while they might have been still correctable. The clock is ticking on correction of nervous system problems.

Q3: Eliminating folate/folic acid makes sense based on what I have read elsewhere also. Do you think that one should try to avoid foods high in folate? I suspect that I am thinking about this too much!

I have the same problem with vegetable source folate as I do with folinic/folic acids. Meat source folate appears to not be a problem. I am going to start a new thread on this in the next couple of days.

Q4: What dose of potassium do you recommend, as a starting point? Also what form of potassium?

I started at 198mg/day and titrated up each time it wasn't enough to prevent low potassium symptoms. I take potassium gluconate. Some prefer the potassium chloride power that is dissolved in liquid. It is faster absorbtion. Iherb as a bunch of types and brands.

Q5: What is your suggested ratio of calcium/magnesium?

I don't have one. Various people have suggested various ratios, including for gender reasons.

Q6: What is your suggested dosage of Gamma E?

There is no evidence to support any specific amount. However, I would bet that some will be better in the long run than none.

Do you have a preferred brand of fish oil for vit A&D?

In the days of old (back when I started taking vitamins 41 years ago), only D2 was available and the only way to get active A was to take A&D derived from shark or cod liver oil. That is no longer the problem. I do believe that a person should take the active natural forms.


Hi, I eat a lot of vegetables, I follow a paleo based diet and I'm concerned about the response for q3. is your recommendation to not eat many vegetables? I eat around a pound a day (spring mix, broccoli, celery whatevers organic and fresh). I've had unexplained periods of low b12 under 200 on the blood test over the last several years and tried injections which made me ill with flu like symptoms, I'm currently taking jarrow b12 and just preparing to start jarrow methyl folate (quatrefolic) 5-mthfr 400mcg. I also take omega 3 and d3( costco brand) and jarrow mk-7. It is really strange how I found this page for years I always had different symptoms that I thought to be related to CFS but brushed them off... about 8 years ago I had a AI issue that resolved after a yr on predisone ( if I knew then what I know know I would have tried changing my diet / vitamins first) and then started seeing low blood counts. The doctors are puzzled over the cause after 5 year of tests. In November I started a Paleo diet and introduced D3 and K2 and felt a nice change overall and modest improvements in my blood counts but started to become moody and anxious. My doctors pretty much are useless on this alternative stuff but I do check before I start anything for an opinion and nod that it's ok. I have not been tested for MTHFR after reviewing my tests but after reading about it for the last 2 weeks I will be getting that done. So what I'm asking could vegetables be causing an issue with my methylation cycle. thank you
 

jeffrez

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I have read somewhere over here (I believe it was Freddd himself) that it is important not to take methylfolate with vitamin C or iron supplements, they make each other inactive (they bond together, or what's it called in English).
I came across this reference recently, not sure if it's been posted before. It might be a good idea for people to check to make sure they're not taking anything else that can compete with folate or b12, either.

Drugs which may interact with folate2 include:
  • Antiepileptic drugs (AED): The AED class including, but not limited to, phenytoin, carbamazepine, primidone, valproic acid, fosphenytoin, valproate, phenobarbital and lamotrigine have been shown to impair folate absorption and increase the metabolism of circulating folate.
  • Additionally, concurrent use of folic acid has been associated with enhanced phenytoin metabolism, lowering the level of the AED in the blood and allowing breakthrough seizures to occur. Caution should be used when prescribing this product among patients who are receiving treatment with phenytoin and other anticonvulsants.
  • Capecitabine: Folinic acid (5-formyltetrahydrofolate) may increase the toxicity of capecitabine.
  • Cholestyramine: Reduces folic acid absorption and reduces serum folate levels.
  • Colestipol: Reduces folic acid absorption and reduces serum folate levels.
  • Cycloserine: Reduces folic acid absorption and reduces serum folate levels.
  • Dihydrofolate Reductase Inhibitors (DHFRI): DHFRIs block the conversion of folic acid to its active forms, and lower plasma and red blood cell folate levels. DHFRIs include aminopterin, methotrexate, pyrimethamine, triamterene, and trimethoprim.
  • Fluoxetine: Fluoxetine exerts a noncompetitive inhibition of the 5-methyltetrahydrofolate active transport in the intestine.
  • Isotretinoin: Reduced folate levels have occurred in some patients taking isotretinoin.
  • L-dopa, triamterene, colchicine, and trimethoprim may decrease plasma folate levels.
  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs have been shown to inhibit some folate dependent enzymes in laboratory experiments.
  • NSAIDs include ibuprofen, naproxen, indomethacin and sulindac.
  • Oral Contraceptives: Serum folate levels may be depressed by oral contraceptive therapy.
  • Methylprednisolone: Reduced serum folate levels have been noted after treatment with methylprednisolone.
  • Pancreatic Enzymes: Reduced folate levels have occurred in some patients taking pancreatic extracts, such as pancreatin and pancrelipase.
  • Pentamidine: Reduced folate levels have been seen with prolonged intravenous pentamidine.
  • Pyrimethamine: High levels of folic acid may result in decreased serum levels of pyrimethamine.
  • Smoking and Alcohol: Reduced serum folate levels have been noted.
  • Sulfasalazine: Inhibits the absorption and metabolism of folic acid.
  • Metformin treatment in patients with type 2 diabetes decreases serum folate.
  • Warfarin can produce significant impairment in folate status after a 6-month therapy.
  • Heme-iron: Can compete for transport and reduce folate absorption. Ensure adequate medical supervision to ensure proper iron levels.
  • Folinic acid may enhance the toxicity of fluorouracil.
  • Concurrent administration of chloramphenicol and folinic acid in folate-deficient patients may result in antagonism of the haematopoietic response to folate.
  • Caution should be exercised with the concomitant use of folinic acid and trimethoprimsulfamethoxazole for the acute treatment of Pneumocystis carinii pneumonia in patients with HIV infection as it is associated with increased rates of treatment failure and mortality in a placebo controlled study.
2
Folate is a broad term that includes folic acid and all reduced forms including l-methylfolate and folinic acid. V-Natal Tabs does not contain l-methylfolate or folinic acid but these warnings are included as general folate information.

Drugs which interact with vitamin B12:
  • Antibiotics, cholestyramine, colchicines, colestipol, metformin, para-aminosalicylic acid, and potassium chloride may decrease the absorption of vitamin B12.
  • Nitrous oxide can produce a functional vitamin B12 deficiency.
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=74275
 

Lotus97

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I came across this reference recently, not sure if it's been posted before. It might be a good idea for people to check to make sure they're not taking anything else that can compete with folate or b12, either.

Fluoxetine: Fluoxetine exerts a noncompetitive inhibition of the 5-methyltetrahydrofolate active transport in the intestine.
I was taking Fluoxetine (and 1500 mcg of folic acid) and I still felt the effects of 100 mcg Quatrefolic methylfolate. I'm not saying the info is wrong, just saying...
 

Freddd

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Hi, I eat a lot of vegetables, I follow a paleo based diet and I'm concerned about the response for q3. is your recommendation to not eat many vegetables? I eat around a pound a day (spring mix, broccoli, celery whatevers organic and fresh). I've had unexplained periods of low b12 under 200 on the blood test over the last several years and tried injections which made me ill with flu like symptoms, I'm currently taking jarrow b12 and just preparing to start jarrow methyl folate (quatrefolic) 5-mthfr 400mcg. I also take omega 3 and d3( costco brand) and jarrow mk-7. It is really strange how I found this page for years I always had different symptoms that I thought to be related to CFS but brushed them off... about 8 years ago I had a AI issue that resolved after a yr on predisone ( if I knew then what I know know I would have tried changing my diet / vitamins first) and then started seeing low blood counts. The doctors are puzzled over the cause after 5 year of tests. In November I started a Paleo diet and introduced D3 and K2 and felt a nice change overall and modest improvements in my blood counts but started to become moody and anxious. My doctors pretty much are useless on this alternative stuff but I do check before I start anything for an opinion and nod that it's ok. I have not been tested for MTHFR after reviewing my tests but after reading about it for the last 2 weeks I will be getting that done. So what I'm asking could vegetables be causing an issue with my methylation cycle. thank you
Hi Tom,

I eat probably more than average veggies. Sometimes If I ham having trouble getting the insufficiency symptoms to go away I decrease veggies for a few days. It's certainly worth trying. I also find that taking a sizable dose 30 minutes before eating to be partially effective. Further not taking the mfolate with potassium or Vit C increases absorption and frequent dosing, 4-5x per day to be more effective than fewer doses. So veggies could be interfering. They did for me all my life.
 

jeffrez

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I was taking Fluoxetine (and 1500 mcg of folic acid) and I still felt the effects of 100 mcg Quatrefolic methylfolate. I'm not saying the info is wrong, just saying...
Haha, yeah, I take 10mg fluoxetine and I still get 5-MTHF effects, too. Might be related to the dosage and the fact that it's only a noncompetitive inhibition.
 

dbkita

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Odd that it is a non-competitive inhibitor. That makes the kinetics complicated. If the reference is true I wouldn't just toss it under the rug and forget about it. Noncompetitive inhibition is very different than standard competitive inhibition, especially as relates to transport. Competitive is standard blocking type interaction, non-competitive can result in inhibition but may be allosteric in nature with a very different chemical equilibrium.

On a separate note, I take medrol every morning and my serum folate is through the rough above the limit and that is taking no folic or folinic acid. Only 5mthf supplements and diet.
 

adreno

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Odd that it is a non-competitive inhibitor. That makes the kinetics complicated. If the reference is true I wouldn't just toss it under the rug and forget about it.
Well, I suppose if we take the mfolate before or after fluoxetine, rather than at the same time, we should be fine? The inhibition takes place in the intestine, according to that source (haven't looked it up, though).
 

dbkita

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Sounds like take the methyfolate 20-30 minutes before to let the bulk of it get absorbed. Couldn't hurt to try and see if there is any difference. If after a few day you no difference then don't worry about it. But again non competitive inhibition of an enzyme is a very different beast than simple competitve.