Doubts about B12/b9

[yellowspain]

Best idea to base it on a variety of blood tests. As you may know, serum B9 and B12 do show deficiency, but too high level could just mean the body can't properly metabolize and still be deficient despite high levels. Beside homocysteine also low RBC and high MCV could point to low B9 or B12 too. However, even it those markers would also show sufficiency, it is still not sure sufficient for other metabolic process requiring B9 too.

Therefore, always best to proceed cautiously, increase doses gradually over weeks, months and years. While monitoring as many lab markers possible and symptoms changes, to adjust accordingly, and as early as possible.

If homocysteine really dropped much further, which I doubt if you get enough protein in your diet, then it would be easiest to correct by decreasing B9 and B12 slightly. Along with methionine rich foods. It definitely wouldn't be serious, extremely rare, and completely reversible.



Personally, had peripheral neuropathy due to P-5-P becoming disallowed above 25 mg/d in the EU. But need above 100 mg/d for B6 sufficiency. So I used instead Pyridoxine I still had at much higher dose, and that causes neuropathy above 100 mg/d for me. It took me about 1 year to reverse the Pyridoxine induced neuropathy by reducing the dose. But beside still not sufficient in B9.

The rest of my blood values have not yet normalized. All my doubts focus on the methylation cycle and how to start it.

I had small fiber neuropathy due to the consumption of vitamin B6, I managed to improve by taking sam-e, but later it caused me new problems. If your folate levels do not increase, it may be due to the absence of cofactors or some absorption problem. I have low folate, despite consuming many foods that contain it.

 

[pamojja]

If your folate levels do not increase,

In my case, repeated RBC and serum folate is above normal for many years. Only whole blood folate is still slight below max range. However, my RBCs, MCVs and homocysteines show consistently otherwise.

 

[yellowspain]

In my case, repeated RBC and serum folate is above normal for many years. Only whole blood folate is still slight below max range. However, my RBCs, MCVs and homocysteines show consistently otherwise.

Are your vitamin B12 and iron okay?

 

[pamojja]

Serum B12, Holo-TC and MMA tests show B12 sufficiency. There were some erratic Transferrin, TSAT and TBIC results in the past, but normalized meanwhile. Ferritin is optimal, and Iron in serum and whole blood always normal.

 

[yellowspain]

I've been testing these days and I can't find the balance between b9/b12. If I take more B9 than B12, I run out of energy. If I increase the dose of b12, I get symptoms of B9 deficiency, if I take an equivalent dose, I get symptoms of folate deficiency.

 

[Mary]

@yellowspain - what are your symptoms of B9 deficiency?

Also, running out of energy when taking more B9 than B12 might be due to potassium deficiency. A major symptom of potassium deficiency is fatigue. As explained before, both folate and B12 can increase your need for potassium, as your body starts to function better. You might need more potassium to utilize the B9 and B12. See this thread: https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-283712

If I hadn't known about this, I would have had to stop taking folate back in 2010. It initially helped my energy a lot, rather quickly, within a day or 2, and then a day or 2 later severe fatigue hit, which fortunately I had been forewarned about - that my potassium might tank suddenly due to the folate, and it did. A potassium supplement which I titrated up gradually over a couple of days took care of the fatigue and I was able to keep taking the folate. And I still have to take extra potassium every day, but it works.

You can try nutritional sources of potassium if you like - low-sodium V-8 or other vegetable juices can be a good low sugar source of potassium.

 

[yellowspain]

@yellowspain - what are your symptoms of B9 deficiency?

Also, running out of energy when taking more B9 than B12 might be due to potassium deficiency. A major symptom of potassium deficiency is fatigue. As explained before, both folate and B12 can increase your need for potassium, as your body starts to function better. You might need more potassium to utilize the B9 and B12. See this thread: https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-283712

If I hadn't known about this, I would have had to stop taking folate back in 2010. It initially helped my energy a lot, rather quickly, within a day or 2, and then a day or 2 later severe fatigue hit, which fortunately I had been forewarned about - that my potassium might tank suddenly due to the folate, and it did. A potassium supplement which I titrated up gradually over a couple of days took care of the fatigue and I was able to keep taking the folate. And I still have to take extra potassium every day, but it works.

You can try nutritional sources of potassium if you like - low-sodium V-8 or other vegetable juices can be a good low sugar source of potassium.

My symptoms are neuropathic pain, low mood, lack of motivation, severe acne... I don't think it's the potassium. In my blood tests it is fine. I have not noticed at any time a noticeable increase in energy. I had folate deficiency and the doctor told me that I should take it for three months to recover. As I said, I can't take b9 without b12, but I can't find the right proportion.

 

[pamojja]

so go low and slow and don't forget your cofactors.

Let's take a close look at this simplified chart, which vitamins plays grossly into B-metabolism:

It seems to me with both B9 and B12 (in the low right corner) after homocysteine is broken down, it needs proper supply of B5 and B7, B2 and B3 next, just to make the basic citric acid cycle work from below. From above B1, and B6 feed into just as well.

Are you covered with most basics, if and when non-dietary high doses of B12 and B9 overwhelm all other B vitamins storages, only provided in low dietary doses?

 

[yellowspain]

Let's take a close look at this simplified chart, which vitamins plays grossly into B-metabolism:
View attachment 54158
It seems to me with both B9 and B12 (in the low right corner) after homocysteine is broken down, it needs proper supply of B5 and B7, B2 and B3 next, just to make the basic citric acid cycle work from below. From above B1, and B6 feed into just as well.

Are you covered with most basics, if and when non-dietary high doses of B12 and B9 overwhelm all other B vitamins storages, only provided in low dietary doses?

Thanks. I am taking 800 mcg of b9 and 500 mcg of b12. All my symptoms are related to b9 deficiency. If I take other vitamins, my symptoms of b9 deficiency get worse.

 

[drmullin30]

Thanks. I am taking 800 mcg of b9 and 500 mcg of b12. All my symptoms are related to b9 deficiency. If I take other vitamins, my symptoms of b9 deficiency get worse.

Sorry if you've already mentioned this but do you know your SNPs for MTHFR? If you have homozygous for 1298 and 677 you may need MUCH larger doses of folate but the risk and difficulty is knowing how much you need of the other which are also dependent on SNP status. At one point I was taking 45 mg per day of folate to see improvements etc. I now think the problem was digestion and absorption as nobody should need that much and when I went low oxalate everything changed I ended up B6 toxic as my body was absorbing orders of magnitude more nutrients and it took several years of readjustment to the low oxalate diet. Going low oxalate and keto/paleo was the best decision I ever made though. Now I only need small doses of B vitamins and regular doses of other cofactors. I try not to go above RDI on most things except, folate, b12, b2, B5, biotin and B1. I don't supplement niacin or B6 anymore as those seem to cause me problems and I eat a lot of meat so it's not an issue.

 

[yellowspain]

Sorry if you've already mentioned this but do you know your SNPs for MTHFR? If you have homozygous for 1298 and 677 you may need MUCH larger doses of folate but the risk and difficulty is knowing how much you need of the other which are also dependent on SNP status. At one point I was taking 45 mg per day of folate to see improvements etc. I now think the problem was digestion and absorption as nobody should need that much and when I went low oxalate everything changed I ended up B6 toxic as my body was absorbing orders of magnitude more nutrients and it took several years of readjustment to the low oxalate diet. Going low oxalate and keto/paleo was the best decision I ever made though. Now I only need small doses of B vitamins and regular doses of other cofactors. I try not to go above RDI on most things except, folate, b12, b2, B5, biotin and B1. I don't supplement niacin or B6 anymore as those seem to cause me problems and I eat a lot of meat so it's not an issue.

Thanks for answering. I am homozygous for C677T. I've been thinking that maybe the dose I take of folate is low and I should increase it. On the one hand I notice small improvements, but on the other hand the healing does not seem to take off. I have also considered the absence of cofactors, but right now, if I consume any other vitamin, I begin to experience symptoms of folate deficiency.

 

[pamojja]

, if and when non-dietary high doses of B12 and B9 overwhelm all other B vitamins storages, only provided in low dietary doses?

.. the absence of cofactors, but right now, if I consume any other vitamin, I begin to experience symptoms of folate deficiency.

Usually, when one takes a vitamin at higher dose - thereby increasing the metabolic rate in which co-factors are used up - those in low supply soon get depleted. Causing secondary deficiencies. But it also works the other way round: By taking the other vitamins, folate might get used up much more efficient and faster.

So while the rather low 800 mcg you're taking might still be supported by lower body stores of other B-vitamins for now, when supplementing those others that might not be the case anymore.

As already written, if you intend to increase, always remember:

Therefore, always best to proceed cautiously, increase doses gradually over weeks, months and years

I would try adding crumbs of the folate tablet (if capsules: fraction of its content) and at low dose B-complex with the lowest dietary doses of individual B vitamins.

 

[yellowspain]

Usually, when one takes a vitamin at higher dose - thereby increasing the metabolic rate in which co-factors are used up - those in low supply soon get depleted. Causing secondary deficiencies. But it also works the other way round: By taking the other vitamins, folate might get used up much more efficient and faster.

So while the rather low 800 mcg you're taking might still be supported by lower body stores of other B-vitamins for now, when supplementing those others that might not be the case anymore.

As already written, if you intend to increase, always remember:


I would try adding crumbs of the folate tablet (if capsules: fraction of its content) and at low dose B-complex with the lowest dietary doses of individual B vitamins.

Thanks for answering. Right now the effect of methylfolate and methylcobalamin has evolved from making me feel tired to depressed. I am very tired of having to constantly look for solutions to my problems, I suppose this is a problem shared with more people here. It's been years since I've had a single day when I'm well, it's exhausting and the doctors don't help.

 

[pamojja]

My symptoms are neuropathic pain, low mood, lack of motivation, severe acne... I don't think it's the potassium. In my blood tests it is fine.

By the way, the 'normal' range for potassium with my lab is 3.5 - 5.1 mmol/l, optimal with functional practitioners about 4-5.

the effect of methylfolate and methylcobalamin has evolved from making me feel tired to depressed.

Sorry to hear of your worsening in mood and energy. Don't feel obliged to check or respond, if it doesn't feel right.

But I immediately have to think of many other factors mayby responsible. Let perplexity.ai make a basic list of B-vitamin deficiency symptoms, and typed at the end of each further possible symptoms of deficiency from a textbook in blue - possibly relevant to you;
:

Vitamin B1 (Thiamine)​

• Weight loss
• Short-term memory loss
• Confusion
• Muscle weakness
• Cardiovascular symptoms
• Severe Effects: Beriberi and Wernicke–Korsakoff syndrome

lack of appetite, depression, irritabilty, imsomnia, neuropathy

Vitamin B2 (Riboflavin)​

• Growth disturbances
• Skin rash
• Inflammation of the mouth and tongue
• Cracks at the corners of the mouth
• Anemia
• Severe Effects: Ariboflavinosis

muscle weakness, fatigue, peripheral neuropathy, depression, light sensitivity, stinging eyes, disturbance in iron, folate, B3, B6, B12 and Vitamin K metabolism

Vitamin B3 (Niacin)​

• Skin issues (dermatitis)
• Digestive problems
• Mental confusion
• Dementia
• Severe Effects: Pellagra

lack of appetite, depressive upset, fatigue, impaired cognitive function, weight-loss, muscle weakness, insomnia, polyneuropathy, psychosis

Vitamin B5 (Pantothenic Acid)​

• Irritability
• Restlessness
• Fatigue
• Sleep disturbances
• Nausea and cramping
• Numbness and staggering gait
• Severe Effects: Rarely seen, typically in individuals on synthetic diets

tiredness, heatache, depressive upset, insomnia, low stress tolerance, dermatitis, muscle cramps, myalgia
,

Vitamin B6 (Pyridoxine)​

• Depression
• Confusion
• Nausea
• Anemia
• Susceptibility to infections
• Skin rashes or dermatitis

irritabilty, tension, insomnia, muscle weakness, peripheral neuropathy, neurotransmitter disturbances

​

Vitamin B7 (Biotin)​

• Skin rash
• Conjunctivitis (pink eye)
• Alopecia (hair loss)
• Central nervous system abnormalities

loss of appetite, depressive upset, tiredness, weakness, muscle pains, parastesias, neuropathy

​

Vitamin B9 (Folate)​

• Weakness and fatigue
• Trouble concentrating
• Irritability
• Headaches
• Heart palpitations
• Shortness of breath
• Severe Effects: Folate deficiency can lead to anemia and neural tube defects in pregnancy

anorexia, pallor, depression, increased fatigueablity, weight loss, forgetful

​

Vitamin B12 (Cobalamin)​

• Fatigue and weakness
• Pale skin
• Heart palpitations
• Loss of appetite
• Weight loss
• Numbness and tingling in hands and feet
• Balance problems
• Confusion and poor memory
• Soreness of the mouth or tongue
• Severe Effects: Megaloblastic anemia, neurological damage, dementia, and other cognitive impairments

loss of appetidete, shorntess of breath, insomnia, tinnitus, neuralgia, neuropathy, parasias, depressive upset, hallizunacions, psychosis

​

Each B vitamin deficiency can lead to significant health issues, and it is crucial to maintain a balanced diet to prevent these deficiencies. Individuals at higher risk, such as older adults, pregnant women, and those with certain medical conditions, should monitor their B vitamin intake closely

Choline, inositol, PABA (p-aminobenzoic acid), and B15 (pangamic acid) are often discussed in the context of B vitamins, although they are not classified as essential vitamins in the same way as the primary B vitamins. Here's an overview of each, including their potential deficiency symptoms.

Choline​

• Fatigue
• Memory problems
• Muscle damage
• Liver dysfunction
• Increased risk of fatty liver disease

cognitive impairments

​

Inositol​

• Anxiety and mood disorders
• Insulin resistance
• Fatigue
• Issues with hair growth

​

PABA (p-Aminobenzoic Acid)​

• Skin issues (dermatitis)
• Fatigue
• Depression
• Anemia (in some cases)

​

B15 (Pangamic Acid).​

• There are no well-documented deficiency symptoms due to its non-essential status, but some claims suggest it may support detoxification and enhance oxygen utilization in the body.

​

While these compounds are sometimes included in discussions about B vitamins, their roles and the consequences of their deficiencies differ significantly from the primary B vitamins.

 

[yellowspain]

By the way, the 'normal' range for potassium with my lab is 3.5 - 5.1 mmol/l, optimal with functional practitioners about 4-5.



Sorry to hear of your worsening in mood and energy. Don't feel obliged to check or respond, if it doesn't feel right.

But I immediately have to think of many other factors mayby responsible. Let perplexity.ai make a basic list of B-vitamin deficiency symptoms, and typed at the end of each further possible symptoms of deficiency from a textbook in blue - possibly relevant to you;
:

Thanks so much for answering. I'm very tired. I don't know how to live being sick.

All the supplements end up generating adverse reactions for me and at the same time I know that they are the key to improving.