R
R++
Guest
Can someone help me understand this? How do these two work together and need each other? What does each do for the methylation cycle??? I still can't put all the pieces together.
Thank you!!
Thank you!!
Hi, R++.
The partial block in the methylation cycle in CFS occurs at the enzyme methionine synthase. This enzyme reacts 5-methyl tetrahydrofolate with homocysteine, to produce tetrahydrofolate and methionine. In other words, the methyl group on 5-methyl THF is transferred to homocysteine to make methionine. This enzyme requires methylcobalamin, a form of vitamin B12, as a coenzyme. The methyl group from 5-methyl THF is first transferred to cobalamin to form methylcobalamin, and then it is transferred to homocysteine.
In order to lift this partial block of methionine synthase, we've found that it's necessary to supply both a form of B12 and a form of folate together. In the Simplified Treatment Approach, the form of B12 is hydroxocobalamin, using the sublingual Perque supplement discussed by R**. Two main forms of folate are used: folinic acid and 5-methyl THF. Other treatments of this type use other forms of these nutrients.
Best regards,
Rich
Hi Rich - what's the difference metabolically, or in activity, between the 5-MTHF and folinic acid? In other words, why not just take folinic acid, for example? That is "active" folate, right? Why the emphasis on the THF?
Also, can you discuss the preference in your protocol for hydroxycobalamin over methylcobalamin? I'm sure that must be detailed in your papers somewhere, but I can't find where (I think) I read such an explanation.
What about if I'm taking methylcobalamin. Does that mean there's no need to take methylfolate as the methylcobalamin already has the methyl group attached?
Hi, Mr. Kite.
I actually prefer including both folinic acid and 5-MTHF. 5-MTHF is the form needed by methionine synthase, which is the enzyme with the partial block. Many people's cells are able to convert folinic acid to 5-MTHF well, but many others have inherited genetic polymorphisms that slow this conversion down considerably. The polymorphisms in the MTHFR enzyme are a good example, and these are very prevalent in the population.
Folinic acid is helpful for a couple of reasons. One is that it is very versatile, in that it can be converted to other forms of folate, which are needed to make DNA, RNA, and purines in general. Another factor is that folinic acid is polyglutamated when it is inside the cells, and this can help to lower the amount of free glutamate, which is an excitotoxin. Excitotoxicity is a problem in CFS, and it is often exacerbated when methylation cycle treatment is entered upon.
I prefer hydroxocobalamin for several reasons. One is that it allows the cells to control the amounts of the coenzyme forms of B12 (methylcobalamin and adenosylcobalamin) that they make, so that they can be matched to the need. Taking methylcobalamin in large dosages by injection or sublingually can overdrive the methylation cycle, as evidenced by a major rise in sarcosine, which I've seen in amino acids testing on some people who have been on this treatment for a while. I am not comfortable with overdriving the methylation cycle, both because I think it slows flow down the transsulfuration pathway and thus limits the normalization of the balance of the sulfur metabolism, including cysteine, glutathione, taurine and sulfate, and also because I am concerned about the possibility of overmethylation of DNA, which could have other deleterious effects.
My other concern is that methylcobalamin is known to be chemically able to methylate inorganic mercury. Many PWCs have significant body burdens of inorganic mercury as a result of having amalgam fillings in their teeth during an extended period while glutathione has been low, so that they have not been able to detox mercury at normal rates. Methylmercury can cross the blood-brain barrier readily. Mercury is a potent neurotoxin if it gets into the brain. This problem has been observed in guinea pigs. I don't have solid evidence for it in humans, but have heard from perhaps three people who may have had this problem, based on what they have reported. So I prefer to be cautious.
This having been said, some people have had good experience with methylcobalamin. It can be especially helpful if a person has a shortage of methyl groups, though that can also be helped by taking some additional trimethylglycine (some of which is in the multi that is part of the simplified treatment). or some SAMe. It's used a lot subcutaneously by the DAN! doctors in autism treatment, and as you probably know, freddd on this forum advocates its use as well. In his case, because of a mutation in the intracellular B12 processing enzymes, his body is not able to utilized hydroxocobalamin readily. But I believe that this is a rare situation, based on the published literature. freddd does not agree that it is rare, based on his experience.
Best regards,
Rich
dear rich vank and fredd and others,
regards and greetings.
rich - it is great to find you here! please reply. I hope fredd with give his input also.
many thanks for your kind help in getting my life back.
regards
b12
(suffering for 18 years)
PS: IN CASE MR. RICH VANK OR FREDD DO ONLINE CONSULTING. PLEASE CONSIDER MY CASE SERIOUSLY. I AM PREPARED TO PAY YOUR FEES VIA PAYPAL.
b12
If anyone who is not a doctor acepts money for giving you their opinions it probably makes it illegal. just thought I'd caution you.
dear rich vank and fredd and others,
regards and greetings.
rich - it is great to find you here! please reply. I hope fredd with give his input also.
many thanks for your kind help in getting my life back.
regards
b12
(suffering for 18 years)
PS: IN CASE MR. RICH VANK OR FREDD DO ONLINE CONSULTING. PLEASE CONSIDER MY CASE SERIOUSLY. I AM PREPARED TO PAY YOUR FEES VIA PAYPAL. I understand that you may be a non-medical person and I am prepared to sign any document stating that you will not be legally held responsible for my condition in any case
(caps only to emphasize. shouting not intended. )
=================
THIS QUERY WAS ALSO POSTED AT WRONG DIAGNOSIS. THIS IS THE FINAL VERSION OF THE QUERY WITH ADDITIONAL NOTES. FREDD AND OTHER MAY REPLY HERE AND IGNORE EARLIER WRONG DIAGNOSIS VERSION.
============
I am a newbie here but, I have read and reviewed many of yours posts and materials on b12 and folates + researched the net for verrry long time.
my symptoms:
(I am a vegetarian. very little milk or cheese). male. below 40. very weak.
= ocd (main problem)
= slight ADHD
= no depression
= CFS
= DSPS (delayed sleep phase disorder). I could only sleep after 3AM for years.
= tinnitus (more on left ear)
= leg cramps (more right side)
= neurofibromas (more on right part of body)
= symptoms and test results show low calcium
= very sweet smell in urine, sweat, feces, saliva etc for years. no diagnosis for years. I do not have diabetes. this was probably due to calciuria and/or phosphaturia (due to impaired genetic level calcium absorption). homeopathy has helped me fix this (to a large extent) and enhance blood calcium levels.
= slight albumin in urine.
= hair fall
= very weak /absent erections. almost no libido.
= very high chemical sensitivity
=====================
diagnosis based on symptoms:
= genetic level calcium absorption problem.
= OCD (low serotonin) [genetic origin. OCD is there n family]
= low cerebral calcium.
= low cerebral folate
= (slightly) under-methylated
= low supply of calcium, b12 and folate from diet.
=====================
treatment:
apart from classical homeopathy to correct genetic issues:
b12 and folate and calcium supplement.
my questions:
1. I had problems of calcium depletion and/or lowered b12 with calcium gluconate and vitamin C (both taken together). any idea why? I take calcium carbonate and that is ok. I also had problems with magnesium and vitamin D (burning, heat and heaviness in head). why?
2. my experiences:
= cyanob12 never worked in past. I understand this now.
= common b-complex gave me hyper-excitement. this was due to low calcium levels in brain - as I understand now. it also made me under-methylated (due to cyano b12 and folic acid - as I understand now)
= methb12 in 500 mcg single dose makes me hyperexcited and overmethylated...and also calcium depleted. why? I don't know this.
= adenob12 - feel more hot. more diarrhea. why?
= folic acid makes me undermethylated. I can understand that now.
= I understand that I an under-methylated by flat taste in mouth. NO desire to take water. if water is taken - head feels watery. is it right symptom of undermethylation? these things gave me undermethylation:
= only folic acid
= cyanob12 + folic acid.
please analyse.
now the right combination of b12 and folates is proving difficult. please help.
madanthony made some great posts at wrong diagnosis. allow me to quote.
"It is an opinion by some, such as Fredd, that therefore MB12 and AB12 are the best form of B12 supplement. No one can know what is the best form FOR YOU unless you undergo genetic testing, such as available at http://www.heartfixer.com/AMRI-Outco...yl Cycle.htm. Some people have genetic mutations that make them sensitive to extra methyls (even if they are undermethylators). For instance there is a COMT allelle which makes it harder to break down dopamine so that even an undermethylator who isn't making much serotonin and dopamine has plenty of dopamine and is therefore sensitive to methyls. Dr. Yasko and heartfixers do encounter this regularly in their practices and they find a basis for the use of hydroxyB12 in certain individuals. The majority of people do not have these mutations."
"I am sure there IS no good way to deal with genetic mutations which require more methyls in some places and fewer in others as there is no way I know of at present to direct the methyls. (Well you can avoid dopamine precursors like cheese if you can't break down dopamine well, but it's not like taking a pill). Dr. Yasko and company attempt to provide careful methyl balance in such cases but the results can never be perfect. So for instance they might prescribe l-METHYLfolate and hydroxyB12 (1 methyl instead of 2 and - YES the other methyl has to come from the metabolism somewhere). They say the people with these mutations are prone to bipolar and very sensitive to methyl intake. I have a bipolar cousin and I have hormone levels that suggest COMT and C677T mutations, so I don't imagine I will get the kind of do-this-and-you're-golden results I am hoping for. But knowledge is power. Um, also, I regard it as a bit of an adventure. Woo-hoo - not so cheap thrills."
and fredd said:
"Hycbl has a reputation as being preferentially converted to adb12 as opposed to mb12"
[ I would like to add that hycbl is connected with calcium absorption]
now, keeping my symptoms in mind and my experiences - please suggest what should I do?
I thought a lot and feel that I do need b12 and folates and my diet does not have them + clear symptoms are there. but, I am not responding well to methb12 and adenob12 and folic acid. also, I am (slightly) on the under-methylated side. but, ALL b12 and folates and b-complex gave some strength to my brain. I also feel that my absorption is OK and injections are not needed. I am hypersensitive to everything and so I need to keep things to bare minimum. after analysing ALL issues: I have decided:
calcium carbonate + hydroxyb12 + methylfolate + rest all from diet. [nothing else]
kindly comment on the hydroxyb12 + methyfolate combo for my particular case. I seem to be sensitive to methyl in b12. so, I hope hydroxyb12 will work for me. but, I hope hydroxyb12 will not deplete calcium like methylb12.
[later on - I was surprised to note that unlike fredd who only emphasizes on methylb12 - dr vinitsky and rich - talk about hydroxyb12]
3. or should I think about adenob12 again with methylfolate?
which combination will be easier on stomach - adeno b12 + methyfolate OR hydrob12 + methylfolate. no diarrhea is wanted by me. I feel hydroxyb12 will be easier on stomach. what is your opinion?
4. rich talks about folinic acid (but, prefers metafolin). I cannot understand this. if hydroxyb12 is used along with folinic acid in any case - the results should be similar to using hydroxyb12 with folic acid - i.e. - UNDERMETHYLATION. I am an ocd case - slightly undermethylated. so, should I take hydroxyb12 with folinic acid or with methylfolate (metafolin).? won't metafolin balance the methylation for me (as I am not taking methylb12)? won't folinic acid or folic acid make me undermethylated? I did experience undermethylation with cyanob12 + folic acid. please choose the right folate for me along with b12.
[later on it was great to find that vinitsky, yasko and rich talk about b12 and folate combo]
dr vinitsky feels that the body should naturally methylate and so he goes for hydoxyb12 and folic acid. no forced methylation. will this approach work for me? I doubt. I feel I do need at least one methylator - at least on the folate side.
please note my weak condition and diarrhea and delayed sleep rhythm and weak brain and SLIGHTLY undermethylated case to choose folinic acid vs. metafolin.
5. which one is lighter on stomach? folinic acid or methylfolate? does addition of methyl make ithe folate more diarrhea prone than plain folic acid?
PS: any reports/user experience about methylfolate effect on stomach at 400 mcg dose? any diarrhea? is it better or worse on stomach than A) folic acid and B) calcium levo-folinate (folinic acid)
6. I feel that RDA of hydrob12 is like cyanob12. so, should I just take 5 mcg or 10 mcg per day of hydroxycbl?
folate - 200 mcg or 400 mcg per day? [yasko says 200 mcg - is that right?] is there any b12 and folate ratio for stable effect? dr vinitsky mentions tooo much folate - I think. for me dr neubrander or fredd or dr ray strand style heavy dosing will not do for mr. I am verrry hypersensitive. physically very weak. and very weak digestion. will it be ok if I take 5 mcg hydroxyb12 daily with 200 mcg methylfolate and 625 mg calcium carbonate (elemental calcium 250 mg). please adjust dose for me. I am prepared to take very low doses [something better than nothing. very slow results is fine but, this weak useless life is of no meaning] - even lower doses is fine - but, I should not get hyperexcited or get insomnia or diarrhea or undermethylated. please decide the correct dose considering my weak brain and body. due to long time low cerebral calcium - I cannot even take a full b-complex tab as that overstimulates my brain. also please consider my weak stomach.
7. I think it is better to take calcium, and b12 and folate - all together? what do you say. [later on - was thrilled to read that dr vinitsky mentions folate and b12 taken together].
= both taken at breakfast or lunchtime (earlier in the day during daytime) to fix my circadian clock. what do you say?
8. I think I should avoid BOTH aspartame and MSG. what do you say?
9. BRAND dr vinitsky mention perque brand for hydroxyb12. rich what is your suggested brand for hydroxyb12? where to buy?
and rich - which brand do you suggest for metafolin in my case? solgar? or should I take folinic acid (please suggest brand).
10. route of administration: vinitsky says ONLY sublingual for BOTH folate and b12 - or else there may be a problem. what do you say?
= if you suggest metafolin for me - is it available in sublingual form?
= is it ok to take sublingual b12 along with oral folate?
= if the hydroxyb12 is only available in high dose (perque is 2000 mg) - is it ok to dissolve in water and take right dose (after how many minutes? can chemical reaction if watery solution is used?)
= will sublingual be easier on stomach?
I have suffered for years. kindly help with your inputs.
if your inputs help me regain my strength and life - I will not be able to thank you enough. please do help me. you will be helping a very sensitive and intelligent person who wishes to help others. FEEL FREE TO TAKE ANY FEES FOR ONLINE INTERACTION. please help - the doctors here are totally useless. if possible please communicate with me DIRECTLY by email frequently.
regards
b12
It does require more self responsibility and the willingness to tolerate the startup responses of something 100x more effective than hycbl.
Can you go into a little more detail about tolerating the startup response? B12 shots made an enormous difference to me for about 5-6 wks and I've been having escalating problems ever since. (The shots are cyanb). I am trying to get a sense about whether or not my "new" problems have anything to do with the B, as it seemed to help so much in the beginning.
Question for anyone trying/with knowledge of B: Is it quite possible that different forms will work for different people for various reasons and should we base our protocols on what we respond to?
Hi, Zoe.
I don't know how large the dosages were in your shots, but I would not recommend getting cyanocobalamin at dosages of milligrams repeatedly if you have CFS. Cyanocobalamin contains cyanide. The human body normally has four ways of detoxing cyanide, including reaction with thiosulfate, pyruvate, alpha ketoglutarate and hydroxocobalamin. However, I have studied one case of CFS in which all of these were depleted. The person was taking several milligrams of cyanocobalamin per day, and became very ill. Treatment with hydroxocobalamin and oxygen was necessary to counter the cyanide toxicity. I think this can be life-threatening. Most people can tolerate micrograms-type dosages of cyanocobalamin, but the larger dosages can cause problems for some people. Cyanocobalamin continues to be sold as the main B12 supplement because it has a longer shelf life and is thus less expensive, but it's not the best form of B12 for the human body.
In CFS, I think it is true that depending on a person's genetic polymorphisms, she or he may do better with hydroxocobalamin or with methylcobalamin. Dr. Amy Yasko emphasizes this in her treatment of autism, which in my opinion shares the same basic biochemical issues with CFS. She bases the choice of B12 forms on characterization of polymorphisms in the genes for the COMT enzyme and the vitamin D receptor. It's important to have enough methylation capacity to produce methylcobalamin in the cells, which they need as a coenzyme for methionine synthase in the methylation cycle, but excess availability of methyl groups may cause problems. Normally, the availability of methylation capacity is limited in the cells by the enzyme glycine N-methyl transferase, which shunts excess methyl groups to glycine, forming sarcosine.
Best regards,
Rich
Can you go into a little more detail about tolerating the startup response? B12 shots made an enormous difference to me for about 5-6 wks and I've been having escalating problems ever since. (The shots are cyanb). I am trying to get a sense about whether or not my "new" problems have anything to do with the B, as it seemed to help so much in the beginning.
Question for anyone trying/with knowledge of B: Is it quite possible that different forms will work for different people for various reasons and should we base our protocols on what we respond to?
With mb12/adb12 plus cofactors I would estimate the cure rate at perhaps 1 in 5 or 1 in 10 or thereabouts depending upon definitions and actually following through on many factors and exercise.
From your description you are having the same problem with cycbl that many people have, an initial period of some results and then escalating problems as the cycbl induces the methylation block and cyanide builds up.
Hi Rich,
The shots have been at 1000 mcg/wk for 5 wks and then every other week. Remarkably, in the first month or so, my myoclonus issues dissipated for the first time (I had this problem as long as 19 years ago, but only for short periods of time and seemed to be related to working outside in hot weather or doing demanding manual labor). In the past several years, it has become a problem of epic proportions. In the last 3-4 wks it reappeared, and has been intractable despite magnesium, klonopin, and more. It could be related to the B12 (as I was surprised that I had no issues tolerating the shots--and expected a negative reaction--as is usually the case with meds/many supplements), but I really have no way of knowing. I went from feeling that I had essentially "kicked" the myoclonus (it is mostly in my shoulders, forearms, hands, neck and face, oddly), to an "attack" that is more resistant to treatment than any before.
The doctor I began to see over a month ago (have only seen him once) mentioned wanting a tissue hypoxia test done, and I have wondered if, because of feeling improvement and being more active--this is all relative of course, that I have pushed the hypoxia and now am suffering the effects. As far as side effects go though, or just symptoms, PLMD is the most intolerable, and so I've been scrambling for possible answers.
I'm not familiar with the "polymorphisms in the genes for the COMT enzyme and the Vitamin D receptor" and not sure of what that means. I do know that I had a D level of 12 when tested earlier this year and had been supplementing 2-4,000iu/day (though not every day) for over a year prior to the test. I was told to take 10,000iu/day for 2 wks, then 5,000iu/day for 2 wks, etc. and was tested about 7-8 wks later and my level was close to 30. I'm not certain if this ties into what you mentioned or if I am just borrowing the "Vitamin D" out of that sentence and applying it to my results!
The current doctor whom I've seen once gives 5-10,000 mcg of methylB12 as often as 2-3 times/wk, depending upon the patient and their reaction. I chose not to go that route as I was having positive results with much less. I need to double check that I am taking the cyan form and not the hydroxyB12 as the vials are at my local practitioner's office. A few weeks ago, when I started to have the reappearance of myclonus, I decided to buy the Perque B12 so that I could supplement more as needed (thinking more would be better) and Folapro. The shots themselves are an issue as they leave me extremely bruised if not done IM, which caused too much local pain. At this point, I'm too exhausted to even consider trying the Perque and Folapro. It sounds like some members here are taking very small doses in order to tolerate the side-effects.
Thanks for your reply,
Zoe