Special Conditions & Considerations
Please click on a condition below to learn more.
Diabetics are at a much higher risk for peripheral neuropathies. In addition, Metformin (still the first-line drug of choice for type II diabetes) can cause B12 deficiency. Please visit the Diabetic Neuropathy page to learn more.
Nutritional Approaches to Treat Diabetic Neuropathy: A Systematic Review
Luke Curtis International Journal of Diabetes Research 2013, 2(3): 56-60
EDITORIAL A Medicinal Food Provides Food for Thought in Managing Diabetic Neuropathy
The American Journal of Medicine, Vol 126, No 2, February 2013
Subgroups of persons with neuropathy have been demonstrated to respond to B6, folates and B12. The studies are of varying quality and results but continue to show benefit. In spite of over 40 years of use, current critical reviews continue to state that mechanisms are not well understood and call for more studies.
Please visit the Diabetic Neuropathy page to learn more about diabetic neuropathy.
Studies going back to the 1960s show an increased incidence of folate deficiency in patients with depression. There appears to be a subset of patients who improve with folate supplementation even when levels test normal. The mechanism is postulated to be improvement in serotonin metabolism which requires B vitamins. Supplementation is also appropriate in any patient with deficiency. Studies have not convincingly demonstrated increased benefit from ultra-high doses of folate.
Folate and depression—a neglected problem
Simon N. Young, PhD J Psychiatry Neurosci 2007;32(2):80-2.
Folinic acid has been demonstrated to be metabolized efficiently in patients with the most common more severe MTHFR mutation (the C677 →T Mutation).
Conversion of 5-Formyltetrahydrofolic Acid to 5-Methyltetrahydrofolic Acid Is Unimpaired in Folate-Adequate Persons Homozygous for the C677T Mutation in the Methylenetetrahydrofolate Reductase Gene
Lori Lathrop Stern, Pamela J. Bagley, Irwin H. Rosenberg, and Jacob Selhub
J. Nutr. 2000 130: 2238-2242
Folinic acid is a naturally occurring reduced form of folate which does not require the action of dihydrofolate reductase (DHFR) for conversion to its active form.
In spite of high hopes, numerous studies continue to show no appreciable benefit from high-dose folate and B12.
Martí‐Carvajal AJ, Solà I, Lathyris D, Dayer M. Homocysteine‐lowering interventions for preventing cardiovascular events.Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD006612. DOI: 10.1002/14651858.CD006612.pub5
Methotrexate is a cancer drug also commonly used for psoriasis and some forms of arthritis. Folinic acid is often used in patients after methotrexate dosing, but Folinic-Plus® can interfere with the therapeutic effect of MTX. The use of all vitamins, nutritional supplements and herbal products should be discussed thoroughly with the treating physician of anyone who has been prescribed methotrexate.