Folic Acid and B12 deficiency

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Regular Member

Date Joined Nov 2007
Total Posts : 147
   Posted 6/22/2009 8:13 PM (GMT -7)   
My recent bloodwork showed that I have a folic acid deficiency and my b12 was on the low side of normal (250 on a scale of 200-1100). I have also been told that I need to have my gallbladder taken out as it is only functioning at 20%. Does anyone know if these things could be related? I am on sulfasalazine which can cause absorbtion issues with folic acid but the the b12 I am a bit baffled by. Over the past few months I have been feeling progressively worse and I just can''t tell if I am in a flare of some sort or if my gallbladder is causing these issues. My symptoms are more flare like than the classic gallbladder trouble but at the same time...after the HIDA scan I developed a pain in my upper right (in the are of the gallbladder) that comes and goes. I meet with the surgeon this week but I am sure he is just going to want to cut me open...and my GI is telling me to take folic acid supplements but mentioned nothing about the b12. Should I just take b12 supplements and hope for the best or would I be better off asking for injections (not sure I would get these since I am not officially low...yet). UGH I wish I could just find doctor with omnipotent diagnostic skills!!!

Lady G
Regular Member

Date Joined Sep 2006
Total Posts : 321
   Posted 6/22/2009 8:35 PM (GMT -7)   
I am not sure on some of the things you talked about, so others will have to answer. But as for b12 it is VERY common amongst alot of Crohnies. Our bodies just don't absorb things proper and b12 seems to a be a huge culprit that hits alot of us. I don't think it has to do with anything like meds, just the fact we don't absorb proper in general. Don't take supplements as once again its an absorbtion issue and pills just won't work on us and all. The best is always the injection from a doc on a schedule they decide is best for you. For me, I go once a month. You CAN get taught to do it at home too in some places, I just let the nurses do it. That way the injections are directly in where they need to be and absorbed, not..well..pooped out before its effective like pills happen to do sometimes. Hope that can help a bit on one of your questions

Regular Member

Date Joined Nov 2007
Total Posts : 147
   Posted 6/22/2009 8:49 PM (GMT -7)   
Lady G thank you for your response about the b12. Do you think I should push my doc for injections even though I am not officially low yet? I am just getting frustrated b/c I kind of feel like all my doctors are just waiting around until something really bad happens. I am trying to be proactive but I am not getting very far :(

Veteran Member

Date Joined Mar 2006
Total Posts : 1034
   Posted 6/22/2009 8:49 PM (GMT -7)   
most people are deficient in the b vitamins, but for us these 2 are the biggies. for a b-12 supplement you want a sublingual. i find the eye dropper ones work better than the lozengers as they dont seem to dissolve for me. the tricky part with any supplements are the additives they put in there that you dont want or need. try to get ones that are wheat free, yeast free, soy free, do not contain magnesium sterate or titanium oxide. go to a healthfood store to get these.

i cannot answer your question on the pancreas.
Crazy Harry

Crohn's since 1993 (17 yrs old then)
surgery in July '05 - removal of 2 inches at ileum and 8 inches of sigmoid colon (had fistula into bladder)
Nov '05 developed colonic inertia; July '06 told i needed ostomy surgery
began maker's diet in August '06 - now feeling the best ever with no symptoms of colonic inertia and i kept my colon
med free as of 10/31/07

Veteran Member

Date Joined Jun 2008
Total Posts : 1058
   Posted 6/22/2009 11:14 PM (GMT -7)   
I'm with Crazy Harry. Sublingual B12 is well absorbed and since you are not actually suffering from Pernicious Anemia, you don't need injections which are needed to overcome a loss of a cellular level B12 transport agent. Injections give you huge excesses of B12 to allow it to seep into cells due to concentration different (osmosis) when the specific factor that selectively transports B12 through cell walls is missing. Folic acid works in tandem with B12 and has a number of benefits. You should be able to absorb some from supplements, but be sure to take at least 1000 mcg daily - preferably more to start since you are deficient - maybe 5000 mcg or 5 mg.

The gallbladder is commonly a problem in Crohn's. There can be direct inflammation of the liver due to a common cross-reaction to T cells from Crohn's. Gall stones can be a symptom that gut bacteria are entering the blood stream and passing into the liver from there. Your symptoms kind of sound like gallstones passing more than anything else. If you have a chronically inflamed gall bladder, it can cause pancreatitis and you REALLY don't want to try that one.

Veteran Member

Date Joined Jan 2005
Total Posts : 1831
   Posted 6/23/2009 3:35 AM (GMT -7)   
As the others stated B12 deficiency isn't uncommon amoung CD patients, especially if your TI has been removed.

The Folic Acid is probably because of the sulfasalazine. I found out last year that I should have been taking folic acid w/ sulfasalazine as it depletes those levels. I'm now on 1 mg /day and monthly B12 shots.

Veteran Member

Date Joined Apr 2006
Total Posts : 1885
   Posted 6/23/2009 12:46 PM (GMT -7)   


That so-called "normal" scale for the B12 is ridiculous. At 400 and below, B12 deficiency is suspected. But below 300, it is not just suspected, but assumed. Your B12 should really be 500 and above to be in the optimal range.

The best, fastest way to get B12 is via an injection of about 1000.  THEN you can try supplements but each person's body is different and there is no way of knowing how much B12 you can absorb, if any, until you do some trial and error.

Based on prior experience, we know that if my daughter gets a shot, it will drop down to 400 after 4 weeks with low B12 supplementation (the amount in most multivitamins). We also know that it will drop down further, to 300, after 8 weeks.

What we don't know is how high do the oral supplements have to be - 500? 1000? So she got a B12 shot three weeks ago, when her B12 was 300, and since then has been trying 1000 oral B12 daily. In another week she will get a blood test to find out whether the oral B12 has managed to keep her from having to get another monthly B12 shot. (But since she won't receive the blood test results for nearly a week, she will get her monthly B12 shot just to play it safe.) 

New Member

Date Joined Jun 2009
Total Posts : 7
   Posted 6/23/2009 4:45 PM (GMT -7)   
my b 12 is always low. I only have about 5-6 ft of sm bowel left. can't absorb b-12. I receive the injections every 2-3 wks depending on my schedule. If you are not truly low in b-12, and you receive the injections, you will notice nothing. If you are deficient in b-12 and receive the injections you will most definitely be able to feel a differnce. Low b-12 can cause you to fell off balanced, clumsy and I get really bad muscle cramps when i am low. My body reminds me that i need my b-12 injection if i happen to forget when i am due.

Regular Member

Date Joined Nov 2007
Total Posts : 147
   Posted 6/23/2009 8:01 PM (GMT -7)   
Thanks for all the info everyone. I am going to talk to my dr. about the injections and the sublingual b12 . I started taking regular supplements last week for both the folic acid and b12 but I am concerned that I may need more than that. My MCH on my CBC was also very very slightly elevated to 35.9. All my other blood tests over the past 5 years had an MCH of 30.8 or I also think that kind of is a signal that something is cooking.

Veteran Member

Date Joined Dec 2008
Total Posts : 947
   Posted 6/23/2009 8:06 PM (GMT -7)   
I would have blood checked and see if you have a low B-12 count. If you do, you would need injections.
Diagnosed with Crohns in 2001
First and hopefully last Ileocecectomy 2/18/2009

Medications: Asacol, Precription Folic Acid, Multivitamin, 1000mg Calcium, Vitamin D, Probiotics,  Monthly B-12 injections.

Living a Great life with my Wife and my two Chocolate Labs
Hunter & Hailey.
I love them dearly.

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