(not sure where to post . . . I assume in the PN thread, but to be safe and insure maximum visibility, I’ll start here)

Maybe someone here can help me to understand exactly what the difference (if may) is between Metanx vs. Folast . . . and inform me if I really need to care about the difference . . . I’m thinking I don’t really care about the difference . . . but I think some of you will know better than me based upon what you know and/or understanding what I’ve found

Quickly, some background (warning: this may take some time) . . .
I am diabetic type 2 (controlling my sugar with various meds and exercise, and trying to lose weight), with some slight/early PN in my feet . . . so my podiatrist prescribes Metanx twice daily . . . I go to my local CVS to get my prescription filled, and they inform me there is a generic for it, call Folast . . . I say fine (since I like to save money for non-name brand drugs), but they need to check with my doctor first . . . when I go to pick up my prescription, I’m informed by my pharmacist that my podiatrist said no to the generic, since he proclaims it is not the same Metanx . . . so I ask what’s the price difference, figuring if it’s a few bucks, I don’t really care . . . and I’m informed for 30 days worth, its something like (sorry don’t have actual figures with me here/now) $30 for the Folast vs. $105 for Metanx . . . I call my doctor and he tells me to get the actual ingredients for the Folast and let him know what I find out . . . I go back to my pharmacy, and check the active ingredients right off the bottle, and sure enough, they are listed as exactly the same (as some others have listed in various entries here) . . . I contact my doctor again, and he says he has found proof on the web that they are not the same (FYI – I also did some web research and everything I found listed Folast as generic for Metanx) . . . and he provides me a link to a personal blog . . . now, before you laugh at this like I did (i.e., my doctor is sending me a personal blog as his proof that I should pay over $300 a year for his prescribed non-generic pills . . . with all due respect doc, you have got to be kidding me?!) . . . however, this site did have some interesting information . . . and many ‘anonymous’ replies that look to be questionable at best . . .

First of all, I assumed that since Folast is an FDA approved generic, I had nothing to worry about (since the FDA would never let a drug be listed as a generic if it wasn’t the same), however, at this site, there appears the following quoted text from the woman’s CVS pharmacist:

*edit*
Then the blog had a response from the makers of Metanx as to why Folast is inferior and why it shouldn’t be bought and/or taken:

*edit*

So . . . at last I get to my questions: . . . what do you know about Folast vs. Metanx . . . is this above just another pharmaceutical trying to protect their profit margins with their own false and misleading half-truths . . . and assuming the above differences do exist, should I care about the above differences . . . i.e., do I really care that the Folast contains a “racemic methylfolate mixture” . . . ? ? ? ?

FYI – you should know that I searched your entire site, and although I found several entries on Metanx and/or some on Folast, I never found one addressing this type of debate between the two products

*edit*

Any help/information you can give me, to help me make up my mind as to whether I should take Metanx . . . or save some $ and take Folast . . . would be greatly appreciated

Thanks!

Hello, LarP.... Welcome to NeuroTalk!

Because of some rules we have here to protect our members from new posters who may spam here, your post had to be edited. However, I have access to what you originally wanted to discuss.
(not that YOU are spamming, but other international people try to)

First off, I've been specializing in nutrient supplements for improving health for over 10 yrs now on the net. Let me just say I have the same qualifications as the pharmacist who was quoted on that blog.... only with one restriction. I am not out to make money off this subject.

Metanx has been around for a while now. It is not a drug, but a mixture of 3 nutrients which are available over the counter.
The only reason it is on RX is because of the high folate content.

You can buy all of the ingredients yourself, online for less than Metanx costs. I will give that information later in this post.

I could not find Folast on the net, or on the FDA website. In fact Metanx is not listed on the FDA website either. This is because it is not classified as a drug.
I did find this however...a recall on Metanx.:
http://www.fda.gov/Safety/Recalls/En.../ucm173256.htm
scroll down to item #99. I could not find details of this however.

The pharmacy who responded to the blog you reference:
http://hendrixplace.blogspot.com/201...-update-2.html
This pharmacy has a vested interest in keeping your business.

Metanx contains according to their website: http://www.metanx.com/
Each Metanx® tablet contains:
L-methylfolate 2.8mg
Pyridoxal 5'-phosphate 25mg
Methylcobalamin 2mg

For a while methylfolate was removed from OTC sale because MERCK only sold it to RX makers. This has changed. It is now available OTC from Solgar in 800mcg strength. Metanx is RX only because the methylfolate is over 800mcg/tablet.

The main ingredient in Metanx is the methylcobalamin which should be taken on an empty stomach for best absorption. Does your pharmacy bottle have an empty stomach sticker? I bet it does NOT. Methyl B12 is the activated form of cobalamin.
Pyridoxal 5 phosphate is the activated B6, and methylfolate is activated folic acid. I've been posting about these vitamins for years, so this new product is welcome in my opinion. It teaches doctors --via sales reps---of the value of this combo. Its only downside is its price, and that many insurances won't pay for it.

So since the FDA does not "approve" Metanx as a drug, it cannot control any competitor who comes along. This also happened in the past with other B12/folate mixes, called FolGard, and FolTX.

I do not know what is in Folast. The manufacturer for this does not have it on the website of either Brookstone or Acella.
I did find a lawsuit logged for this problem here:
http://dockets.justia.com/docket/cou...ase_id-137581/
So things are going to be messy about this subject for a while, IMO.

You can buy these vitamins yourself. For less outlay of money.
Many of us here use this supplier: iherb.com

Here are 3 links to products you can mix.
Jarrow was one of the first OTC companies to offer this. Since you take 2 Metanx a day this link would offer you that amount in one tablet:
http://www.iherb.com/Jarrow-Formulas...enges/117?at=0
This is a two month's supply for your dosing.
Take always on an empty stomach, and you do not have to use under the tongue, but you can chew them up and swallow.
Many of us on the Peripheral Neuropathy forum have used this for years, and had good blood work to prove it.

This is the P5P that I use:
http://www.iherb.com/Now-Foods-P-5-P...blets/740?at=0

For you at two Metanx a day, this would be one tablet daily and is a two month supply.

This is the methylfolate:
http://www.iherb.com/Solgar-Folate-M...ets/13961?at=0

I really don't think you need so much folate as Metanx offers.
You could do 2 of these and still have a two month's supply.
There is some evidence coming out that high folate therapies may induce colon cancer. This was shown in some young women taking high dose folate when pregnant, and the subject has not been verified completely yet. However, for neuropathy the folate is secondary anyway, so I would think you could get by with less of this more safely, anyway.

I think these 3 would put you in the generic pricing category.
All 3 manufacturers of these products are very reputable and not "secretive" as you have seen with Brookstone/Acella.

Please feel free to post here and/or at our PN forum for more discussion.
http://neurotalk.psychcentral.com/forum20.html

I have a special B12 thread that explains methylcobalamin at length there...at this link:
http://neurotalk.psychcentral.com/thread85103.html

The complexity of this seems high to new patients. If you read this over a few times and my thread at PN, you'll see why doctors are just not keeping up these days. My hat is off to your podiatrist who is helping you well, and informed. Obviously a PamLab rep visited him!

I would also like to add that there are some other nutrients that can help diabetic neuropathy.

They are all moderate in price but not as inexpensive as these 3 that are in Metanx.

1) Benfotiamine (a better form of thiamine B1)

2) Acetyl-l-carnitine to improve mitochondrial functions/energy production

3) R-lipoic acid (an improved form of alpha lipoic acid) which has studies for many years in diabetic neuropathy.

If you are interested, just say the word... I'll give you starting doses and which to buy at iherb.com

Hi, I am trying to find the correct supplements to purchase on Iherb for PN (small fiber). I am not diabetic. But I am really interested in knowing which brands to buy and at what starting doses, if possible.

Thank you,
Sunrise

Hi Sunrise, why don't you send me a PM, including what meds you take, and what supplements you use now?

hey mrsD - many thanks for taking my question and for the complete and timely reply - i really do appreciate it - when i have time (over the next couple of days), i will take the time to re-read your reply in depth and reply to it - thanks again/talk to you soon

More on the cancer risk and folic acid:

http://coloncancer.about.com/b/2009/...ancer-risk.htm

The data is piling up about this connection of high folate intake and risk.

Metanx can be useful for people with the MTHFR DNA mutation that prevents the body from properly methylating (activating) B12 and Folate. It is estimated that 1 in 10 people have this difficulty. However, when doctors give a FIXED combination of these 3 vitamins, the folate level becomes really high. Some doctors are telling patients to use 2 Metanx a day... and that puts people into 5.6 milligrams of methylfolate.

I can see a short period of time of use of this in MTHFR patients to relieve a deficiency. However, this dose has not been studied in depth as safe for long term use.

It is possible still that the connection of folate to colon cancer will not be cemented into fact. But young women with low risk have turned up with this cancer from taking regular folic acid in high amounts to prevent spina bifida in their babies. I have personally seen expectant mothers with high risk of this taking 5mg of folic acid daily in the recent past.

I searched alot this morning and cannot find out what the recall of Metanx in July 09 consisted of. This troubles me also.

This is why I think patients who need these nutrients in their active form, can find them themselves and taylor their doses accordingly.
Methylcobalamin is now appearing in some stores locally. And yesterday, a Puritan's Pride catalog came to my home, offering it as a new item! The reason I continually insist on taking this B12 ON AN EMPTY STOMACH is because studies of drugs used in microgram amounts orally have found that they can be lost in the fiber found in the digestive tract. This then causes them to not be optimally absorbed. Levothyroxine and digoxin now have recommendation to take on an empty stomach.
Hence, B12, which is also in microgram amounts, and needful of passive absorption in the intestine, should not be taken with food either, for best results. In people with intact normal acidic stomachs, who do not have failure of intrinsic factor, this is less critical. But I think that patients with neuro problems have them because something is not working right. So therefore, taking the B12 so it CAN be absorbed is best == empty stomach.

I have a B12 thread with medical links given on this thread. It has a link to a new B12 formulation coming out soon, with better absorption tested in studies. Please take a look at that thread.

The other two ingredients of Metanx, are available by NOW and
Solgar. Locally you may find them, in large health stores that carry a complete line of these two manufacturers. However, locally you can expect to pay more. Many of us here use iherb.com because they are fast, very much less in cost than local stores, and offer a vast array of quality products and don't charge high shipping rates. In fact for a long time they were the only place I could find methylcobalamin. But now this is becoming more common, and that feature is less dominant. I still purchase many unusual items from them today.
There are other discount vitamin suppliers now on the net. You could use them too, if you stick with the reputable brands I've suggested.
NOW's P5P is enteric coated, because P5P is not stable in stomach acid. I don't know if Metanx is enteric coated or not, so that is why I suggest NOW brand for it.

Hi Lar, and welcome to NT!

As you can see, this is a great site with a lot of of friendly and helpful people.

Hello and welcome to NeuroTalk. Great to see you have come to be with us. Just let us know if we can be of any help.

Again welcome, looking forward to seeing you around.

Darlene

In reply to:
I just returned from an anti-aging conference in LA where Jonathan Wright, MD briefly addressed the folic acid causing colon cancer concerns. According to him, the risk is in the metabolic conversion of folate to MTF to l-methyl folate (the bioavailable form) - in that conversion is where carcinogenic activation occurs. This bears further investigation in that up to 30% of the population have the genetic SNPs C677T and A1298C which result in hyperhomocysteinemia (a risk factor for stroke, heart attack, Alzheimer's, macular degeneration, and recurrent pregnancy loss besides neuropathic issues) due to an inability to properly metabolize folic acid to l-methylfolate. L-methyl folate and the active forms of B6 and B12 are needed to break down homocysteine. Homocysteine will likely be the 'cholesterol' of this coming decade. Treatment of hyperhomocysteinemia will emerge in prominence - the real risk of taking l-methylfolate vs. folic acid (folate) needs to be further explored. One of the cruder treatments of the inability to effectively metabolize folic acid is to give mega-amounts of folic acid. This could be an added risk factor for colon cancer. However, it could be that giving l-methylfolate (and the bioactive forms of B6 and B12) - needed to effectively breakdown homocysteine - bears no cancer risk and has obvious tremendous benefit.