[LarP]

(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!

[mrsD]

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!

[mrsD]

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

[LarP]

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

[mrsD]

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.

[azoyizes]

Hi Lar, and welcome to NT!

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

[Darlene]

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

[LarP]

mrs D et al –

Again, many thanks for taking my question(s) . . . I do appreciate it.

But, before I reply to your last posts, I want to apologize for this not-very-timely response. As per my previous quick/short response to you, I knew I would not be timely in getting back to your initial reply, however on top of my already busy schedule (which I won’t bore you with); I had a medical emergency with an immediate family member that just took any/all spare time. Thankfully, that appears to be behind me now, thus my response and hopefully much more timely replies in my immediate future.

As you will see below, I also didn’t want to rush my reply back to you, as this is very important to me and I wanted to understand what you wrote.

To help me, and maybe you too (since it appears you’re involved with many other threads a day) keep in sync with my many questions and your responses, I’ve decide to number them. With that being said:

1) You wrote:
“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?’
Well, I never did actually get a bottle of Metanx or Folax from my pharmacy (once I was told the price difference for the Metanx, I canceled my prescription) . . . and what do you mean "on an empty stomach": i.e., first thing in the morning, before I eat any breakfast, with all my other diabetes pills? . . . and then I usually don’t have something for breakfast 30 minutes later . . . is that OK/what you mean on a empty stomach? (or do you mean before lunch or dinner?)

2) I want to make sure I get your ‘prescription’ correct:

one Methyl B-12, 5000 mcg, per day on empty stomach (as per your link)

one P-5-P (Coenzyme B6), 50 mg, per day (with the above? and again, as per your link)

one Folate Metafolin Folic Acid, 800 mcg, per day (with the above? ad again, as per your link)

and taking this above, once a day, will equal 2 Mentax daily that was originally prescribed to me, correct?

3) assuming I take the above in the morning on an empty stomach with my other daily pills, do I need to be concerned that any in the above vitamins will react negatively with what I am already taking . .. specifically below:

for my diabetes type-2:
Metforman 1000 mg (and again before I go to bed)
Januvia 100mg
Glimepride 4 mg

For my cholesterol
Simvastatin 80mg

For my general health
Low does aspirin
Puritan Pride ‘One’ time release multivitamin

4) you should also know that before changing over to the Puritan Pride One multivitamin (puritan . com/multivitamins-067/puritans-pride-one-time-release-003661?NewPage=1), I was taking their mega-vitamin (puritan . com/multivitamins-067/mega-vita-min-time-release-004212?NewPage=1) . . . however, after reading what Metanx was, I was worried about taking it with my mega-vitamin (evn though my podiatrist said i had nothing to worry about), so I called Metanx and spoke to someone there, and he informed me that he was only concerned that my B-6 would be well over 100mg a day, and I should find a vitamin that contained 50 mgs or less of B-6 . . . thus my recent switch to Puritan Pride One – does this make sense to you? (if not, hopefully it’s at least more information for you to keep/store in you mental database)

5) I did take the time today to read many of the PN posts and the b-12 one – (another reason why I’m so late at getting back to, as I didn’t want to rush my reply and have the time to read these other posts) – thanks . . . there appears to be more good than bad news for many of your readers (which also makes me feel better)

6) In a later post, you mention the following that can also help me with my diabetic neuropathy, specifically:
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.
I think currently I’d like to go with the above ‘Mentax equivalent’ before adding any additional pills of any kind to my morning ‘cocktails’ . . .
And again, just sharing with you: my podiatrist does prescribe alpha lipoic acid (600mg daily), for PN, but only when you have pain (again, just sharing info with you, as I believe that knowledge is power)

7) I currently have no fear of colon cancer (a later post of yours referring to this when taking high folic acid) as I just had a colonoscopy after the first of the year, and all was ‘good’

OK, I think I’ve read everything you’ve replied to me about . . . and I have a general knowledge of what you are saying . . . and I am in sync with you. Please reply when you have time (and edit as necessary . . . I understand).

Oh, and one final question, is there a mechanism in place to contribute to the upkeep of this forum, since I know these things are not ‘free’ and I really do appreciate all the help you are giving me.

[mrsD]

I am going to reply in RED to your questions....okay? It is easier to read that way.

Originally Posted by LarP

mrs D et al –

Again, many thanks for taking my question(s) . . . I do appreciate it.

But, before I reply to your last posts, I want to apologize for this not-very-timely response. As per my previous quick/short response to you, I knew I would not be timely in getting back to your initial reply, however on top of my already busy schedule (which I won’t bore you with); I had a medical emergency with an immediate family member that just took any/all spare time. Thankfully, that appears to be behind me now, thus my response and hopefully much more timely replies in my immediate future.That's okay you can take your time as you like...I am here almost every day anyway...

As you will see below, I also didn’t want to rush my reply back to you, as this is very important to me and I wanted to understand what you wrote.

To help me, and maybe you too (since it appears you’re involved with many other threads a day) keep in sync with my many questions and your responses, I’ve decide to number them. With that being said:

1) You wrote:
“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?’
Well, I never did actually get a bottle of Metanx or Folax from my pharmacy (once I was told the price difference for the Metanx, I canceled my prescription) . . . and what do you mean "on an empty stomach": i.e., first thing in the morning, before I eat any breakfast, with all my other diabetes pills? . . . and then I usually don’t have something for breakfast 30 minutes later . . . is that OK/what you mean on a empty stomach? (or do you mean before lunch or dinner?) on an empty stomach means first thing in the morning with no food. Fiber and food will absorb the microgram amounts of methyB12 and keep it from being absorbed. Normally in our bodies, intrinsic factor binds the B12 in food and carries it thru for us. When you take separate B12 orally you rely on passive absorption in the intestine. Some people may have some intrinsic factor but since many have signs of low B12 you cannot rely on yours to do that for you. It might be gone.

2) I want to make sure I get your ‘prescription’ correct:

one Methyl B-12, 5000 mcg, per day on empty stomach (as per your link)yes

one P-5-P (Coenzyme B6), 50 mg, per day (with the above? and again, as per your link) you can take this every other day or daily based on what your other vitamin B6 intake already is. We have some posters on PN here who claim to have side effects at 50mg a day or lower. Not common but they do show up here. Taking this separately gives you freedom to control you doses better than a fixed mix like Metanx.

one Folate Metafolin Folic Acid, 800 mcg, per day (with the above? ad again, as per your link)
and taking this above, once a day, will equal 2 Mentax daily that was originally prescribed to me, correct? Metanx is very high in the methylfolate. If you take 2 of them a day it puts you over 5mg a day! I posted on that thread the new reports of high folate dosing connected to colon cancer...please go back and read that. I believe that the OTC dose of 800mcg a day from Solgar is adequate for most people. It is the B12 that is the major player anyway. We consume folate now in foods that are fortified.

3) assuming I take the above in the morning on an empty stomach with my other daily pills, do I need to be concerned that any in the above vitamins will react negatively with what I am already taking . .. specifically below:

for my diabetes type-2:
Metforman 1000 mg (and again before I go to bed)
Januvia 100mg
Glimepride 4 mg should be no problems...I'd take the methyl B12 alone tho, just to be sure. The other two don't matter.

For my cholesterol
Simvastatin 80mg This is a HUGE problem.... this drug causes NEUROPATHY...and loads of other neuro problems. You need to come to the PN board for further details. They are too numerous to list here. We even have some members damaged by this statin and other statins!

For my general health
Low does aspirin
Puritan Pride ‘One’ time release multivitamin

4) you should also know that before changing over to the Puritan Pride One multivitamin (puritan . com/multivitamins-067/puritans-pride-one-time-release-003661?NewPage=1), I was taking their mega-vitamin (puritan . com/multivitamins-067/mega-vita-min-time-release-004212?NewPage=1) . . . however, after reading what Metanx was, I was worried about taking it with my mega-vitamin (evn though my podiatrist said i had nothing to worry about), so I called Metanx and spoke to someone there, and he informed me that he was only concerned that my B-6 would be well over 100mg a day, and I should find a vitamin that contained 50 mgs or less of B-6 . . . thus my recent switch to Puritan Pride One – does this make sense to you? (if not, hopefully it’s at least more information for you to keep/store in you mental database) I use Puritian's products too. I think they are reputable. I answered the B6 question above.

5) I did take the time today to read many of the PN posts and the b-12 one – (another reason why I’m so late at getting back to, as I didn’t want to rush my reply and have the time to read these other posts) – thanks . . . there appears to be more good than bad news for many of your readers (which also makes me feel better) you are welcome.

6) In a later post, you mention the following that can also help me with my diabetic neuropathy, specifically:
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.
I think currently I’d like to go with the above ‘Mentax equivalent’ before adding any additional pills of any kind to my morning ‘cocktails’ . . . this is a good idea...which I often suggest to start slowly and see what happens. Sometimes you don't need to go further, and by limiting things slowly you see what is working, how much it works or any side effects that result.
And again, just sharing with you: my podiatrist does prescribe alpha lipoic acid (600mg daily), for PN, but only when you have pain (again, just sharing info with you, as I believe that knowledge is power) that good! r-lipoic is a newer more potent version of alpha lipoic.

7) I currently have no fear of colon cancer (a later post of yours referring to this when taking high folic acid) as I just had a colonoscopy after the first of the year, and all was ‘good’
this is nice to know. The high folate is not really involved in nerve actions as B12 is. In fact if you have low B12 levels, the folate in the serum may be falsely elevated already. The major benefit for using the methylfolate is to see if you radically respond to it. The genetic errors involving methylation can only be tested for by expensive DNA tests, or by trying the activated forms and see if you respond. I suggest you start with the lower 800mcg dose of methylfolate and see if it works. There is nothing to prove you need that high dose at all, at this point. You can always increase later. Some people may get "hyper" on folic acid -- I do. It is a treatment for severe depression. The RX vitamin Deplin is 7.5mg of methylfolate for this use, in fact.

OK, I think I’ve read everything you’ve replied to me about . . . and I have a general knowledge of what you are saying . . . and I am in sync with you. Please reply when you have time (and edit as necessary . . . I understand).

Oh, and one final question, is there a mechanism in place to contribute to the upkeep of this forum, since I know these things are not ‘free’ and I really do appreciate all the help you are giving me. No, at this time our admin DocJohn, does not accept donations of money that I know of. It is very generous of you to offer, but he runs this as a sister forum to PsychCentral. If you need to contact him one of us can forward your message to him. All of us here are volunteers. I am now retired and can devote some time to helping out here. The best way for you to contribute is as you are doing...providing questions and information so others can learn and perhaps fix things. I think becoming a member here is sort of a "donation" ..a giving back so to speak.

[LarP]

Hey mrs D –

just finding the time again to respond . . . as I jinxed myself the last time I replied . . . no sooner did I find the time to reply and then my family member took another turn for the worse that evening (but she’s back at a rehab center now, doing better) . . but I don’t think this time was as much of delay responding on my part . . . and I have fewer questions

thanks for the formatted red reply the last time – it really helped me (and hopefully others too) . . . OK, I still need a little clarification on few of your replies to my questions, so, I’ll copy/paste and format our ‘mini questions threads’ below and note my last reply/question in blue:

1) You originally wrote: “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?’ Well, I never did actually get a bottle of Metanx or Folax from my pharmacy (once I was told the price difference for the Metanx, I canceled my prescription) . . . and what do you mean "on an empty stomach": i.e., first thing in the morning, before I eat any breakfast, with all my other diabetes pills? . . . and then I usually don’t have something for breakfast 30 minutes later . . . is that OK/what you mean on a empty stomach? (or do you mean before lunch or dinner?)
on an empty stomach means first thing in the morning with no food. Fiber and food will absorb the microgram amounts of methyB12 and keep it from being absorbed. Normally in our bodies, intrinsic factor binds the B12 in food and carries it thru for us. When you take separate B12 orally you rely on passive absorption in the intestine. Some people may have some intrinsic factor but since many have signs of low B12 you cannot rely on yours to do that for you. It might be gone.
OK, I get it, first thing in the morning on an empty stomach, no probs . . . but, how long do I wait until I can have something to eat . . . and can I drink coffee soon after, or should I wait on this too?

2) I want to make sure I get your ‘prescription’ correct:
one Methyl B-12, 5000 mcg, per day on empty stomach (as per your link)
yes
no question, got it (clear enough)

one P-5-P (Coenzyme B6), 50 mg, per day (with the above? and again, as per your link)
you can take this every other day or daily based on what your other vitamin B6 intake already is. We have some posters on PN here who claim to have side effects at 50mg a day or lower. Not common but they do show up here. Taking this separately gives you freedom to control you doses better than a fixed mix like Metanx.
ok, so maybe I should start out taking it everyday . . . however, if I do get “side effects”, what will they be/what am I looking for? . . . or are you saying that maybe I don’t even need this vitamin due to my B-6 dosage now with my Puritan Pride One tablets (@ 50 mgs per pill daily) ? Please clarify for me (thanks) – net net, I’m not trying to be cheap here, however, the fewer pills/vitamins I need to take daily, the better off I’ll be, no?

one Folate Metafolin Folic Acid, 800 mcg, per day (with the above? and again, as per your link)
and taking this above, once a day, will equal 2 Mentax daily that was originally prescribed to me, correct?
Metanx is very high in the methylfolate. If you take 2 of them a day it puts you over 5mg a day! I posted on that thread the new reports of high folate dosing connected to colon cancer...please go back and read that. I believe that the OTC dose of 800mcg a day from Solgar is adequate for most people. It is the B12 that is the major player anyway. We consume folate now in foods that are fortified.
no question, got it, one a day is enough

3) assuming I take the above in the morning on an empty stomach with my other daily pills, do I need to be concerned that any in the above vitamins will react negatively with what I am already taking . .. specifically below:

for my diabetes type-2:
Metforman 1000 mg (and again before I go to bed)
Januvia 100mg
Glimepride 4 mg
should be no problems...I'd take the methyl B12 alone though, just to be sure. The other two don't matter.I assume your reply to my question above about how long to wait for the b12 to be absorbed into my body on empty stomach before AM eating/drinking coffee will also indicate how long to wait before I take the glimepride too

For my cholesterol
Simvastatin 80mg
This is a HUGE problem.... this drug causes NEUROPATHY...and loads of other neuro problems. You need to come to the PN board for further details. They are too numerous to list here. We even have some members damaged by this statin and other statins!
well, I certainly am happy that I asked this question . . . and I didn’t see this on the PN board the last time I looked via the link you provided … but, I have assince stopped taking this med, will search/read the forum and once I am more educated, I plan on contacting my diabetes doctor and podiatrist . . . do you know of any other generic cholesterol on the market that people are taking instead of simvastatin?

And I have one new question . . . how will I know if this is working (beside getting another density nerve fiber density test in 6 months and hopefully seeing my numbers go up) . . . only recently have my feet/toes started to tingle a tad a various random (?) times during the day . . . which I assume is the onset of PN . . . if the above vitamins work, will this tingling decrease/stop over time (in weeks/months)? – I understand that results my not be consistent for everybody/me, but I’m just looking for something I can watch for so I know this is working before another nerve fiber test

Thanks again so much for your time . . . I look forward to placing my vitamin order later this week and start on road to recovery