The studies done with B12 orally showing various absorption rates, were done on an EMPTY stomach.

One thing you will see as you investigate various supplements, is that the makers of them are imperfect. And Big Pharma who makes drugs, are also imperfect.

Do what you think is best. If you want the BEST results take your B12 on an empty stomach.

Metanx was NOT enteric coated either... and P5P is best protected from stomach acid with an enteric coating. The better manufacturers of it provide it this way.

Taking vitamins with food is a generalization. It reflects the need for acid in the stomach for many of them. But taking microgram doses of B12 (and this pertains to some RX drugs also), with food, loses the drug in the fiber of the food, and it won't get to the lining of the intestines adequately. So in the case of B12 you need an empty stomach with nothing in the small intestine, to absorb the tiny micrograms of the cobalamin.

You are not going to absorb 1000mcg of methylB12...per dose. If you are lucky and do it correctly, you may absorb 13 micrograms of that huge dose. (this was found in the study I provide on the B12 thread. 13mcg a day is about 3 times the RDA and over time is adequate to improve B12 status in most people).

So I suggest you do it the way that has been opened for you and disregard the makers of Metanx, who are in error on this factoid.

Thanks.

I ordered the Kirkland 5mg from CostCo. They had a $3.00 non-member surcharge, but since they do not have one where I live it was not worth $55 to join.

I was just surprised to see Puritan Pride say to take it with food. Empty stomach it will be .

I am thinking 5mg/day. Your 5mg/day maxed out your lab. What level should I be trying to obtain for PN and homocysteine control? Typically, what is the dosage used by most folks?

Your comments have been very helpful. Thank you very much!

Next is to look at P5P.

My Metanx prescription was also declined by Express Scripts for reason that my insurance does not cover it. But it's isn't so clear to me because when I bought it through my local pharmacy, they got approval from my insurance. I am not just sure if they will allow a refill. I started taking it last April 3 so i don't know yet if there will be an effect on my pain. I hope so..does it have a good effect on your neuropathy?

You mentioned about some studies that suggest increased risk of colon cancer with Metanx, did it mention which ingredient/s of Metanx that make it high risk?

I called an online pharmacy that sells Metanx (I forgot the name)- I asked if they have generic, the pharmacist said they do but these are not considered as AB generic.

If I could not get a refill next week, I might just try buying a separate folate to be combined with Vit B12 and Vit B6.

The tablet form of MetaNx was changed to a capsule. That is the reason it was listed as discontinued. I would need a new Rx for the capsule form. However, MetaNx is listed as a "medical food" which is not covered under any circumstances by my coverage. I have been taking MetaNx since ~1996 (originally prescribed because of high homocysteine). I did not realize I had PN until I stopped taking MetaNx -- shock! Yes it did help me.

It was folate; however, later studies concluded that no risk exists.

My local pharmacy told me that a generic was Foltanx manufactured by Breckenridge. My doctor has submitted a Rx to Express Scripts using the generic component formula - I expect to see it rejected too.

Based on the comments by mrsD that is my strategy. I ordered the CostCo Kirkland B12 5000 mcg, but have canceled the order (gotta find another source since Kirkland does not have 1000 mcg). I was getting 2mg with MetaNx and think I should start with 1mg tabs two a day. I have ordered Solgar - Folate (Metafolin) 800 Mcg and am thinking about the Solgar P5P.

I hate having to fix something that was really not broken.

You can still use the 5mg and just take it twice a WEEK, to get the dose you want.

I have to wonder about the studies also for homocysteine effects. Recently there have been studies (they quote them on the Mayo site) that vitamins don't work. I have to wonder if ANYONE in research learns from other studies on microgram dosing... EMPTY STOMACH!!! Also P5P should be enteric coated and saved from stomach acids. AND all 3 vitamins should be given in their activated states... so that best results can be had for the MTHFR patients. Sometimes it is like the left hand not knowing what the right hand is doing! ...sigh!
Putting P5P in there with two other ingredients that don't need enteric coating, doesn't make sense. An all in one pill was rather doomed IMO.

When reading "studies" on nutrients, which tend to have results all over the place, we never see what variables are controlled and which are not. I think this is the main reason for all the data which seems to be very hard to corroborate.

Upon reading the NEW ingredients for Metanx...one has to wonder???

Only thing missing is the kitchen sink?
from
http://www.metanx.com/helpful-resources/package-insert/

Mrs.D,

When i do my own combinations of vitamin bB12, Methylfolate and B6, do you think it would be okay if I take my usual VitB12 2500mcg (I used to take it 2x a week as you suggested after I had my 1999 blood result back in June 2012), B-Complex, then the Methylfolate that you suggested.

Before Metanx (prior to June 2013), I was not taking a separate vit b6 (I was only taking 1x a week B-Complex) because at one point in my treatment, one neuro told me to stop the b-complex. I remember he said that high b6 causes neuropathy. I think I get sufficient B6 from my diet so I just take the 2x a week b-complex.

I'm not sure if I'm making any sense....basically, my question is can I combine:

1. Vitamin B12 2500 mcg at 2x week
2. Vitamin B-Complex at 2x a week
3. Methylfolate 800mg

Thank you.

Sounds okay to me. To get neuropathy from B6 you would have to consume 500mg a day or MORE (most of the studies had much more than 500mg a day) for a LONG time ....It is not really that common.

Why doctors fixate on this B6 issue, when statins and fluorquinolone antibiotics are right under their noses and pens, doing far more damage every day, is beyond me .

After thinking about my quote above with the LONG ingredient list for the new improved Metanx capsules... I've had an idea.

All that LONG list of other nutrients...would make it very hard to make a generic...since generics have to be identical to be AB rated. On the downside for patients, making a capsule is more expensive than a tablet, so the patient will end up paying more for the added ingredients and capsule formulation.

It's money, money and more money... It's sad but its the way life is. Take us, MAC patients, big pharmaceuticals don't invest on new medicines to fight this bacteria because, they think their market is not that big meantime, we have not much options but to take the current available medications that even doctors admit that "side effects are worse than the disease". Tsk! Tsk!

I think my options are

Puritan's Pride Methylcobalamin Vitamin B-12 1000 mcg 1000 mcg / 30 Microlozenges
24 bottles - 720 tables (2 people for 1 year) costs $47.92 @ $.07/ 1mg tablet

Source Naturals, MethylCobalamin, Cherry Flavored Sublingual, 1 mg, 120 Tablets
6 bottles - 720 tablets (2 people for 1 year) costs $53.70 @ $.07/ 1mg tablet

CostCo Kirkland Signature™ Sublingual B-12 5000 mcg., 300 Tablets
3 bottles - 900 tablets (2 people for ? year) costs $62.97 costs
@ $.07/ 5mg tablet - $.01/ 1mg tablet

So two Kirkland per week is 10mg or 7 other is 7 mg -- big cost difference.

My initial thinking was that it would be better to space it out to even out the absorption, but your comments suggest that is not necessary. So I take 5mg per day and see where is my B12 level. Please explain again why I should not take B12 for 4-7 days before the blood work?

Thank your for your assistance.

Mike

BTW, I know B12 is empty stomach - had to find with all my other medications. Any drug interactions?

When should B6 & Folate be taken and any drug interactions?

Mike