Dear Dr. Roach: My wife of 59 years has a number of health issues, of which the most devastating is Alzheimer’s disease. This year she was selected to participate in the study of a new investigational drug. She has been receiving a monthly injection of B-12 for a number of years.
During the screening process, it was determined that she has not been receiving the full benefits of the B-12 injections. It seems that she had some kind of blockage, preventing full acceptance.
Her regular doctor put her on Deplin. She would be required to take this medication for the rest of her life, but because it’s not covered under our medical plan and is costly, he gave her L-methylfolate Cap Forte 15.
After a short amount of time, its price also became economically difficult. Her doctor then put her on SAMe, 200 mg daily. It is my understanding that he has begun changing other patients over to SAMe because of the cost issue.
Is my wife receiving the benefits from this over-the-counter medicine, and will it provide the results intended?
Dear A.N.: Some research suggests that dementia may be slowed by treatment with a mixture of B vitamins, especially B-12, folic acid and B-6. I am grateful to you and your wife for being part of a study so we can answer with some certainty, if it really helps.
One issue that many investigators are actively researching is whether some individuals with different versions of a gene responsible for folic acid metabolism, MTHFR, have increased risk for dementia.
Deplin is the brand name of L-methylfolate, an activated form of folic acid that may be (but isn’t yet proven to be) better for some people. Methylfolate is much more expensive than regular folic acid, which is purchasable almost anywhere.
In most people, it probably doesn’t make a large difference.
SAMe, on the other hand, has some good evidence as a supplement in people with depression, and those with osteoarthritis. Biochemically, SAMe and methylfolate are similar in that they are methyl donors. It’s not unreasonable to think that it may have value in slowing dementia, but there is not enough evidence for me to recommend taking it.
I am confused, though, about why you and your wife are paying for these medications; study medications normally are provided free to study participants. I can’t recommend these supplements outside of a clinical trial, despite the fact that they are very safe.
One final point is that in people with vitamin B-12 deficiency, taking folic acid supplements (of any type) can make the B-12 deficiency critical.
Dr. Roach Writes: I wrote a column on the small amount of decreased absorption of thyroid replacement hormones following food and even coffee. I had recommended waiting an hour after eating, especially if the dose of thyroid hormone were small or needed to be precisely regulated.
Several readers asked whether it is safe to take thyroid hormone on an empty stomach, and it is.
Email questions to ToYourGoodHealth@med.cornell.edu.