Folate instead of Folic acid

I'm a breastfeeding mum, and found out today at the GP that I have low folic acid levels. Vitamin b12 was high though. I've been feeling awful for the last few months, and seem to have all the symptoms of folic acid deficiency.I've been prescribed 5mg of folic acid a day until my levels are back up, but after a bit of research I would prefer to take folate and not folic acid. Unfortunately folate doesn't come in doses higher than 1000mcg. Could I take 5 of these a day to tally up to my 5mg a day instead? Without it being dangerous?


17 Replies

  • Why would you want to take methylfolate? It is more expensive, has lower bioavailability and, for the vast majority of people, folic acid is easily converted to methylfolate.

    I would recommend following your doctor's advice rather than some clickbait non-doctor on the Interwebs.

  • Whichever way you look at it, folic acid is synthesized. Human exposure to folic acid was non-existent until its chemical synthesis in 1943. Unlike the natural folates which are metabolised to THF (tetrahydrofolate) in the mucosa of the small intestine, folic acid undergoes initial reduction and methylation in the liver, where conversion to the THF form requires dihydrofolate reductase. The low activity of this enzyme in the human liver can result in unnatural levels of unmetabolized folic acid entering the systemic circulation which will show up in your serum folate levels.

    We are all on the web, sharing information from non-doctors. My personal experience is that if I had ignored my GP 10 years ago I wouldn't be on this forum.

  • Low activity of DHFR can, indeed, lead to high levels of folic acid - if taken in very high doses.

  • Not sure I entirely understand what you are saying. Surely high intake (doses) of folic acid will always lead to high serum levels regardless of DHFR. The low activity of DHFR just determines how much of that is unmetabolized and presumably is unable to be utilized by B12.

    Just checking my own understanding of it all.

  • If you take sensible amounts of folic acid then it will all be converted, fairly rapidly, to dihydrofolate, regardless of your DHFR activity.

    If you take large amounts of folic acid and you have normal DHFR activity then it will all be converted, fairly rapidly, into dihydrofolate.

    If you take large amounts of folic acid and you have poor DHFR activity then your body cannot convert it to dihydrofolate quickly and you will have high circulating levels of unreduced folic acid.

  • Thank you, I understand what you are saying. However, from the reports on clinical trials that I have read DHFR has an extremely slow rate of conversion and variable activity in the human liver, and as you say, high doses (whatever that might be) is limited to saturation of DHFR. From a personal point of view, being well past my sell by date, and not knowing whether I have poor, average, or normal DHFR I am erring on the side of caution and sticking to folate. My intake of folic will be limited to fortified foods and hopefully whatever DHFR activity I have will ensure those small amounts will be adequately converted.

    Thanks for your input, interesting discussion.

  • If you have low activity of DHFR then taking large amount units of methyltetrahydrofolate (MTHF) supplements may not be a good idea either.

    MTHF is converted to tetrahydrofolate (THF) in the reaction mediated by B12 (homocysteine -> methionine). THF then gets converted to methylenetetrahydrofolate (MeTHF).

    MeTHF takes part in two pathways. One is the reduction by MTHFR to go back to MTHF.

    The other pathway is part of DNA synthesis. In this process the MeTHF is converted to dihydrofolate (DHF) which is reduced by DHFR.

    So, if your DHFR activity is low and you take too much MTHF then you'll get a buildup of MeTHF.

  • Very interesting, what a wonderful place we inhabit! I take just about 40% of the RDV for folate (5-MTHF) - so hopefully that will save me from a build up of MeTHF - which I had never heard of!!

    I have great faith in the wisdom of the body and as folate is actively transported from the gut mucosa, and folic acid relies on passive diffusion, I can't help thinking it was less of a design fault than the body's attempt to deal with a synthetic substance, one which it would have never been exposed to prior to 1943. Perhaps this is why DHFR activity is low in the human liver - it was never designed to deal with the additional reliance of folic acid to metabolise - just folate.

    Thanks again

  • But folic acid is absorbed twice as well as natural folates:

  • Interesting article. Thought the paragraph on folate malabsorption (3rd para down after the graph) particularly interesting - although I am never quite sure whether they are actually talking about folate or folic acid or just using them interchangeably.

    Thanks again

  • It is very confusing. If you're a chemist then folic acid = folate. And only folic acid = folate.

    But biologists lump the whole lot together as folate and rarely bother to tell you which one(s) they're talking about.

  • Sorry, I meant to comment on the advice you were seeking. Personally, I would be inclined to take one 1000mcg (5-MTHF) of folate and then add in as many folate containing foods as you can, have folate checked again and see where your levels are, but you didn't say how low your levels were. The body only stores folate to last a few months.

  • Thank you for your reply. My folic acid level was 3.0. My diet isn't great so I don't know if I'll be able to reach the levels I need to. I think maybe 2 or 3 a day of folate and then the rest with food?

  • It is probably a good idea to look into changing your diet to increase the amount of folate you consume. Because those foods (leafy green vegetables, beans and pulses, seeds and nuts) are also packed with other good things.

  • 3.0 is quite low. By nature I am always a bit cautious, especially if making suggestions to others. However, if you are able to get re-tested in the not too distant future, 2-3 per day is only going to bring you to just about half of the prescribed 5mg folic acid. And, if some of the folic acid ends up unmetabolised you are probably going to end up with the same amount of usable folate anyway.

    Best wishes, hope it all goes well.

  • Don't forget that food folates only have 80% of the bioavailability of folic acid -

    That means you need to take 1250 ug of folate to equal 1000 ug of folic acid.

  • Interesting link Eaoz, thanks

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