Folate instead of Folic acid - Pernicious Anaemi...

Pernicious Anaemia Society

32,672 members24,065 posts

Folate instead of Folic acid

OnePlusThree profile image
15 Replies

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?

Thanks

Written by
OnePlusThree profile image
OnePlusThree
To view profiles and participate in discussions please or .
Read more about...
15 Replies
fbirder profile image
fbirder

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.

fbirder profile image
fbirder in reply to

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

in reply tofbirder

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.

fbirder profile image
fbirder in reply to

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.

in reply tofbirder

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.

fbirder profile image
fbirder in reply to

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.

in reply tofbirder

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

fbirder profile image
fbirder in reply to

But folic acid is absorbed twice as well as natural folates: ncbi.nlm.nih.gov/pmc/articl...

in reply tofbirder

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

fbirder profile image
fbirder in reply to

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.

OnePlusThree profile image
OnePlusThree in reply to

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?

in reply toOnePlusThree

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.

Interesting link Eaoz, thanks

Not what you're looking for?

You may also like...

B12 neuro folic acid

Neuro bad symtoms there’s so much different advice around I’m so confused most are saying b12...
Milley2 profile image

Folic Acid 5mg too much?

Hello, My doctor prescribed me 5mg folic acid for 4 months because my red cell folate was low...
GastritisB12 profile image

Folate or Folic Acid ?

Hi, Can anyone advise if it is best to supplement with Folate or folic Acid when receiving B12...
KMC21 profile image

Checking on my understanding of Folic Acid

The friend I am giving information to and not advising has Serum Folate test results of 3.3 ug/l....
WIZARD6787 profile image

Folic acid

Hi I've posted further down so I wondered if anyone else could help me. I've got folic acid 5 mg...
Ndobins profile image

Moderation team

See all
Gambit62 profile image
Gambit62Administrator
Foggyme profile image
FoggymeAdministrator
taka profile image
takaAdministrator

Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.

Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.