Should I take folic acid?
This is a hot topic with pretty compelling research. Let’s first talk a little about folate.
Folate is required for DNA production and repair, detoxification/methylation, neurotransmitter production, formation of red blood cells, white blood cells and platelets; therefore, issues with folate can be VERY far reaching. This creates impaired healing, fatigue, anemia, depression, anxiety, birth defects, infertility and much more. This is why many OBGYNs will prescribe folic acid to their patients both before pregnancy and during. Is this a good idea or is there a better option?
So folic acid is good right? That might not be the case anymore.
First and foremost, folic acid is not folate. There are over 100 forms of naturally occurring folate and folic acid is not one of them. Folic acid is actually a synthetic form of folate. It’s used in supplements and fortified foods because it’s cheaper to make and use. However, it takes quite a bit of effort to turn it into a usable form in the body.
The synthetic form of folate, Folic Acid, has to be converted into Dihydrofolate before it can be used in the body. The body is very slow at doing this and may not be able to keep up with the amount of synthetic folic acid you are consuming. This means there is a good chance of synthetic folic acid floating around in the bloodstream un-metabolized, which isn’t a good thing. Un-metabolized folic acid can block the active forms from getting into the cells where it is needed! This can create problems that mimic folate deficiency and your labs look perfectly normal. SIDE NOTE: even if you are negative for MTHFR mutations, excessive folic acid supplementation can potentially cause MTHFR related issues!
This is why many doctors will run B12 and folate levels in the blood, and it will show an elevated or normal level. This DOES NOT mean your natural B12/folate levels are good! This lab is not enough to tell what’s really going on. You have to look inside your body’s cells to see if the folate is getting in and being used correctly. Just because you get it into the blood, doesn’t mean you are using it or even getting it into your cells! You can do this by looking at your anemia markers, RBC vitamin levels, homocysteine levels, or an Organic Acid Test to get a good idea of what’s going on physiologically. I’ve started running Organic Acid Testing on all my patients, and it’s probably a good idea you have one too. If you have elevated B12 or folate levels in your blood, I’m very suspect of you taking the wrong form of the vitamin or having a genetic mutation somewhere.
So what do you do?
As we have said, synthetic folic acid supplementation can cause issues and even mimic MTHFR problems in patients who do not have the mutation (take our MTHFR e-course to understand this further).
B12: Methylcobalamin, Adenosylcobalamin, Hydroxocobalamin
Folate: 5-methyltetrahydrofolic acid
Sometimes people who have depression, anxiety, infertility, MTHFR/ DHFR mutations, or altered labs need to supplement with extra forms of folate. It’s also a good idea to supplement prior to conception/pregnancy. Folinic acid and Methyl-folate are great forms to take. Methyl-folate is an excellent and widely used form that will bypass the mutations at the MTHFR enzyme that up to 40% of us have, including myself (Dr. Chad). Many people notice a large boost in energy, a decrease in depression, successful pregnancy and even weight loss just by switching forms.
Folinic acid is another form that is widely used. It’s commonly used while on folate antagonizing drugs (ex: methotrexate) and after certain antibiotics. It’s also a safer form of folate to use with people who cannot tolerate methylfolate and/or have a lot of anxiety. Sometimes people (possible COMT and VDR mutations) cannot tolerate methylfolate and are better off using folinic acid because it can aggravate anxiety. This is why it’s important to start small with methylfolate and work your way up. I’ve seen too many patients come in complaining of anxiety with MTHFR and they are taking 2000 mcg of methyl-folate from another doctor, and it’s thrown them into anxiety attacks. YOU MUST START SLOWLY! Sometimes I start as low as 400 mcg with patients and work up until they feel better.
If you notice the benefits of methylfolate wearing off after a while, its probably a good idea to look and see how your mitochondria are doing. Sometimes toxic exposure can wreck havoc here and we have to address that. That’s beyond the scope of this article, but I’ll have something up soon! Please see a licensed practitioner to help.
If you’re taking a multivitamin or prenatal, please read the label and see what form of folate it contains. If it’s folic acid, you might want to look for a new one.
A good Multivitamin would be Metagenic’s PhytoMulti: Link here