Methyl Folate & Folic Acid for women
Before we get into this topic, there’s a few important things to note about vitamins & minerals
All the micronutrients work together (and should be given proper respect for their unique and important physiological roles).
Supplementing an excessive amount of one single nutrient could be harmful.
It’s always best to test not guess…however testing vitamins & minerals is not always accessible so there are recommended guidelines called “tolerable upper limits” that tell us the highest amount we should supplement based on current nutrition research. Some people can benefit from higher doses than the tolerable upper limit, but always work with a practitioner who understands your health holistically if you are going to take vitamin & mineral supplements, especially in high doses.
What is folate?
One of the most commonly known vitamins to support a healthy pregnancy is folate, or vitamin B9. This vitamin supports the development of a baby’s nervous system and prevents neural tube defects. Folic acid is the synthetic form of folate that is found in a lot of prenatal vitamins. In 1998, to combat the risks of folate deficiency, the FDA began fortifying our bread, pasta, rice and cereals with folic acid. Folate is the natural form of vitamin B9. In the body, folate must be converted into methylfolate through a series of chemical reactions. Folic acid must also go through a few reactions to become bioavailable. The bioactive form (methylfolate) is what participates in the many processes in the body.
Folate is also found in foods including animal products (especially organ meats) leafy greens, vegetables & citrus fruits. It’s pretty difficult to get enough folate from the diet alone to support a healthy pregnancy, this is why it’s important for women to supplement in their reproductive years.
In addition to supporting a healthy pregnancy, folate also functions in:
Production of DNA & ribonucleic acid, the building blocks of all our cells.
Production of red blood cells which carry oxygen to our cells and help us feel energized.
The function of neurotransmitters serotonin, dopamine and norepinephrine which impact our mood & mental health. In fact folate deficiency may play a role in depression due to it’s impact on these neurotransmitters (Bottiglieri T, 2005).
A folate deficiency can lead to feeling weak, lethargy, low appetite and heart palpitations. As stated previously, no nutrient works in isolation. Vitamin B9 works closely with vitamin B12, so it’s important to have adequate amounts of both.
The recommended amount of folic acid for ANY woman of reproductive age is 400 mcg. If a woman has previously had a baby with a birth defect, then the CDC recommends 4,000 mcg folic acid each day.
Methylfolate & MTHFR
There is some debate about taking folic acid verses methylfolate due to the recent discovery of the MTHFR gene. This gene impact how we use folic acid and other nutrients in the body. Researchers now think about 50% of women can’t fully absorb folic acid and turn it into the bioavailable form.
Which should you take in pregnancy?
As previously stated, it is still recommended to supplement with folic acid, especially in pregnancy. Folic acid has shown the best results for reducing the risk of neural tube defects. However, you can also supplement with methylfolate. The American College of Obstetricians and Gynecologists recommends pregnant women take at least 400 micrograms of dietary folate equivalent (DFE) daily, starting one month before conception and continuing through the first 12 weeks of pregnancy. If you have confirmed you have the MTHFR gene, then it is essential to also be taking methylfolate throughout your life. Ideally, measuring your micronutrient levels (I run these labs through Vibrant America) and homocysteine levels.
Are there risks of too much folic acid?
Yes potentially. Studies have determined the upper limit of folic acid to be 1,000 mcg daily. Taking above this amount could cause a vitamin B12 deficiency. Excess folic acid can also accumulate in the body as unmetabolized folic acid.
There are some mixed results from studies looking at when women took higher than the recommended 1,000 mcg of folic acid. Some studies did find women who over-supplemented in pregnancy had children with decreased memory and cognitive function. However keep in mind, correlation does not show causation, this doesn’t mean it’s directly from the folic acid. Throughout the many studies on folic acid, there is still no real conclusion on the risks of oversupplementing.
Some researcher are also studying if there are risks of “unmetabolized folic acid”. Some think that folic acid may actually block the body’s ability to use folate as effectively.
Who is most at risk for folate deficiency?
According to the National Institute of Health, there are multiple groups at risk of deficiency, specifically women. About 19% of adolescents (14-18 years) and 17% of women (aged 19-30) don’t meet the estimated average requirement for folate. 23% of non-Hispanic black women do not get enough folate. Factors that can impact metabolism of folate (in addition to the MTHFR gene) are oral contraceptives, Metformin and alcohol intake.
References
Bottiglieri T. Homocysteine and folate metabolism in depression. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Sep;29(7):1103-12. doi: 10.1016/j.pnpbp.2005.06.021. PMID: 16109454.
CDC. Folic acid safety, interactions, and effects on other outcomes. cdc.gov.
