In honor of National Folic Acid Awareness Week which just passed (January 6-12), I thought I’d shed some light on the importance of this water-soluble B-vitamin. Folic acid and folate are not the same. Folic acid is the synthetic form of folate used in supplementation and fortified food, while folate (also called methylfolate) is the active form of this vitamin.
Folate is important because it acts as a methyl-donor, playing a crucial role in DNA and RNA formation, nervous system function, homocysteine metabolism, and liver detoxification. Low folate may be associated with mood disorders, anemia, heart disease and stroke, autism, dementia, and cancer.
Some causes of folate deficiency include alcoholism, pregnancy (the need for folate doubles by the third trimester), malabsorption, a genetic mutation causing the inability to convert folic acid to it’s active form, or medications like anticonvulsants, oral contraceptive pills, and the diabetic medication metformin.
Did you know that folate is needed to build neurotransmitters like serotonin, dopamine, and norepinephrine? Low levels of these neurotransmitters are associated with depression, anxiety, and other mood disorders. A mutation in the gene that converts folic acid to active folate is estimated to be present in up to 70% of people suffering from depression. In these cases, supplementing with methylfolate has shown great improvement in symptoms. Extremely high rates of the genetic mutation have also been found in children with autism.
Folate breaks down homocysteine, an amino acid that circulates in the blood and is associated with heart disease, stroke, and peripheral vascular disease. Ensuring adequate folate either through the diet, folic acid supplementation, or methylfolate supplementation if a genetic mutation is present, may reduce the risk of heart disease.
If you have a personal and/or family history of early heart disease, mental illness, cancer, or frequent miscarriages, you may want to ask your physician about testing for a MTHFR genetic mutation (the enzyme required to convert folic acid to active folate).
Getting B-vitamins through the diet is the best choice and will be adequate for most people eating a healthy, whole-foods diet. Supplementing with folic acid will be beneficial if you don’t get enough folate through foods as long as you don’t have a MTHFR genetic mutation. Choosing a supplement may be difficult as there are a lot of options out there, and the form of the folate does matter. When you’re reading the back of supplement labels, 5-MTHF is active methylfolate. Occasionally the form will be specified. When it is, you’re looking for the L-methylfolate. Don’t choose blends of D-methylfolate and L-methylfolate because the D form decreases activity of the L form. Deplin is a prescription only form of methylfolate that comes in 15 mg tablets. Deplin may be covered by insurance if genetic testing reveals MTHFR mutations. Talk to your naturopathic physician to see if supplementation with B-vitamins will benefit your health, and to determine the appropriate dosage and forms for your unique needs. Remember, long term supplementation with a single B-vitamin may cause depletion of other important B-vitamins, so it’s important to work with your doctor to achieve optimal health.