Thoughts on folic acid, folate, 5-MTHF, or L-5-MTHF

Each of the B vitamins is referred to by a specific number. B1 is called thiamine and B7 is biotin. Some compounds that were originally referred to as B vitamins were corrected later as more was learned about their forms. Thus we don’t have a B4 or B8.

B9 is generally thought to have two different forms — folic acid and folate. These forms carry out crucial functions like creating red blood cells and healthy development of brain cells for infants. B9 is important in the formation of DNA and cell growth.

Not getting enough B9 has consequences that can lead to heart disease and stroke. Birth defects have been associated with insufficiencies as well as an increased cancer risk for adults.

Folate can be found naturally in foods, especially dark green leafy vegetables, while folic acid is synthetically produced. The Latin word “folium” means leaf, thus we get the word folic. Folate can also be found in legumes, eggs, Brussels sprouts, broccoli and asparagus. Citrus fruits and beets are good sources.

Folate is more accurately the name given to a group of compounds with very similar properties. The body converts folate in the digestive system into the forms that in can actively use. One is called levomefolic acid or, if you want an even more complicated name, 5-metyhltetrahydrofalte. This is often abbreviated as 5-MTHF.

Typically consumer grade supplements that include B9 have the folic acid form. This is the same for fortified foods. You’ll find it in flour and cereals. This form is certainly less expensive to produce. The synthetic form of B9 is referred to as pteroylmonoglutamic acid. Whew!

Folic acid needs to be converted to more active forms in the liver and other tissues to be used. That process is slow and not very efficient. Thus it may not all get converted into the 5-MTHF form before the next round is consumed. Thus we have the potential problem of accumulating too much folic acid.

While folic acid has long been considered more absorbable than what we can get from food, we now know it takes more work for the body to actually utilize it. Excess folic acid has been associated with several health problems.

Long term elevated levels of un-metabolized folic acid are linked to increased cancer risk and may mask low levels of B12 deficiency that could lead to dementia and impaired nerve function.

Some people with genetic mutations are unable to utilize B9, whether folic acid in supplements or folate form in food. There is an enzyme responsible for this transformation that is missing. Methylation is the process by which folic acid is converted by this enzyme into the active form, also called reduced. When the genes that guide this process are out of order, the conversion is impaired. Unfortunately almost 66% of us have these gene mutations.

I think, it’s really best to get as much B9 as you can directly from food. And when supplementing look for products that have the more active form of 5-MTHF. It will tell you on the back what form it is. If it doesn’t specifically say than I assume it is folic acid.

There are several types of the active form of B9 made by companies. One is a brand called Metafolin which is found as a prescription under the names Deplin or Metanx. Another form is called Quatrefolic which is often written as L-5-MTHF. The nice thing about this form is that it is easily absorbed in the intestine in higher amounts.

The main thing to remember, is make sure you get as much folate from food as you can. And when you need to get more, use a form that is active and won’t over accumulate in your body.

Scott Porter, a functional medicine pharmacist, is the director of the Center for Functional Nutrition at Sandpoint Super Drug.