About one in 7 people have a genetic deficiency that keeps them from converting folic acid to its final usable form. The genetic defect is in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, causing a folate deficiency even though they have plenty in their diet or supplements.
Folic acid/folate is a B-vitamin (B-9) that is needed to make healthy new cells, protein synthesis, as well as stimulate antioxidant activity. It is found in peas, beans, citrus fruits, and leafy green vegetables. Deficiencies during pregnancy can lead to major birth defects like spina bifida (an incomplete closure spinal column that leaves the spinal cord less protected), encephalocele (an incomplete closure of the skull allowing brain tissue to protrudes out through the skull to the skin), and anencephaly (an absence of parts of the brain, skull, and scalp). New evidence shows that it also cause premature birth and heart defects.
Folate is needed to convert the amino acid homocysteine into methionine. When there is insufficient folate in its usable form, homocysteine levels will rise. Homocysteine is inflammatory and plays a role in the hardening of arteries as well as increases the risk of heart attacks, stroke, and Alzheimer’s disease. Some say that it is an even larger risk factor than high cholesterol and that statin drugs reduce heart disease by reducing inflammation rather than lowering cholesterol. Other nutritional deficiencies that can increase homocysteine levels are B-6 (pyridoxal-5-phosphate is the active form) and B-12 (methylcobalamin and adenosylcobalamin are the active forms).
Other causes for folate deficiencies are excessive alcohol consumption, smoking, celiac disease, kidney dialysis, diabetes, MS, age, other nutritional deficiencies. Drugs such as aspirin/ibuprofen/NSAIDs, antacids, antibiotics, barbiturates, birth control pills, anticonvulsive/epileptic/bipolar medications, diuretics, H2 blockers (Tagamet, Pepcid, Zantac), and proton pump inhibitors (Nexium, Prevacid, Prilosec).
Depression and Anxiety
The American Journal of Epidemiology recently published a review of literature that that indicated that this genetic defect may play a role common psychiatric disorders including depression, anxiety, bipolar disorder, and schizophrenia.
The review encompasses 26 studies with 1,280 people with depression, 2,762 cases of schizophrenia, and 550 cases of bipolar disorder. They found that people with these disorders were significantly more likely to have this genetic defect, and suggest that supplementation with folate would help.
Other studies have already shown that low blood folate levels are found in 1/3 to ½ of all people suffering from depression. One study showed that low blood plasma levels doubled the chance of depression. Another found that seniors are more likely to have depression with low folate and B-12 levels. Finally, for those with depression, lower folate levels increased the length and severity of there depression.
5-methyltetrahydrofolate (5MTHF) is the fully converted form of folate. People with the genetic defect can utilize this form directly. One study showed that supplementation with 5MTHF caused 81% of patients to see improvement in depression in six weeks. Another study showed that patients with normal blood folate levels that were given 5MTHF improved the same amount as those on antidepressant drugs.
Other nutrients that I’ve seen help depression include Vitamin C, Iron, Niacinamide, B-6, Manganese, Zinc, and Copper.
There are many types of folate supplements. For those with the genetic deficiency for folate conversion, I recommend the final form of 5-MTHF. Again one in seven people have this deficiency (I am one of them).
If you have a family history of these issues, 5-MTHF may be beneficial. In my practice, I start with recommending 1mg 2x/day. Because folate is needed to detoxify alcohol, I recommend taking extra when drinking. I like Thorne's 5-MTHF best because of it's purity.
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