In today’s episode I’m going to be talking about the vitamin known as folate or vitamin B9, and dispelling myths and confusion.

Along with the other B vitamins, vitamin B9 is used to convert food into fuel and support healthy new cells, such as for skin, hair, blood cells, and even collagen (joints), as well as the cervix. Folate is also used for making and breaking down neurotransmitters, such as serotonin and dopamine, which influence our mood, energy, focus and sleep.

During pregnancy, vitamin B9 is needed to ensure proper spinal cord development and to prevent birth defects and miscarriages. Folate is also important for the detoxification processes carried out in the liver, as well as for protecting our DNA.

The reason I want to cover this vitamin is because I find that there’s so much confusion about it and so many of you are trying to figure out whether you need more or less folate. Also, I want to help you understand the gene variations related to folate (MTHFR) to make sure that you can prevent health issues that are associated with these gene variations.

Folate vs Folic Acid

One of the first confusions is about the difference between folic acid and folate. A lot of times you’ll find that “folic acid” and “folate” are used as if they’re the same thing, when they are not. Folic acid is a synthetic nutrient, so it’s not found in nature, whereas folate is the form that is found in nature and is the active form our bodies can use. 

In biochemistry, folate is referred to as methyl folate, or L-methylfolate, or 5-methyltetrahydrofolate. It is the precise enzymatic form available for immediate cellular absorption and use. In other words, the human body can use it without any conversion needed. For the purposes of this article, I’ll refer to it as folate.

Folic acid, on the other hand, must first be converted to folate. We each have a certain degree of ability to turn folic acid into folate within our bodies, which is determined by our genetic individuality, and our stress exposure and recovery. Depending on your genetics, you may have a 10% to 80% decreased ability to turn folic acid into folate.

Folic acid is used to fortify different foods. It’s a synthetic substance (and less expensive) that’s added to processed (engineered) foods. If you think of bread and cereal, you are likely to see folic acid listed on the ingredient list. It can also be used in multivitamins, B complex supplements, and prenatal vitamins, as well as protein shakes. 

I recommend against using supplements containing folic acid, and to choose products containing folate instead.

Folate is found in green vegetables like spinach, broccoli, asparagus, and Brussels sprouts. Meat products also have this natural form of the nutrient, such as liver and other forms of meat, as well as eggs. You can also find it in sunflower seeds, legumes, and peanuts for example. 

How to Measure Folate in Your Body

Depending on your genes, your body may have a better or worse ability to turn folic acid into folate. If you want to know your folate levels, blood work can be misleading because the blood test for “folate” includes both the synthetic and the natural form (and other metabolites).

For a more accurate measurement of how much active folate you have in your body we need to either do a specialty test (there are labs that do specialty tests to identify your actual active levels) or do a test for something called homocysteine because homocysteine is a metabolite in our biochemistry that uses folate. So, if we measure the homocysteine, we can get a sense of if your body has enough folate, and how well it is being used.

Homocysteine is also influenced by B6 and B12 levels, so it is also helpful to check your methylmalonic acid because methylmalonic acid tells us about your B12 metabolism. If methylmalonic acid is at a good level, we know B12 deficiency is not the cause of elevated homocysteine. These tests can be done at a regular lab and can be covered by insurance. 

I want you to know this because I want you to know that there are people like me who have a lot of additional training to understand all this biochemistry and nutrients and can help guide you to optimize your homocysteine, methylmalonic acid, folate dose, and the use of it in your body. So, I don’t want you to feel like you’re on your own with any of this.

Folate and MTHFR

MTHFR is a type of gene mutation or variation that lowers the efficiency of the MTHFR enzyme. When you have an MTHFR gene variation (or two), it potentially decreases your ability to convert folic acid into methylfolate. 

The reason I say “potentially” is because it is not an absolute effect. Whenever we have gene variations, it doesn’t automatically mean they will influence our health. Gene expression has to do with our emotional and physical stress (and toxin) exposure, and the extent to which we support ourselves to recover from stress. More on that below. 

There are two main MTHFR genes that research has shown to have a potential effect on our health – C677T and A1298C. And it is possible to have one or two variations on each of those genes. That means that you may have one or two variations MTHFR gene variations, and at least 40% of us have at least one. 

The degree to which an expression MTHFR gene variation affects your ability to convert folic acid depends on the gene and whether you have one or two variations. Be sure to listen to my FREE Masterclass on MTHFR to learn more.

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Having an unaddressed MTHFR gene variation and inadequate folate levels can have a wide variety of negative effects on the body. It known to be related to increased levels of anxiety, depression, migraines, fatigue, abnormal pap smears and cervical cancer, miscarriages, joint hypermobility (EDS) and pain, as well as heart disease, diabetes, dementia, and cancer. Be sure to read the blog posts on my website on this topic to learn more and check the reference below if you’d like to read the research.

Fortunately, it is possible to do testing to get the information we need in order to know how to best support your body and provide adequate folate (in the active form), as a detour around the MTHFR gene variations. We can also support you to recover from stress so that you can more efficiently use it and potentially even turn off the gene expression. 

It’s important to know that just because you have an MTHFR gene variation doesn’t mean that you absolutely need a certain dose of folate. And it doesn’t mean you need folic acid either.

We have to look at both the genes and how the genes are influencing your health at this moment in time. To do that, we need to measure your neurotransmitter levels (which can be measured in urine) to see if your levels are too high or too low. We need to check your cortisol levels to find out whether stress and trauma has disrupted your cortisol levels. We need to do a high quality IgA/G food panel to find out if you have leaky gut and inflammation coming from your digestion. And in some cases, we also need to check your metabolism using an organic acid panel, and to check for toxins in your system. 

It is only when we have the full picture of both your genes and how those genes are influencing your metabolism that we can determine whether you need more or less folate in your diet or supplements.

What Affects Our Ability to Use Folate Besides Genetics?

If you have a gene variation but if it’s not expressing, then it is not affecting your health. But still, it’s not just about the gene variation. And it’s not just about taking folate. 

There are factors from our environment, or what I refer to as stress exposure, that affect our ability to use folate effectively. 

• Emotional Stress and Trauma: Any kind of emotional or psycho-emotional stress in the present moment, or even in the past, or accumulated stress, will influence your cortisol and adrenaline levels. When those levels get out of balance, your ability to utilize folate is hindered.
• Physical Stress: Whether you have an injury, infection, or nutrient depletion, it can affect your ability to use folate effectively and it also affects your genetic expression. Those same stresses affect not just folate, but also our ability to use all the other B vitamins in a process called methylation. If you want to learn more about methylation you can watch episode #145 of How Humans Heal.
  So, our ability to use our B vitamins is affected by emotional and physical stress and that’s why I talk so much about stress recovery – because it determines your ability to optimally benefit from folate and the other B vitamins. With stress recovery, you can optimize your cortisol and adrenaline, and you can optimize other functions in your body, so that you can get the most out of folate from your diet. 
• Nutrient Deficiencies: Another important factor in how your body is able to benefit from folate is your nutrient intake and nutrient deficiencies. Several nutrients are involved in the processing of folate, including iron, magnesium, and zinc. If you have nutrient deficiencies because you are not getting adequate amounts from your diet, or if you are taking medications that deplete your nutrients, it can influence your ability to use folate effectively.
• Medications: Certain medications affect the ability to use folate. Birth control pills (and estrogen in general) deplete folate; methotrexate (which is a medication used to treat rheumatoid arthritis) and sulfa drugs block the DHFR enzyme and conversion of folic acid to folate; metformin inhibits absorption of folate from the digestion; and anticonvulsant drugs cause a depletion by increasing liver enzyme function. If you’re taking any of these medications it’s important that you talk to your practitioner to you make sure that you are taking the right tests and the right form of folate. 
• Inflammation: Your ability to use folate is also affected by inflammation in your body. The main cause of inflammation is your diet and digestion. If you’re consuming foods that are more inflammatory to your body, then your ability to use folate could be affected. To know which foods are inflammatory for your body you can do a food sensitivity panel. With this home test you can see which foods to reduce or avoid in order to lower inflammation in your body. The test also indicates the degree of leaky gut, which is another source of inflammation that can be addressed. Learn more in my Free Masterclass on Leaky Gut.
• Toxins: Exposure to toxins, including toxins from overgrowing gut bacteria, as well as toxins from our environment, food, water, and home, such as mold toxins and heavy metals, all affect your ability to adequately use folate. If you would like to know more about how to detoxify your body, you can check out my 14-Day Detox Program here.

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How Much Folate Do I Need? Why Do I Feel Worse When I Take Folate? 

A common confusion or myth is that the solution for elevated homocysteine is to take more folate. I am often contacted by people who were told to take folate, and then felt worse. 

Why? Well, we need to work through the list above, considering each factor that could be influencing or blocking your ability to use folate effectively. If you feel worse in any way when you take folate, it tells me there’s a traffic jam in your metabolism, often caused by lack of stress recovery, inflammation and leaky gut, high toxin levels, and/or nutrient deficiencies. When we go through systematically to figure out the causes, and address them, then your body will start using folate again, and you’ll feel better, not worse.

It’s not always that you need more or less folate. It’s about giving your body what it needs in order to utilize folate effectively. We need to break up the traffic jams that are blocking your metabolism.

The standard dietetic recommendation is for 600 to 800 IU of folic acid daily. I convert that to folate (not folic acid). It’s important to recognize that is the bare minimum. That’s not taking into account your individuality, your gene variations or expression, your unique stress and toxin exposures, and your individual imbalances. So, we need to figure out what is the right amount for you. 

This is why I would say that it can be helpful to know your potential gene variations and to understand where to get the right information so you can figure out what’s the right amount of folate for you. 

Keep in mind – the right amount of folate for you could change from year to year if your hormones change, if your environment changes, if your job changes, etc. That’s why I think everyone should have their homocysteine levels checked in their blood work at least once a year.

You may or may not know if you have a MTHFR gene variation. Either way, you can still get your blood work for homocysteine and methylmalonic acid and you can work on identifying the factors that might be decreasing your ability to use folate efficiently. 

Should I Get Tested for MTHFR? 

You don’t have to do an MTHFR gene test but if you do, I think it is important to know is that this is just one piece of information. MTHFR and methylation influences and is influenced by, other enzymes, such as MTRR, CBS, COMT, and MAO. Because of this interplay, you’re likely to want to know other gene variations as well, so we can solve the whole puzzle.

So if you are thinking of testing for an MTHFR gene variation, I recommend running a genetic panel that allows you to keep your genetic data, and which we can then run through software programs that show us the other pertinent gene variations as well. At this point in time I recommend doing an Ancestry.com panel and then my office can generate a Strategene report for you and I can review it with you.

It can be very validating to find out about your genes and to understand how they may be influencing the way you feel. It also allows you to be proactive about your health and disease prevention. 

At the same time, without support to interpret and integrate the information, it can be overwhelming. So before taking the leap, I encourage you to set yourself up for success by working with a practitioner who can help you. That is why I offer these services through my office by phone and zoom. Wherever you are in the world, I can help you. 

All of my protocols, including my Say Goodbye to HPV Program, 14-Day Detox, and Stress Warrior Program, all include my approach to methylation because I find it to be essential.

The thing is we’re all unique humans. We’re all going to have some genetic variations. These genetic variations are not life threatening and actually have the potential to benefit your health because once we identify them, we can address them using nutrients, diet, stress recovery, hormone balancing, and detoxification. 

We can even potentially influence genetic expression by helping you Master Your Stress.

If you want to learn more about this you can listen to my FREE MTHFR Masterclass here.

If you’re looking for products that contain methylfolate you can look in my website and online store. You will find multivitamins, B complexes, prenatals, and protein shakes that contain methylfolate so you can be sure you’re getting a product that has the right form of folate in it.

If you want to feel better by rebalancing your cortisol and neurotransmitters, start with this home test kit. You can also sign up for my Stress Warrior Program here.

Also, if you want to learn more about how to recover from stress so that you can get back to feeling your best, you may want to read my book Master Your Stress Reset Your Health. In the book, I also share the quiz I developed to help you identify how stress has affected you specifically by knowing your Stress Type. You can also take this Stress Type Quiz online.

If you want to go through your specific case me and improve your health (mental or physical) you can set up a one-on-one appointment here.

We’re here to help you!

Disclaimer: This specific article and all other Content, Products, and Services of this Website are NOT intended as, and must not be understood or construed as, medical care or advice, naturopathic medical care or advice, the practice of medicine, or the practice of counseling care, nor can it be understood or construed as providing any form of medical diagnosis, treatment, cure, or prevention of any disease.

References:

1. Courseault J, Kingry C, Morrison V, Edstrom C, Morrell K, Jaubert L, Elia V, Bix G. Folate-dependent hypermobility syndrome: A proposed mechanism and diagnosis. Heliyon. 2023 Apr 9;9(4):e15387. doi: 10.1016/j.heliyon.2023.e15387. Erratum in: Heliyon. 2023 May 16;9(5):e16356. PMID: 37095957; PMCID: PMC10122021.
2. Badiga S, Johanning GL, Macaluso M, Azuero A, Chambers MM, Siddiqui NR, Piyathilake CJ. A lower degree of PBMC L1 methylation in women with lower folate status may explain the MTHFR C677T polymorphism associated higher risk of CIN in the US post folic acid fortification era. PLoS One. 2014 Oct 10;9(10):e110093. doi: 10.1371/journal.pone.0110093. PMID: 25302494; PMCID: PMC4193871.
3. Zetterberg H. Methylenetetrahydrofolate reductase and transcobalamin genetic polymorphisms in human spontaneous abortion: biological and clinical implications. Reprod Biol Endocrinol. 2004 Feb 17;2:7. doi: 10.1186/1477-7827-2-7. PMID: 14969589; PMCID: PMC356929.
4. Zannas AS. Naturalistic Stress Hormone Levels Drive Cumulative Epigenomic Changes along the Cellular Lifespan. Int J Mol Sci. 2021 Aug 16;22(16):8778. doi: 10.3390/ijms22168778. PMID: 34445485; PMCID: PMC8395735.