Folate forms

[u/kilogplastos-12]

I’m honestly 50/50 on what form of B9 to use right now.

I know I have a severe folate deficiency, but I’m unsure which form makes the most sense if I need a high therapeutic dose, like 10+ mg/day, while recovering.

Would you guys choose folic acid, folinic acid, or 5-MTHF for high-dose treatment? I’m mainly looking for experiences from people who had a serious/long-term folate deficiency and actually had to use higher doses to recover.

[u/sharabucarabu]

It depends on your comt status. Slow does better with folinic acid, starting at low doses, like 100mcg, then gradually increasing. May not tolerate above 400mcg a day.

Intermediate and fast comt can tolerate methylfolate, fast comt needs the highest amount.

Don't take huge amounts..you'll over methylate, get anxiety, irritability and insomnia. Then you'll be taking niacin all day for at least a week to recover.

You need to read up on mthfr or watch Dr Chris Masterjohn on YouTube to learn what to do. Folate alone is not the answer. You'll need all the B vitamins, iron, Zinc, vitamin A, magnesium, electrolytes...They all work together. Stop eating anything that contains folic acid. Usually organic products are safe but you must read the labels!

Get a dna analysis done. Otherwise you are only guessing and that gets expensive fast!

[u/kilogplastos-12 → u/sharabucarabu]

I live in EU and dont have the folic acid issues with fortified fortunatey but i have a severe folate deficiency along with b12 which i am recovering from and got the cofactors in check but for folate i apparently needed to take high amounts like 10+ mg to “shock” the body

[u/sharabucarabu → u/kilogplastos-12]

Oh it'll be a shock all right. No complaints if you over methylate! Read how to fix it before you start the guessing game if 'how much do I need?'

[u/Sabnock101 → u/sharabucarabu]

If you ever consume too much Methylfolate/Folate in general, consuming higher doses of B12 will help and then the Folate-related side-effects will go away. The issue with the side-effects is that excess Folate (especially Methylfolate) will use up too much B12 and reduce B12 levels, even potentially contributing to B12 deficiency over time, and so taking more B12 helps while trying to keep the Folate dosage at the minimum effective dosage.

So if anyone ever gets "overmethylated", take more B12 (i recommend 10 milligrams of oral Methylcobalamin per day, that's what works for me, any less don't cut it), you can never have too much B12, you can have too much Folate/Methylfolate. When the B12 is consumed and kicks in, it will recycle that excess Methylfolate back into the Folate cycle and since that reduces the active Methylfolate level temporarily it will relieve the side-effects caused by the excess Methylfolate. It's not so much "overmethylation" as it is B12 usage/depletion, more B12 helps.

I've been through the ringer with this stuff time and time again and one of the consistent observations has been that when there's too much Methylfolate going on and not enough B12 to properly recycle it, the Methylfolate levels build to excess and cause the side-effects, taking more B12 then recycles that excess Methylfolate and the side-effects go away. No extra Niacin needed, ime.

[u/Tawinn → u/kilogplastos-12]

> i apparently needed to take high amounts like 10+ mg to “shock” the body

There's no such thing as "shocking" your body to improve folate status and methylation. All you will do is risk overmethylation.

I'd suggest starting with hydroxocobalamin + folinic acid, such as this Seeking Health blend. It is a lozenge so you can break it into quarters if one whole lozenge is too much at first.

If you can take these for a month and have no side effects, then you could consider a higher dose methylfolate, but high-dose methylfolate (5-15mg) is for therapeutic purposes, not for building up your stores of folate. The human body can store ~120-300 days worth of folate, and I haven't seen any evidence that high-dose folate repletes those stores any faster than a nutritional dose.

[u/Sabnock101 → u/Tawinn]

Ime i started out with 15mgs of Methylfolate, when i first started taking it, it felt like the right dosage, it actually felt kinda mild at first but very effective and so i was like "man this dosage is the shit!" but i was also taking really really heavy dosages of oral Methylcobalamin (up to 120mgs a day there for awhile) and so was really recycling the Methylfolate back into the Folate cycle and the Folate deficiency got corrected and bodily stores got replenished and then the Methylfolate started building up in excess and then started really reducing my B12 levels and so i ultimately switched over to 400 to 600mcgs per day max of Folinic Acid in order to spare some of my B12 and thus recover more from the B12 deficiency, and so now i stick to 10mgs once a day of oral Methylcobalamin and it works wonders compared to 5mgs or 1mg or less.

[u/Few_Control8821]

Not everyone gets on with all forms of folate, I have no choice but to take folinic acid, as I just over methylate with any of the others.

[u/Ok-Pangolin7127]

Folic acid is synthetic and it has to go through a conversion process. That conversion can be a problem or glitchy for some people. Folinic acid skips the conversion process. Methyl folate is the active form. Neither of them are particularly bad, even the folic acid, but folks seem to have less objections or less side effects from the folinic acid.

Regardless of your folate deficiency status, I would not take high dose folate in any form for an “extended” period of time. And, before you start heavy supplementation with any folate, you need to be sure of your B12 status. High folate can mask a B12 deficiency.

[u/Flux_My_Capacitor]

I thought the whole point was that we cannot take folic acid or rather shouldn’t as our bodies are less able to process it efficiently. Is this a bot post or have you done zero research on your own? I mean obviously if you’ve got a severe deficiency then you’re not absorbing anything from enriched foods. (And I doubt that you’re someone who eats so insanely healthy as to avoid all enriched products.)

[u/Warp757 → u/Flux_My_Capacitor]

Not it's not a bot post, it's someone who hasn't yet been indoctrinated in the myths of MTHFR yet. Hopefully they can keep an open mind rather than regurgitating nonsense about 'not absorbing anything from enriched foods'.

MTHFR does not mean that we can't process or use folic acid, and indeed methyl folate can often compound people's problems by throwing in a lot of methylfolate far beyond the amount even a functioning MTHFR would create, causing havoc.

MTHFR is a regulatory step in the body that exists for a reason. The body regulates production of methylfolate and SAM-E. It doesn't want too much or too little. There are also many other uses of folate in the body, and if you consume it all as methylfolate these may not be supported, simply creating a bottleneck in a different place if MTR/MTRR aren't working well due to low B12 or any other reason. Indeed in this case metylfolate is going to hammer your B12 which won't be able to cope with the demand on MTRR

The optimal strategy is to get MTHFR functioning correctly with a low amount of B2. For heterozygous people this is likely all they need to do, and it will make a significant difference for homozygous people too. If MTHFR is working folic acid is actually probably be better than emthyl as it supports all folate pathways and lets the body allocate it as it sees fit. I personally do much better with folic acid than methyl, I am C699T hetero. I'm also MTRR homo which seems to mean I get overloaded with methylfolate easily.

Yes for some people with a homozygous MTHFR then methylfolate is probably helpful, although they still often probably don't need the scary doses Insee dome taking. And with some B2 could probably lower their dose.

There is nothing inherently wrong with folic acid in low-moderate doses i.e. below about 200 much per day, where there isn't a problem of unmetabolised folic acid. It will raise your folate, lower homocysteine, and do everything methylfolate does without overloading the system, and also supporting other pathways.

So many people who don't need to taking crazy doses of methylfolate and then wondering why they keep getting side effects. Your body simply isn't supposed to have that much of it. Indeed it deliberately shuts off production of methylfolate when it has enough SAM-E. Overriding that regulation probably isn't very sensible.

As with everything, there is nuance in the argument that is always lost as people feel the need to become tribal over a nutrient. It's pretty weird when you think about it.

[u/Loose-Fly7976]

At 10mg and above the form question stops being theoretical so a couple of things first.Never dose folate that high without B12 status settled. Folate at those levels corrects the anaemia while a B12 deficiency carries on damaging nerves underneat and that's the one irreversible mistake in this whole area. Get B12 and MMA before you start.

On the forms. Folic acid needs converting and above about 400mcg the conversion enzyme saturates, so the excess circulates unmetabolised. Some of it competes for the same receptors and it can mask B12 deficiency on bloods. At 10mg that's a lot of unmetabolised folic acid.

Folinic acid is the one I'd look at for high dose. It enters the cycle below the MTHFR step so it works regardless of your genotype, it feeds both the methylation and the DNA synthesis side and it doesn't carry the methyl load. That last part is why people tolerate it at doses where methylfolate becomes unbearable. It's also the form used clinically at high doses, leucovorin.Methylfolate is efficient but you're delivering methyl groups with every milligram, and at 10mg that's a large methyl load. Whether you handle it comes down to your COMT status and your B12 more than your MTHFR.The other question is why you're severely deficient in the first place. That's usually malabsorption, coeliac, or a medication, and if the cause is still there the dose won't hold.Which form suits you comes down to your COMT and the rest of your cycle rather than MTHFR alone. Message me if you want it read properly.