Did you know that folic acid and folate are different things?
Folic acid is a synthetic, inactive product not found in nature.
The term “folate” has a few different meanings but in general, it means the natural forms found in foods (not fortified, that is folic acid again) and the active form known as METHYL-folate (or more technically correct, 5-Methyl tetra-hydro folate, 5-MTHF to her friends).
The issue is the enzyme that converts folic acid to the next form (called DHF) is saturated at 200 mcg ish in most people.
Bear in mind most supplements are 400 mcg.
So, with folic acid, may come as real issue of un-metabolised folic acid (UMFA).
How do we know this for sure?
A study gave 5000 mcg folic acid to patients, then measured the levels:
Thus, if we go looking, we can find high levels of UMFA in many people.
So why is the issue ?
Well, if unmetabolised folic acid is still hanging around, it may interfere with active folate from the receptor, lowering the cellular activity level of active folate.
Folate plays a central role in many things, but especially new cells/DNA (think anameia, spinal bifida etc)
Plus, UMFA also seems to push up inflammatory cytokines (the mediators of inflammation), specifically TNF alpha in this case (TNF alpha is the target of many “biologic” drugs for auto-immunity).
All this together leads us to the surprising finding that folic acid supplements seem to be associated with higher levels of cancer.
Is folic acid all bad?
No, clearly not.
We know folic acid can prevent neural tube defects, and this is because while we do get elevated UMFA once the enzyme has been saturated, we do get more active form folate (5MTHF) from the folic acid that does make it down the line.
Back in the day, we had no choice about what to take, but then good old big pharma came to the rescue, specifically Merck, those lovely benevolent people who only care about our health.
The one good thing about big pharma is they employ vast numbers of PhD biochemists to plot pathways. They need to know exactly how enzymes work and which co-factors are needed to then be able to manipulate them with drugs.
Thus, a lot of our biochemical knowledge is thanks to big pharma.
So, Merck worked out how to make the active form and patented it as Metafolin, which they sold as Deplin for depression.
They even helpfully explained how poor folic acid was:
Thus, we can now give the active form 5MTHF in supplements.
There simply is no need to risk high levels of UMFA in order to push up your active folate/5MTHF.
Hence, we use the active form is our best selling one a day multi:
That is a pretty good yardstick for a poor quality supplement, folic is mostly junk, active forms are the good stuff.
If your patients are pregnant, a good option is the G&G vitamins pregnancy pack, which gives all-round support including active folate & DHA. Available on the natural dispensary or directly with G&G.
Note that the basic pregnacare is folic acid only, and even the pregnacare MAX has a 50/50 split of folic acid and 5MTHF but is the best of the commercially available products.
ACTIONS TO TAKE:
– Next week if the universe allows my MAC to be repaired, then I will open up the CCCN course once again, for the final time in its current format, keep your eye peeled. The info above on folate came straight from Module 2.
– If your patients are taking supplements already when they come to see you, always find out what brands or where they bought them. They can bring them in or take a photo, but the bottom line is this:
Supermarket/shop bought are 99% awful, with poor forms in low doses that might do more harm than good. There is a reason they are cheap!!
If Holland Barratt are selling a second bottle for 1p, consider how much mark up there must be on the 1st one? How can they do that?
Because the ingredients are cheap and nasty in low doses, I’ll wager they contain folic acid not 5MTHF.
If bought online/ Amazon, that varies more, better chance of good forms & higher doses but it is still very dodgy, hence I have prepared this handout for patients, see below and attached.
Remember the CORE 4 range was specifically formulated to reduce inflammation, increase energy and reduce nerve hypersensitivity, to give your care the best chance to work.
Ideally, you should be selling supplements in clinic, this is for the benefit of your patients.
Yes, they can give you an additional stream of income or you can sell at trade if you wish, but allowing patients to buy cheap crap harms them and harms you via poorer outcomes from care for your patients.
We are in the process of developing a new website for IN health supplements and fingers crossed we will soon have the ability for patients to buy direct from us at retail and if they give your name (and we will ask), then you can recieve a 20% commission on all supplement sold to your patients for life.