Folic acid must be converted to its active forms to be used by the body. This is a multi-step biochemical process that occurs in the intestines and liver. In the presence of intestinal or liver dysfunction this conversion may not occur sufficiently enough to meet the body’s needs. Furthermore, up to 60-percent of the U.S. population may have a genetic enzyme defect that makes it difficult for them to convert folic acid into active 5-MTHF. For these individuals and many others, 5-MTHF supplementation may be a more effective method of folate repletion.
Because deficiencies of folic acid have been linked to low-birth-weight infants and neural tube defects, folic acid requirements double during pregnancy. The Centers for Disease Control and Prevention recommends folic acid supplementation for all women of childbearing age because the biggest need is during the first trimester, when a woman may not even be aware she is pregnant. Supplementation with the more active form may be preferable.
In concert with vitamin B12, 5-MTHF functions as a methyl-group donor involved in the conversion of the amino acid homocysteine to methionine. Methyl-group donation is vital to many biochemical conversion processes, including the synthesis of serotonin, melatonin, and DNA.
It is important for women of childbearing age to get enough folic acid not just those who are planning to become pregnant. Only 50 percent of pregnancies are planned, so any woman who could become pregnant should get enough folic acid every day, especially before conception and during early pregnancy.
5-methyltetrahydrofolate (5-MTHF) supplementation is not recommended concurrent with methotrexate cancer therapy, as it can interfere with methotrexate’s anti-neoplastic activity; however, this folate source has not been shown to interfere with the anti-inflammatory activity of methotrexate. An individual taking methotrexate for psoriasis or rheumatoid arthritis can safely take a supplement containing folate.
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