I’m glad yesterday’s post on 5-MTHF was helpful for people.
From some of the responses I’ve gotten I see there are some questions, that I’ll try to clear up with today’s follow on post.
What brand of 5-MTHF do I use?
I rarely use the prescription forms of 5-MTHF (Deplin) because insurance coverage of them is very spotty, and I like the supplemental forms we have available that are free of binders, fillers, dyes and coatings which some people are very sensitive to.
Unfortunately there is no hard and fast rule for dosage. Exact dosages have NOT been studied sufficiently and pinned down. So we’re making educated guesses, and dosages will be different for different people.
The prescription forms are available in 7.5mg and 15mg tablets, and some people need the higher doses of 15mg tablets to get the best effect.
Here are the dosages I start with:
For kids, teens and adults I usually start around 1mg daily, then after a week or so when we’ve seen what initial effects we’re going to get and made sure we’re not seeing any negative side effects, I increase to 2mg daily, increasing doses further as needed.
Is this 5-MTHF?
I received a number of questions about specific supplements, but it boils down to this question, is this 5-MTHF?
The bottom-line answer is, if it doesn’t say 5-MTHF (or L-methylfolate), then it’s not in there.
5-MTHF is a high end addition, so the company is always going to highlight it. It’s like going to buy a car, if it has leather seats they’re always going to mention it. If they don’t say anything about leather seats in the car you’re looking at, you can be sure it doesn’t have them.
Here’s one example of a supplement from a professional company:
Ignoring everything else in this supplement for the time, we scan down and find two entries, something called folates, and something called Folinic acid (5-Formyl tetrahydrofolate).
Are either of these things 5-MTHF?
The folates listed are a patented synthetic preparation of folic acid that is much closer to what is found in food than regular folic acid found in many supplements. Better, but still not 5-MTHF. If you remember the biochemistry chart about folic acid, you see we’re still at the top of the folate pathway.
What about folinic acid (5-Formyl tetrahydrofolate)?
Still no, but we’re getting closer. Folinic acid falls farther down the pathway, but we’re still not at 5-MTHF yet.
The major use of folinic acid is with methotrexate. Methotrexate is a very common immune suppressing drug used commonly in auto-immunity (IBD and RA are two conditions I see it very commonly used for). It is also used in cancer treatment.
How does methotrexate work? It blocks one of the enzymes (dihydrofolate reductase; labeled DHFR on the chart) higher up on the pathway that acts on folate.
Why do this? If you remember the post from yesterday you remember that one of the things that the folate pathways do is create DNA.
By blocking this enzyme and preventing folate metabolism, you interfere with DNA metabolism, which in the case of cancer helps block cancer cells from reproducing and spreading. In the case of autoimmunity it seems to work by another action and inhibits T-cells (a type of white blood cell that coordinates the immune system) from functioning normally.
When used for autoimmune conditions, folinic acid is (should be) given because the mechanism that is suppressing the immune system doesn’t depend on folate or folate metabolism to work properly., and most of the side-effects come from the suppression of the folate pathway. And folinic acid happens after the suppressed enzyme, so the rest of the system works properly (assuming there are no mutations).
If methotrexate is being used for cancer treatment, then you would not want to give either folinic acid or 5-MTHF as that would allow DNA synthesis to work properly, undermining the action of the drug.
So, does this supplement contain 5-MTHF?
One other prescription form
Metanx was also brought to my attention. It is sometimes prescribed for diabetic peripheral neuropathy (nerve damage) or heart disease or high homocysteine. It contains:
Does this supplement have 5-MTHF?
L-methylfolate is 5-MTHF. And this supplement contains 2.8mg along with high quality forms of B6 and B12. 2.8mg is going to work well for some people, will be too much for some, and not be enough for others.
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