Folic acid deficiency results in the inability to degrade formiminoglutamic acid (FIGLU). As a result, FIGLU accumulates in your urine. High FIGLU on an organic acid test is a marker for low folate.
It is important to use both folic acid and folate supplementation for several reasons. The pathway that involves MTHFS, an enzyme in the methylation pathway, functions in the folate cycle. There it catalyzes a reaction that turns formyl tetrahydrofolate, or folinic acid, into tetrahydrofolate (THF). THF is what you ordinarily think of as folic acid.
MTHFS also impacts the formation of two purines that are necessary for DNA and RNA formation. DNA and RNA are important for the formation of fast turnover cells like blood cells, GI tract lining, or wound healing. If you have a mutation that reduces MTHFS activity, folinic acid can build up to high levels. When that happens, your synthesis of these purines is reduced, and your tetrahydrofolate level is also decreased.
I work with Dr. Amy Yasko. Her program uses only low dose folinic acid so that this build up does not occur. The two purines are supplemented to support DNA and RNA production, and low dose folic acid along with probiotics are added as a secondary way to make THF. In this way, the impact of any possible MTHFS mutation is bypassed, even if you not have data regarding this gene.
Dr. Amy covers all her bases when adding nutritional support. She includes low dose 5 methyl THF in her supplementation because that is the only way to bypass an MTHFR C677T mutation. No amount of folinic acid, folate, or folic acid will do it. Using high dose 5 methyl THF at the beginning of a treatment for MTHFR + can trigger more detox than is optimal, especially for an adult. Your body may need nutritional groundwork to ease into 5 methyl THF administration.
Folate is basically a chain of glutamates. The difference between folic acid and folate is the stability of the molecule and the length of their glutamate chains. So, if you are MTHFR C677T++ and you take high dose folate, you potentially have a chain of unused glutamate molecules left in your body. You cannot process it efficiently to 5 methyl THF because of your mutation. There is the risk of folate’s breaking down to release glutamate. Most of the folate that is used for Dr. Amy’s program is 5 methyl THF, with some low dose folinic acid.
Dr. Amy has specific reasons for the choices she makes in terms of supplements and the forms that she uses. The RDA for folate/folic acid is 300 micrograms for a child that is 1 year old, and up to 1,000 micrograms daily for an individual 19 years of age or older. Thus, the 15 to 40 micrograms used for her program is not an issue, especially since the body does need some folate and folic acid aside from the need for 5 methyl THF and folinic. To put this in an easily understandable perspective, a bowl of cheerios has 400 micrograms of folic acid, as compared to the 15 to 40 micrograms used in her program.
If you are MTHFR C677T or have other methylation genetic issues, you may not be satisfied with the treatments you have tried. You may still be tired, hurting, brain-fogged, depressed, or having gut or autoimmune issues. You need a medical professional who know this area and who can help. Contact Dr. Mullan at NancyMullanMD@aol.com for information or to set up an office visit or remote appointment.
Chronic Disease Recovery 
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