Active Folate

Methylfolate is a genuine form of vitamin B9, but the story told about it runs ahead of the evidence. These are the questions our naturopaths ask to match the form to your situation, and to spot when the answer belongs with your doctor.

A good fit if

• A practitioner has recommended an active folate for you and you want to know what to look for on the label
• You want a dose below 500 micrograms and need the flexibility a liquid gives you
• You're checking whether the folate in your prenatal multivitamin is already an active form before you buy a second product
• You've had an MTHFR result and want the form question explained honestly, without a sales pitch
• You take a B-complex and want to work out how its folate counts towards your total

Check with us first if

• You're pregnant, planning a pregnancy or could become pregnant. Australian guidance names folic acid specifically, and no clinical study has tested 5-MTHF for the outcome that guidance is there to prevent. Bring in what you're taking and we'll go through it with you.
• You're over 50, vegan or vegetarian, or on long-term metformin or a proton pump inhibitor. Your vitamin B12 should be checked before you take folate at supplement doses, and switching form doesn't remove that step.
• You take methotrexate, sulfasalazine, trimethoprim or epilepsy medicines such as phenytoin, carbamazepine or valproate. All of them interact with folate, whichever form you choose.
• You already take a prenatal, a B-complex or a multivitamin. The Australian cap is a combined total across folic acid, folinic acid and levomefolic acid, so products add up.
• You've been told you need a much higher dose than 500 micrograms. That's more than any listed medicine can supply, so it has to come from your doctor.
• You're buying a 1 mg, 5 mg or 15 mg product from an overseas website. Those aren't regulated by the TGA for quality and safety.
• You take prescription medicines of any kind. Check with your doctor, pharmacist or our naturopaths before starting.

• Levomefolate calcium (Schedule 1 item 3013). Best known for: The longest-established methylfolate raw material, and the one most single-ingredient Australian capsules and drops use. Absorption: Delivers levomefolic acid directly. The calcium salt is just the carrier; your body sees the same vitamin molecule from either salt. Typical use: Capsules, tablets and oral liquids. Labels show the salt weight first and the levomefolic acid amount underneath.
• Levomefolate glucosamine (Schedule 1 item 3014). Best known for: The salt in the branded raw material most common in Australian preconception formulas. Absorption: Also delivers levomefolic acid. The salt was developed to keep the raw material stable on the shelf, not to change how the vitamin works in you. Typical use: Once-a-day capsules and preconception tablets. A 500 microgram dose is shown as 1.052 mg of the salt.
• Oral liquid drops. Best known for: Lets you take doses below 500 micrograms, which tablets can't. Absorption: The same levomefolic acid, in glycerol and water. The liquid doesn't change absorption; it just means you can divide the dose more finely. Typical use: Doses set by a practitioner, and people who can't swallow capsules. One Australian liquid gives 100 micrograms per two drops.
• Methylfolate inside a preconception or prenatal multivitamin. Best known for: How most Australians actually take methylfolate: combined with B12, iodine and iron rather than bought on its own. Absorption: No different from the single ingredient. The catch is adding up: the folate in the multi counts towards the same combined 500 microgram limit. Typical use: The usual preconception choice. Read the label before adding a separate folate on top.
• High-dose methylfolate bought from overseas websites. Best known for: 1 mg, 5 mg and 15 mg strengths that can't legally be sold as listed medicines in Australia. Absorption: Not the issue. These are far above the Australian limit and above the NHMRC Upper Level for supplemental folic acid. Typical use: Not checked by the TGA for quality or safety. A dose in that range is a medical decision, not a shopping one.

Reference values. The NHMRC sets recommended intakes for folate as a whole, not methylfolate specifically, measured in micrograms of dietary folate equivalents: 400 µg a day for adults, 600 µg a day in pregnancy and 500 µg a day while breastfeeding. There's no official way to convert supplemental 5-MTHF into dietary folate equivalents, so a methylfolate label can't be matched neatly to those numbers.

Typical supplemental range. Australian products almost all contain 500 micrograms of levomefolic acid, because that's the most a listed medicine can provide. Liquids go lower and are easier to divide, commonly 100 micrograms per serve. Read the levomefolic acid amount, not the salt weight listed above it: 1.052 mg of levomefolate glucosamine gives you 500 micrograms of the vitamin, and 108.4 micrograms of levomefolate calcium gives you 100 micrograms.

Upper level. The NHMRC upper limit is set in micrograms of folic acid from supplements and fortified foods: 1,000 µg a day for adults. There's no separate upper limit for levomefolic acid. In Australia the practical ceiling is the legal one, quoted word for word in the Australian status section.

Worth knowing. Two maths traps are worth knowing. A prenatal multivitamin, a B-complex and a separate active folate can quietly add up past the combined cap, and the salt weight on the front of a label is always bigger than the vitamin it gives you. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• The folates in food are largely methylated already: 5-MTHF is the predominant folate in the diet as well as in blood, so this is not an exotic molecule, but no food supplies it as the isolated salt used in supplements
• Leafy greens such as spinach and rocket: 1/2 cup boiled spinach, 131 µg DFE
• Legumes (lentils, chickpeas, black-eyed peas): 1/2 cup boiled black-eyed peas, 105 µg DFE
• Australian bread made from fortified bread-making flour, which supplies folic acid rather than methylfolate: 100 g (about three slices), an average of 120 µg of folic acid

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Anaemia that hasn't been diagnosed. Any form of folate can correct the blood signs of vitamin B12 deficiency while nerve damage keeps progressing. Get it investigated first.
• Vitamin B12 deficiency, or a risk of it (over 50, vegan or vegetarian, or long-term metformin or proton pump inhibitor use). Check your B12 before taking folate in any form.
• Pregnancy and preconception. Australian guidance names folic acid, and no clinical study has tested 5-MTHF against neural tube defect outcomes. Talk it through with your practitioner.
• Methotrexate. It interacts directly, so only your prescriber should decide.
• Epilepsy medicines including phenytoin, carbamazepine and valproate. They lower blood folate, and folate supplements may make them work less well.
• Sulfasalazine and trimethoprim. They work against folate, so talk to your prescriber before taking it.
• Doubling up on products. Australia's 500 microgram limit is a combined total across folic acid, folinic acid and levomefolic acid, so a prenatal plus a B-complex plus a separate folate can go over it.
• Doses above 500 micrograms. This is more than an Australian listed medicine may provide, so it's a decision for your doctor.
• Products from overseas websites at 1 mg and above. They aren't checked by the TGA for quality and safety, and they're above the NHMRC Upper Level for supplemental folic acid.
• Babies under 12 months. No Upper Level could be set, so folate should come from milk, formula and food only.
• New numbness, pins and needles, unsteadiness or memory changes. Stop and get medical help promptly.
• If you take prescription medicines, check with your doctor, pharmacist or one of our naturopaths before you start.