Preventing birth defects with folic acid and ready-to-use MTHF

What folic acid does

Folic acid plays a central role in DNA synthesis and cell division — the processes your body depends on to grow and to repair its own tissues. It also converts homocysteine into methionine, a step that lowers the homocysteine level in the blood and is good for the heart.

In fertility care, folic acid does the following:

• Improves pregnancy rates
• Improves sperm quality
• Prevents birth defects in the baby — above all neural tube defects (where the neural tube fails to close), cleft lip, cleft palate and defects in the closure of the abdominal wall

Folic acid comes in several forms

Folate occurs in foods of both plant and animal origin — dark green leafy vegetables such as spinach and broccoli, green peas, liver and cereal grains — where it takes the form of tetrahydrofolate. The synthetic folic acid you find in vitamins and supplements is another form. And then there is L-5-methylfolate (MTHF): the ready-to-use form, and the form in which folate is transported to the organs.

• Spinach
• Broccoli
• Green peas
• Liver
• Cereal grains

Whichever form it arrives in, folic acid has to be converted by enzymes into its active form before it can do any work in the body.

Why folate deficiency happens

• Not getting enough from food
• Impaired absorption in the gut — for example after part of the bowel has been removed, or from drugs that block folate absorption
• A problem with folate metabolism itself — for instance a fault in the enzyme that converts folic acid into its active form, such as the MTHFR enzyme, or drugs that inhibit folate metabolism
• A shortage of the nutrients folate metabolism depends on — vitamin B6, vitamin B12 and serine — will also leave you folate deficient

Treating folate deficiency

For most people, a supplement of 1–5 mg of folic acid a day is enough to prevent deficiency.

But if your folate metabolism is not working normally — for example if you carry a mutation in the MTHFR gene, which is common — plain folic acid on its own may not be enough, and the baby is still at risk of birth defects such as neural tube defects, cleft lip, cleft palate and so on.