By Richard Knox, TX State Dietetic Intern
Folate (also known as vitamin B9) is an essential vitamin that helps make DNA, proteins, and red blood cells. It also helps with heart health and mood. When we eat foods with folate in them, that folate is turned into a different form called 5-MTHF by the body for use. That change is helped by an enzyme called MTHFR (methylenetetrahydrofolate reductase – wow, what a mouthful). In some people, gene mutations of MTHFR can lead to decreased enzyme activity, leading to less folate being converted into 5-MTHF causing folate deficiencies.
According to the CDC, people with an MTHFR gene mutation can process all types of folate, including folic acid, the synthetic form of folate found in supplements and packaged foods. Studies however agree that more research is needed to better understand the relationship between active folate, other B vitamins, and MTHFR gene mutations. We have noted that some clients at Food 4 Success have seen symptoms with MTHFR gene mutation that are related to their folate, B12, and/or B6 levels.
If you have lab work that shows folate or other B vitamins out of normal range and have tested positive for a MTHFR gene mutation, you can use the following tips for food shopping and reading labels to understand dietary sources of folate:
Choose foods that contain 5-MTHF, the active form of folate that bypasses MTHFR:
-Vegetables, such as spinach and other leafy green vegetables, asparagus, broccoli, green peas, black-eyed peas, and avocado contain 5-MTHF.
-Other foods containing active folate include beef liver, peanuts, sunflower seeds, citrus fruits, whole grains, seafood, and eggs.
Folic acid can compete with 5-MTHF receptors, lowering levels of active folate. This can lead to increased levels of the amino acid homocysteine, which can raise your risk of heart disease.
Foods that contain folic acid include fortified or enriched foods:
-Pasta, bread, white rice, and flour
-Crackers, pizza crust, and breadcrumbs may also be fortified, so be sure to check the label
-Organic and gluten-free grains are usually not enriched with folic acid
You may also see health claims on the front of the package about folate decreasing the risk of neural tube birth defects. Folate may appear on the package under any of the following names: folic acid, vitamin B9, folacin, pteroylglutamic acid (PGA), 5-methyltetrahydrofolate (5-MTHF), or methyl folate.
Managing folate intake to achieve adequate levels can be tricky when living with a MTHFR gene mutation. Strategies to remove or adjust intake of different forms of folate, along with regular lab work, can help you manage folate levels, and possibly other B vitamins. Eating a diet rich in protein sources, fruits and vegetables, and fiber is a great first step to increasing folate intake. Additionally, if you are experiencing reduced folate levels due to a MTHFR gene mutation, 5-MTHF supplements are available on any vitamin aisle and may have names such as L-methylfolate or methyl folate.
MTHFR mutations can be confusing to understand, and its complexities are still trying to be understood. Be sure to seek a registered dietitian (RD) when seeking guidance with this condition. Not all nutritionists have this credential, and it is very important to watch for when it comes to complex medical conditions. We at Food 4 Success can help!
References
•Carboni L. Active folate versus folic acid: The role of 5-MTHF (Methylfolate) in human health. Integr Med (Encinitas). 2022;21(3):36-41
•Dhawan, A., MD, Eng, C., MD, PhD. Is the MTHFR gene mutation associated with thrombosis? Cleveland Clinic. Updated February 6, 2024. consultqd.clevelandclinic.org/is-the-mthfr-gene-mutation-associated-with-thrombosis
•Levin BL, Varga E. MTHFR: Addressing genetic counseling dilemmas using evidence-based literature. J Genet Couns. 2016;25(5):901-911. doi:10.1007/s10897-016-9956-7
•Folic acid. US Centers for Disease Control and Prevention. Updated May 15, 2024. cdc.gov/folic-acid/data-research/mthfr/index.html
•Understanding Food Labels. The Nutrition Source, Harvard T.H. Chan School of Public Health. Updated June 2021. nutritionsource.hsph.harvard.edu/food-label-guide/
