Why folate is so important for your mental health

Most women know how important folic acid is to sustain a healthy pregnancy. But did you know that synthetic folic acid and folate are not the same thing? The metabolically active form of folate (known as 5-MTHF) has been found particularly effective for treating depression.

It is recommended that all women of childbearing age take folic acid supplements as pregnancy is not always a planned event. Low dietary intake of folic acid before and during pregnancy increases the risk for delivery of a child with a neural tube defect (NTD) such as spina bifida and anencephaly. Taking folic acid supplements before and during the early stages of pregnancy significantly reduces the occurrence of NTDs and results in increased infant birth weight and improved Apgar scores, along with a decreased incidence of foetal growth retardation and maternal infections.

How does folic acid differ from folate?

Folic acid and folate are not the same. Folate is a natural form of vitamin B9 that is found in food sources. Folic acid is a water-soluble B vitamin created in a lab to add to supplements and foods. Folic acid needs to be broken down into folate (5-MTHF) before the body can use it.

“Research has shown a link between folate deficiency and depression.”

Folic acid cannot be synthesised by our bodies. This means that we need to ensure that our diets are rich in folates, which must first be converted to the metabolically active folate 5-MTHF (5-methyltetrahydrofolate) to be effectively utilised by the body. Although folates may be abundant in our diets, cooking or processing destroys them. The best folate sources in foods are green, leafy vegetables, sprouts, fruits and brewer’s yeast. Liver and kidney also contain high amounts of folates.

Folate deficiency is considered to be one of the most common nutritional deficiencies and may be caused by:

• Deficient food supply
• Defects in utilisation, as in alcoholics or individuals with liver disease
• Malabsorption
• Increased needs in pregnant women, nursing mothers, and cancer patients
• Metabolic interference by drugs
• Folate loss in haemodialysis
• Deficiencies in enzymes or cofactors needed for the generation of active folate
• Absorption of folic acid appears to be significantly impaired in HIV disease, irrespective of the stage of the disease

Signs and symptoms of folate deficiency include:

• Macrocytic anaemia
• Fatigue
• Irritability
• Peripheral neuropathy
• Tendon hyper-reflexivity
• Restless leg syndrome
• Diarrhoea
• Weight loss
• Insomnia
• Depression
• Dementia
• Cognitive disturbances
• Psychiatric disorders

Improve your mood

5-MTHF is involved in the formation of neurotransmitters – dopamine, norepinephrine and neurotonin – and for this reason a number of exciting studies have looked at the potential role of folate (particularly 5-MTHF) in depression. Research shows depressed patients have a high incidence of low folate levels or are folate deficient. These folate deficient individuals also tend not to respond well to antidepressants.

5-MTHF has a high bioavailability (seven times higher than synthetic folic acid). Folate is stored in red blood cells (RBCs) and folate levels remain elevated for periods in excess of 40 days following discontinuation of supplementation. Folic acid has a low bioavailabity and is poorly transported to the brain. Unmetabolised folic acid is rapidly cleared from the central nervous system primarily through bile and excreted in urine.

Research has shown a link between folate deficiency and depression. Folate, specifically the form 5-MTHF, has been used as stand-alone depression treatment or as an adjunctive treatment with anti-depressants. There are many causes of folate deficiency. Certain medications (such as anti-convulsants, antibiotics, oral contraceptives, and some anti-cancer agents) can deplete folate levels. Poor folic acid absorption, chronic diseases, alcoholism and poor diet are also causes of folate deficiency.

Genetics also plays a key role in folate deficiency. Many individuals have MTHFR (methylenetetrahydrofolate reductase polymorphisms), where folic acid cannot be used by the body immediately. The body needs to break it down in a complex enzymatic process. These individuals are unable to break down folic acid into 5-MTHF, thereby making them folate deficient.

Taking 5-MTHF for your mental health

The good news is that by supplementing with 5-MTHF, your body can use this folate form to help with your mental health. This is different to supplementing with high amounts of folic acid, too much of which can conceal a vitamin B12 deficiency.

The treatment of depression is a complex issue. Together with your healthcare professional, 5-MTHF supplementation has the potential to benefit depressed individuals who have folate deficiency.

This article offers information and should not be considered as medical advice. Consult your doctor or healthcare professional before making any changes to your diet, medications or supplements.