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Medical Forum / General / Nutrition / January 2007

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folic acid and B vitamins - more evidence to support us lifestyle food cultists

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TC - 19 Jan 2007 17:05 GMT
http://www.forbes.com/forbeslife/health/feeds/hscout/2007/01/19/hscout601131.html

Folic Acid Boosts Cognition in Older Adults
01.19.07, 12:00 AM ET

FRIDAY, Jan. 19 (HealthDay News) -- Dutch researchers have added
another chapter to the continuing debate over whether folic acid
supplements can sharpen the aging mind. Their conclusion: The nutrient
does improve cognitive function in older adults.
Previous studies on the subject have been split, although most have
suggested that folic acid supplementation in people with high levels of
the amino acid homocysteine in the blood helps with cognitive function.
Higher homocysteine levels are associated with an increased risk for
cardiovascular disease and stroke and possibly also Alzheimer's
disease.

The new study, published in the Jan. 20 issue of The Lancet, adds to
the growing impression that adding folic acid can help brain
functioning, at least in certain groups of people.

"We can certainly take away that folate is going to be beneficial for
cognitive improvement when you have high homocysteine levels," said
Maria Carrillo, director of medical and scientific relations at the
Alzheimer's Association.

"This underscores the importance of B vitamins," added Richard Finnell,
Regents Professor in the Center for Environmental and Genetic Medicine
at Texas A&M's Health Science Center Institute of Biosciences and
Technology at Houston. "They do more than protect babies against birth
defects."

Folic acid, or folate, is a B vitamin probably best known for its role
in helping to prevent neural-tube defects in newborns.

But folic acid also has several other functions: It helps the body
digest and utilize proteins and to synthesize new proteins when they
are needed; it's essential for the production of red blood cells and
the synthesis of DNA; it helps with tissue growth and cell function; it
helps to increase appetite when needed; and it stimulates the formation
of digestive acids.

Food sources of folate include beans and legumes; citrus fruits and
juices; wheat bran and other whole grains; dark, green leafy
vegetables; poultry; pork; shellfish and liver, according to the
National Institutes of Health.

Cognitive function, especially areas such as information processing
speed and memory, decline with age. These cognitive changes have been
linked to a risk of dementia.

For this study, first reported at the Alzheimer's Association's 2005
prevention conference, researchers randomly assigned 818 older adults
in Holland, aged 50 to 70 years old, to receive 800 micrograms of folic
acid supplementation daily or a placebo for three years.

All participants had low folate levels, as evidenced by elevated
homocysteine concentrations.

Adults who received the folic acid supplementation had improved
cognitive functioning, especially in the areas of memory and
information processing speed. What's more, folate concentration
increased 576 percent in those getting the supplements, and
homocysteine levels fell 26 percent.

"Folate can help people with high homocysteine levels," Carrillo
confirmed. "This is in line with what we have been thinking."

The same Dutch researchers, reporting in the Jan. 2 issue of the Annals
of Internal Medicine, found that people who took a folic acid
supplement had less decline in hearing low-frequency sounds over time,
compared with people who didn't take the supplement.

More information

The National Institute on Aging has more on aging and dietary
supplements, including vitamins and minerals.

*************

Real nutrition leads to real health.

TC
DZ - 19 Jan 2007 17:22 GMT
> http://www.forbes.com/forbeslife/health/feeds/hscout/2007/01/19/hscout601131.html
...
> Folic Acid Boosts Cognition in Older Adults
> Adults who received the folic acid supplementation had improved
> cognitive functioning, especially in the areas of memory and
> information processing speed. What's more, folate concentration
> increased 576 percent in those getting the supplements, and
> homocysteine levels fell 26 percent.
...
> *************
> Real nutrition leads to real health.

Folic acid used for supplementation is synthetic and not the same
chemically as the natural form of folate. I suppose there would be a
lot of "processing" and purification involved in the making of that
chemical. That doesn't really bother me, but how is it "real" food?
TC - 19 Jan 2007 17:37 GMT
> > http://www.forbes.com/forbeslife/health/feeds/hscout/2007/01/19/hscout601131.html
> ...
[quoted text clipped - 12 lines]
> lot of "processing" and purification involved in the making of that
> chemical. That doesn't really bother me, but how is it "real" food?

I agree. If fake manufactured processed folate shows such great
results, imagine what will happen when they get enough
folate-containing real foods in their diets.

My point is that we can't deny the importance of real nutrients to our
health. By real nutrients, I mean those vitamins and minerals that have
been shown scientifically to be essential to our survival and our
thriving physically.

And the converse is that we have to understand how detrimental to our
health these fake manufactured overly processed nutrient-deficient
foods are.

Real nutrition equals real health.

TC
David Harmon - 20 Jan 2007 00:52 GMT
On Fri, 19 Jan 2007 17:22:59 +0000 (UTC) in sci.med.nutrition, DZ
<22777@145806466.2733218530.31145.24927.3955> wrote,
>Folic acid used for supplementation is synthetic and not the same
>chemically as the natural form of folate.

What's the difference?
DZ - 20 Jan 2007 02:57 GMT
>> Folic acid used for supplementation is synthetic and not the same
>> chemically as the natural form of folate.
>
> What's the difference?

Folate in food is predominantly a mixture of 2 forms -
5-methyl-H4 folate and 10-formyl-H4 folate
(http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=405403)

The synthetic one is "PGA", pteroylmonoglutamic acid. It has higher
bio-availability and is converted to the 5-methyl-H4 form by the body,
but the reaction is saturated at doses higher than 400 mcg
(http://pmid.us/15738964) so it's probably better to take it in
divided doses.
Jim Chinnis - 20 Jan 2007 19:25 GMT
DZ <sc13nc3d@gmail.com> wrote in part:

>>> Folic acid used for supplementation is synthetic and not the same
>>> chemically as the natural form of folate.
[quoted text clipped - 10 lines]
>(http://pmid.us/15738964) so it's probably better to take it in
>divided doses.

I'm not aware that PGA has markedly lower conversion with doses above 400
mmg. The abstract of the cited document looks like an opinion piece rather
than a lab study. If you have the full text, can you quote the paragraph or
so dealing with limits on folic acid conversion?

I would greatly appreciate it if you could clarify this!
--
Jim Chinnis  Warrenton, Virginia, USA  jchinnis@alum.mit.edu
DZ - 20 Jan 2007 23:47 GMT
> DZ <sc13nc3d@gmail.com> wrote in part:
>>>> Folic acid used for supplementation is synthetic and not the same
[quoted text clipped - 18 lines]
>
> I would greatly appreciate it if you could clarify this!

I quoted that excerpt once before, so I'll just post a groups link to
Michael's reply that also conatained the abstracts of the quoted
studies -
http://groups.google.com/group/sci.life-extension/msg/5ea918023595f373

HTH
Jim Chinnis - 21 Jan 2007 05:34 GMT
DZ <sc13nc3d@gmail.com> wrote in part:

>> DZ <sc13nc3d@gmail.com> wrote in part:
>>>>> Folic acid used for supplementation is synthetic and not the same
[quoted text clipped - 25 lines]
>
>HTH

Thank you. More after I've done some thinking and reading.
--
Jim Chinnis  Warrenton, Virginia, USA  jchinnis@alum.mit.edu
Jim Chinnis - 22 Jan 2007 15:45 GMT
DZ <sc13nc3d@gmail.com> wrote in part:

>> DZ <sc13nc3d@gmail.com> wrote in part:
>>>>> Folic acid used for supplementation is synthetic and not the same
[quoted text clipped - 25 lines]
>
>HTH

This is interesting. I haven't read all the material, but if conversion is
lmited above 400 mmg, all the studies that show no cardiac benefit of folic
acid supplementation (above 400 mmg) may be failing to find a benefit
because of the reduced conversion. Further, I gather that a divided dosing
schedule might change that.

Of course, the cognitive benefits shown might be due to the unconverted
synthetic form in the blood... ;-)
--
Jim Chinnis  Warrenton, Virginia, USA  jchinnis@alum.mit.edu
Matti Narkia - 22 Jan 2007 16:37 GMT
>DZ <sc13nc3d@gmail.com> wrote in part:
>
[quoted text clipped - 33 lines]
>because of the reduced conversion. Further, I gather that a divided dosing
>schedule might change that.

According to the article

"What are the benefits of taking the "fancy" form of folic acid,
5-methyl tetrahydrofolate, and how would I know if it is better for me
if I decide to try it?"
<http://www.austinchronicle.com/gyrobase/Issue/column?oid=oid%3A269705>

mutations have been found at two locations on the gene needed to
convert folic acid into 5-MTHF and that roughly a quarter of the
population has one or both of the mutations. The conversion of folic
acid to 5-MTHF still takes place in these people but even more slowly
than normal, and there is a tendency for homocysteine to become
elevated.

Using 5-methyltetrahydrofolate in supplementation instead of folic
acid would overcome the conversion problem:

I don't know about the availabily of 5-methyltetrahydrofolate. It is
probably available somewhere, but is not ubiquitous as the regular
folic acid. Does anyoone know where to get it? About the first link my
quick web search returned was
<http://www.fallonpharmacy.com/prod_details.php?pid=2490>, but that is
mixture, and the amount of 5-MTHF is not given.

Here's another search result, seems to be mainly informative, but
badly formatted :-):

L-5-Methyl Tetrahydrofolate
<http://nwclinic.com/L5.html>

Signature

Matti Narkia

William Wagner - 22 Jan 2007 16:46 GMT
> I don't know about the availabily of 5-methyltetrahydrofolate. It is
> probably available somewhere, but is not ubiquitous as the regular
> folic acid. Does anyoone know where to get it? About the first link my
> quick web search returned was
> <http://www.fallonpharmacy.com/prod_details.php?pid=2490>, but that is
> mixture, and the amount of 5-MTHF is not given.

https://www.vitaminshoppe.com/search/en/query.jsp?q=+5-methyltetrahydrofo
late&x=53&y=10&intsource=main

or

http://preview.tinyurl.com/yorfqj

Seems to be a few different manufacturers.

Bill

Signature

S Jersey USA Zone 5 Shade  
http://www.ocutech.com/  High tech Vison aid
This article is posted under fair use rules in accordance with
Title 17 U.S.C. Section 107, and is strictly for the educational
and informative purposes. This material is distributed without profit.

RArmant - 22 Jan 2007 19:57 GMT
>I don't know about the availabily of 5-methyltetrahydrofolate. It is
>probably available somewhere, but is not ubiquitous as the regular
>folic acid. Does anyoone know where to get it?

http://www.metafolin.com/

Source Naturals Metafolin
http://www.amazon.com/Source-Naturals-Metafolin/dp/B0006O2FO4

You might look into folinic acid.
http://www.iherb.com/store/ProductDetails.aspx?c=Herbs&pid=SNS-02028
Matti Narkia - 22 Jan 2007 23:57 GMT
>>DZ <sc13nc3d@gmail.com> wrote in part:
>>
[quoted text clipped - 50 lines]
>Using 5-methyltetrahydrofolate in supplementation instead of folic
>acid would overcome the conversion problem:

A related study:

Willems FF, Boers GH, Blom HJ, Aengevaeren WR, Verheugt FW.
Pharmacokinetic study on the utilisation of 5-methyltetrahydrofolate
and folic acid in patients with coronary artery disease.
Br J Pharmacol. 2004 Mar;141(5):825-30. Epub 2004 Feb 9.
PMID: 14769778 [PubMed - indexed for MEDLINE]
<http://www.nature.com/bjp/journal/v141/n5/full/0705446a.html>

Abstract:

  1. Methylenetetrahydrofolate reductase (MTHFR) is a regulating
     enzyme in folate-dependant homocysteine remethylation,
     because it catalyses the reduction of 5,10
     methylenetetrahydrofolate to 5-methyltetrahydrofolate (5-
     MTHF).

  2. Subjects homozygous for the 677C right arrow T mutation in
     the MTHFR enzyme suffer from an increased cardiovascular
     risk. It can be speculated that the direct administration of
     5-MTHF instead of folic acid can facilitate the remethylation
     of homocysteine in methionine.

  3. The aim of this study was to determine the pharmacokinetic
     properties of orally administered 6[R,S] 5-MTHF versus folic
     acid in cardiovascular patients with homozygosity for 677C
     right arrow T MTHFR.

  4. This is an open-controlled, two-way, two-period randomised
     crossover study. Patients received a single oral dose of
     either 5 mg folic acid or 5 mg 5-MTHF in each period. The
     concentrations of the 6[S] 5-MTHF and 6[R] 5-MTHF
     diastereoisomers were determined in venous blood samples.

  5. All pharmacokinetic parameters demonstrate that the
     bioavailability of 5-MTHF is higher compared to folic acid.
     The peak concentration of both isomers following the
     administration of 6[R,S] 5-MTHF is almost seven times higher
     compared to folic acid, irrespective of the patient's
     genotype. However, at 1 week after the administration of a
     single dosage 6[R,S] 5-MTHF, we detected 6[R] 5-MTHF
     following the administration of folic acid, indicating
     storage of this isomer in the body.

  6. Our results demonstrate that oral 5-MTHF has a different
     pharmacokinetic profile with a higher bioavailability
     compared to folic acid, irrespective of the patient's
     genotype. Detrimental effects of the storage of high levels
     of the non- natural isomer 6[R] 5-MTHF cannot be excluded."

Signature

Matti Narkia

Jim Chinnis - 23 Jan 2007 01:20 GMT
Matti Narkia <mna@mbnet.fi> wrote in part:

>"Detrimental effects of the storage of high levels
>      of the non- natural isomer 6[R] 5-MTHF cannot be excluded."

I guess we have to just eat a lot of folate-rich foods...
--
Jim Chinnis   Warrenton, Virginia, USA
Matti Narkia - 23 Jan 2007 12:33 GMT
>Matti Narkia <mna@mbnet.fi> wrote in part:
>
>>"Detrimental effects of the storage of high levels
>>      of the non- natural isomer 6[R] 5-MTHF cannot be excluded."
>
>I guess we have to just eat a lot of folate-rich foods...

Unless we use Metafolin™, which contains only the natural isomer 6[S]
and no non-natural isomer 6[R]. From its product brochure
<http://www.metafolin.com/pdfs/About%20the%20Product_13.12.pdf>:

   "The chemical synthesis Metafolin™ starts from the commercially
   available B-complex vitamin folic acid, which is reduced to
   tetrahydrofolate. This reduction step leads to the formation of
   a new chiral center and two diastereoisomers in an equimolar
   ratio. In nature, methylfolate consist only of the pure L-
   isomer (6S-isomer); processes were thus developed allowing the
   isolation of the natural L-methylfolate by selective
   crystallization. Metafolin™ is produced in accordance with cGMP
   using a patented process."

Other Metafolin links:

Merck’s Metafolin receives EU approval
<http://www.nutraingredients.com/news/ng.asp?id=66329-merck-eprova-metafolin-folate>

Metafolin ruled safe for use in supplements and foods by JECFA
2005-08-08 - Merck Eprova AG
<http://www.npicenter.com/anm/templates/newsATemp.aspx?articleid=13245&zoneid=80>

JECFA Evaluations-CALCIUM L-5-METHYLTETRAHYDROFOLATE
<http://www.inchem.org/documents/jecfa/jeceval/jec_326.htm>

Merck offering nature-identical folate in new markets
<http://www.in-pharmatechnologist.com/news/ng.asp?id=61793-metafolin-folate-folic>

Merck Eprova AG Highlighted for Inventing Metafolin(R) With the Frost
& Sullivan Product Differentiation Innovation Award of the Year.
Tuesday 9 January 2007-
<http://www.prnewswire.co.uk/cgi/news/release?id=187683>

Merck KGaA begins Marketing of Metafolin in the United States, opens
new era in the field of dietary-supplement ingredients
<http://me.merck.de/EMD/UK/uknews2.nsf/d4c60a303233fb87c1256fc500368312/f2f6088ac
fb8dc42c1256fc5003a7e39?OpenDocument
>

Sources:

<http://www.findarticles.com/p/articles/mi_m0KFY/is_7_23/ai_n15346554/pg_2>
<http://www.lef.org/newshop/items/item00719.html>
<http://vitanetonline.com/description/SN1647/vitamins/Metafolin-800-mcg/>
<http://www.shopping.com/xPO-Source-Naturals-Metafolin-800-Mcg-120-Tablets>

Metafolin Medline references:

Joint FAO/WHO Expert Committee on Food Additives.
Evaluation of certain food additives.
World Health Organ Tech Rep Ser. 2006;934:1-145, back cover.
PMID: 17069402 [PubMed - indexed for MEDLINE]
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=R
etrieve&dopt=abstractplus&list_uids=17069402
>

Venn BJ, Green TJ, Moser R, Mann JI.
Comparison of the effect of low-dose supplementation with
L-5-methyltetrahydrofolate or folic acid on plasma homocysteine: a
randomized placebo-controlled study.
Am J Clin Nutr. 2003 Mar;77(3):658-62.
PMID: 12600857 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/full/77/3/658>

Houghton LA, Sherwood KL, Pawlosky R, Ito S, O'Connor DL.
[6S]-5-Methyltetrahydrofolate is at least as effective as folic acid
in preventing a decline in blood folate concentrations during
lactation.
Am J Clin Nutr. 2006 Apr;83(4):842-50.
PMID: 16600937 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/abstract/83/4/842>

Lamers Y, Prinz-Langenohl R, Moser R, Pietrzik K.
Supplementation with [6S]-5-methyltetrahydrofolate or folic acid
equally reduces plasma total homocysteine concentrations in healthy
women.
Am J Clin Nutr. 2004 Mar;79(3):473-8.
PMID: 14985224 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/full/79/3/473>

Pentieva K, McNulty H, Reichert R, Ward M, Strain JJ, McKillop DJ,
McPartlin JM, Connolly E, Molloy A, Kramer K, Scott JM.
The short-term bioavailabilities of [6S]-5-methyltetrahydrofolate and
folic acid are equivalent in men.
J Nutr. 2004 Mar;134(3):580-5.
PMID: 14988450 [PubMed - indexed for MEDLINE]
<http://jn.nutrition.org/cgi/content/full/134/3/580>'

Bostom AG, Shemin D, Bagley P, Massy ZA, Zanabli A, Christopher K,
Spiegel P, Jacques PF, Dworkin L, Selhub J.
Controlled comparison of L-5-methyltetrahydrofolate versus folic acid
for the treatment of hyperhomocysteinemia in hemodialysis patients.
Circulation. 2000 Jun 20;101(24):2829-32. Erratum in: Circulation 2000
Aug 1;102(5):598.
PMID: 10859289 [PubMed - indexed for MEDLINE]
<http://circ.ahajournals.org/cgi/content/full/101/24/2829>

Medline references about the absorption of natural and synthetic
folates:

McKillop DJ, McNulty H, Scott JM, McPartlin JM, Strain JJ, Bradbury I,
Girvan J, Hoey L, McCreedy R, Alexander J, Patterson BK,
Hannon-Fletcher M, Pentieva K.
The rate of intestinal absorption of natural food folates is not
related to the extent of folate conjugation.
Am J Clin Nutr. 2006 Jul;84(1):167-73.
PMID: 16825692 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/abstract/84/1/167>

   "... CONCLUSION: These results suggest that the ratio of
   monoglutamate to polyglutamate in natural folates is not a factor
   that limits the extent of intestinal absorption of food folate."

Wright AJ, Finglas PM, Dainty JR, Wolfe CA, Hart DJ, Wright DM,
Gregory JF.
Differential kinetic behavior and distribution for pteroylglutamic
acid and reduced folates: a revised hypothesis of the primary site of
PteGlu metabolism in humans.
J Nutr. 2005 Mar;135(3):619-23.
PMID: 15735104 [PubMed - indexed for MEDLINE]
<http://jn.nutrition.org/cgi/content/full/135/3/619>

Signature

Matti Narkia

Matti Narkia - 23 Jan 2007 12:39 GMT
>Matti Narkia <mna@mbnet.fi> wrote in part:
>
>>"Detrimental effects of the storage of high levels
>>      of the non- natural isomer 6[R] 5-MTHF cannot be excluded."
>
>I guess we have to just eat a lot of folate-rich foods...

Unless we use Metafolin, which contains only the natural isomer 6[S]
and no non-natural isomer 6[R]. From its product brochure
<http://www.metafolin.com/pdfs/About%20the%20Product_13.12.pdf>:

   "The chemical synthesis Metafolin starts from the commercially
   available B-complex vitamin folic acid, which is reduced to
   tetrahydrofolate. This reduction step leads to the formation of
   a new chiral center and two diastereoisomers in an equimolar
   ratio. In nature, methylfolate consist only of the pure L-
   isomer (6S-isomer); processes were thus developed allowing the
   isolation of the natural L-methylfolate by selective
   crystallization. Metafolin is produced in accordance with cGMP
   using a patented process."

Other Metafolin links:

Merck’s Metafolin receives EU approval
<http://www.nutraingredients.com/news/ng.asp?id=66329-merck-eprova-metafolin-folate>

Metafolin ruled safe for use in supplements and foods by JECFA
2005-08-08 - Merck Eprova AG
<http://www.npicenter.com/anm/templates/newsATemp.aspx?articleid=13245&zoneid=80>

JECFA Evaluations-CALCIUM L-5-METHYLTETRAHYDROFOLATE
<http://www.inchem.org/documents/jecfa/jeceval/jec_326.htm>

Merck offering nature-identical folate in new markets
<http://www.in-pharmatechnologist.com/news/ng.asp?id=61793-metafolin-folate-folic>

Merck Eprova AG Highlighted for Inventing Metafolin(R) With the Frost
& Sullivan Product Differentiation Innovation Award of the Year.
Tuesday 9 January 2007.
<http://www.prnewswire.co.uk/cgi/news/release?id=187683>

Merck KGaA begins Marketing of Metafolin in the United States, opens
new era in the field of dietary-supplement ingredients
<http://me.merck.de/EMD/UK/uknews2.nsf/d4c60a303233fb87c1256fc500368312/f2f6088ac
fb8dc42c1256fc5003a7e39?OpenDocument
>

Sources:

<http://www.lef.org/newshop/items/item00719.html>
<http://vitanetonline.com/description/SN1647/vitamins/Metafolin-800-mcg/>
<http://www.shopping.com/xPO-Source-Naturals-Metafolin-800-Mcg-120-Tablets>

Metafolin Medline references:

Joint FAO/WHO Expert Committee on Food Additives.
Evaluation of certain food additives.
World Health Organ Tech Rep Ser. 2006;934:1-145, back cover.
PMID: 17069402 [PubMed - indexed for MEDLINE]
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=R
etrieve&dopt=abstractplus&list_uids=17069402
>

Venn BJ, Green TJ, Moser R, Mann JI.
Comparison of the effect of low-dose supplementation with
L-5-methyltetrahydrofolate or folic acid on plasma homocysteine: a
randomized placebo-controlled study.
Am J Clin Nutr. 2003 Mar;77(3):658-62.
PMID: 12600857 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/full/77/3/658>

Houghton LA, Sherwood KL, Pawlosky R, Ito S, O'Connor DL.
[6S]-5-Methyltetrahydrofolate is at least as effective as folic acid
in preventing a decline in blood folate concentrations during
lactation.
Am J Clin Nutr. 2006 Apr;83(4):842-50.
PMID: 16600937 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/abstract/83/4/842>

Lamers Y, Prinz-Langenohl R, Moser R, Pietrzik K.
Supplementation with [6S]-5-methyltetrahydrofolate or folic acid
equally reduces plasma total homocysteine concentrations in healthy
women.
Am J Clin Nutr. 2004 Mar;79(3):473-8.
PMID: 14985224 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/full/79/3/473>

Pentieva K, McNulty H, Reichert R, Ward M, Strain JJ, McKillop DJ,
McPartlin JM, Connolly E, Molloy A, Kramer K, Scott JM.
The short-term bioavailabilities of [6S]-5-methyltetrahydrofolate and
folic acid are equivalent in men.
J Nutr. 2004 Mar;134(3):580-5.
PMID: 14988450 [PubMed - indexed for MEDLINE]
<http://jn.nutrition.org/cgi/content/full/134/3/580>'

Bostom AG, Shemin D, Bagley P, Massy ZA, Zanabli A, Christopher K,
Spiegel P, Jacques PF, Dworkin L, Selhub J.
Controlled comparison of L-5-methyltetrahydrofolate versus folic acid
for the treatment of hyperhomocysteinemia in hemodialysis patients.
Circulation. 2000 Jun 20;101(24):2829-32. Erratum in: Circulation 2000
Aug 1;102(5):598.
PMID: 10859289 [PubMed - indexed for MEDLINE]
<http://circ.ahajournals.org/cgi/content/full/101/24/2829>

Medline references about the absorption of natural and synthetic
folates:

McKillop DJ, McNulty H, Scott JM, McPartlin JM, Strain JJ, Bradbury I,
Girvan J, Hoey L, McCreedy R, Alexander J, Patterson BK,
Hannon-Fletcher M, Pentieva K.
The rate of intestinal absorption of natural food folates is not
related to the extent of folate conjugation.
Am J Clin Nutr. 2006 Jul;84(1):167-73.
PMID: 16825692 [PubMed - indexed for MEDLINE]
<http://www.ajcn.org/cgi/content/abstract/84/1/167>

   "... CONCLUSION: These results suggest that the ratio of
   monoglutamate to polyglutamate in natural folates is not a factor
   that limits the extent of intestinal absorption of food folate."

Wright AJ, Finglas PM, Dainty JR, Wolfe CA, Hart DJ, Wright DM,
Gregory JF.
Differential kinetic behavior and distribution for pteroylglutamic
acid and reduced folates: a revised hypothesis of the primary site of
PteGlu metabolism in humans.
J Nutr. 2005 Mar;135(3):619-23.
PMID: 15735104 [PubMed - indexed for MEDLINE]
<http://jn.nutrition.org/cgi/content/full/135/3/619>

Signature

Matti Narkia

Matti Narkia - 20 Jan 2007 03:00 GMT
>On Fri, 19 Jan 2007 17:22:59 +0000 (UTC) in sci.med.nutrition, DZ
><22777@145806466.2733218530.31145.24927.3955> wrote,
>>Folic acid used for supplementation is synthetic and not the same
>>chemically as the natural form of folate.
>
>What's the difference?

Below some clippings from my old folate/folic acid notes:

From
<http://www.cce.cornell.edu/food/expfiles/topics/stover/folicqanda.html>:

  "Q. What's the difference between the terms folic acid and
   folate?
   
   A. In cells, folic acid exists in many chemical forms with
   respect to its oxidation state, one-carbon substitutions and
   number of glutamate residues. In general, the term folates,
   when used in the generic sense, refers to all chemical forms
   of folic acid. The term folic acid refers to the oxidized,
   monoglutamate form of folate otherwise known as
   pteroylglutamic acid.
   
   Q. Is there a difference in bioavailability between folic
   acid in foods versus supplements?
   
   A. The bioavailability of food folate is difficult to
   predict. In general, the oxidized, monoglutamate form of
   folate, the form found in supplements and the form used to
   fortify foods, has a much greater bioavailability than food
   folate which tends to be in a chemically reduced and in a
   polyglutamated form. The absorption of supplement folate
   during fasting is near 100%. Prior to absorption, folate
   polyglutamates must be enzymatically converted to folate
   monoglutamates, and the efficiency of this reaction varies
   depending upon the food source of folate. Therefore, while
   all sources are important, more folate is absorbed from
   fortified foods and supplements. Folic acid supplements are
   even more bioavailable if taken between meals."

From
<http://europa.eu.int/comm/food/fs/sc/scf/out80e_en.pdf>:

   "Folate is the generic name for a number of compounds having
   a similar activity as folic acid (pteroylglutamic acid,
   PGA), i.e. being involved in single carbon (C1-) transfer
   reactions. Folic acid (PGA) is a synthetic folate compound
   used in food supplements and in food fortification because
   of its stability, and becomes biologically active after
   reduction. Natural (dietary) folates are mostly reduced
   folates, i.e. derivatives of tetrahydrofolate (THF), such as
   5-methyl- THF (5-MTHF), 5- formyl-THF and 5,10-methylene-
   THF, and exist mainly as pteroylpolyglutamates, with up to
   nine additional glutamate molecules attached to the
   pteridine ring.

   [...]

   Food folates, mainly present as polyglutamates, have to be
   hydrolysed by a (brush border associated) deconjugase enzyme
   in the gut before absorption can occur. Folate absorption
   from natural food is generally lower than synthetic forms
   (e.g. folic acid) contained in supplements, due to matrix
   effects and the presence of inhibitors of the conjugase
   enzyme in some foods. Folic acid (PGA) enters the folate
   cycle after reduction by a (dihydro-)folate reductase. This
   enzyme is present in the intestinal mucosal cell, but also
   in other tissues, such as liver and kidney. Reduction of PGA
   may be a slow process in some subjects and at higher intake
   levels (> ca 260 µg) PGA may appear unchanged in the
   circulation (i.e. in the postprandial state after supplement
   use (Kelly et al., 1997). Under normal conditions 5-MTHF (as
   monoglutamate) is the only form present in plasma, mainly
   protein-bound. Tissue uptake is carrier-mediated and/or
   through folate binding proteins. In tissues folates are
   retained as polyglutamates and the folate coenzymes can be
   interconverted in numerous (de-)methylation reactions, such
   as in DNA synthesis (formation of thymidilate from
   deoxyuridine), amino acid interconversions, such as the
   remethylation of homocysteine to methionine. In this latter
   methionine synthase (MS) reaction vitamin B12 is also
   involved as a cofactor. About 50% of the folate body store,
   estimated to be 13-28 mg, is considered to be present in the
   liver (for review see Report of the Standing Committee on
   the scientific evaluation of dietary reference intakes
   (DRIs) and its panel on folate and other B-vitamins and
   choline. Food and Nutrition Board, Institute of Medicine,
   1998)."

From
<http://users.umassmed.edu/martin.marinus/Mph200/FolicAcidMetabolism.pdf>:

   "DHF and THF from natural sources are polyglutamated and
   need to be enzymatically converted to the monoglutamate for
   absorption from the small intestine."

(DHF=dihydrofolic acid; THF=tetrahydrofolic acid)

From
<http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/fol_0110.shtml>:

   "The term folate is used in two different ways. Folate, a
   member of the B-vitamin family, is a collective term for a
   number of chemical forms which are structurally related and
   which have similar biological activity to folic acid. Folate is
   also the term which is used for the anionic form of folic acid.
   Folic acid or pteroylglutamic acid (PGA) is comprised of para-
   aminobenzoic acid linked at one end to a pteridine ring and at
   the other end to glutamic acid. The pteridine-para-aminobenzoic
   acid portion of the molecule is called the pteroyl group. Folic
   acid is a synthetic folate form which is used for food
   fortification and nutritional supplements. It is not one of the
   principal naturally occurring forms of folate, used in the
   collective sense.

   The naturally occurring forms of folate differ in the extent of
   the reduction state of the pteroyl group, the nature of the
   substituents on the pteridine ring and the number of glutamyl
   residues attached to the pteroyl group. The naturally occurring
   folates, include 5-methyltetrahydrofolate (5-MTHF), 5-
   formyltetrahydrofolate (5-formyl-THF), 10-
   formyltetrahydrofolate (10-formyl-THF), 5,10-
   methylenetetrahydrofolate (5,10-methylene-THF), 5,10-
   methenyltetrahydrofolate (5,10-methenyl-THF), 5-
   formiminotetrahydrofolate (5-formimino-THF), 5,6,7,8-
   tetrahydrofolate (THF) and dihydrofolate (DHF). Most naturally
   occurring folates are pteroylpolyglutamates, containing two to
   seven glutamates joined in amide (peptide) linkages to the
   gamma-carboxyl of glutamate. The principal intracellular
   folates are pteroylpentaglutamates, while the principal
   extracellular folates are pteroylmonoglutamates.
   Pteroylpolyglutamates with up to 11 glutamic acid residues
   exist naturally.

   [...]
 
   PHARMACOKINETICS

   Folic acid or pteroylglutamic acid (PGA) is the form of
   folate used in food fortification and the principal form of
   folate found in nutritional supplements. Natural food
   folates are pteroylpolyglutamate derivatives.
   Pteroylpolyglutamate derivatives are hydrolyzed to
   pteroylmonoglutamate forms prior to absorption from the
   small intestine. The enzyme that catalyzes the cleavage is
   called folate conjugase or gamma-glutamylhydrolase. The
   monoglutamate forms of folate, including folic acid, are
   transported across the proximal small intestine via a
   saturable pH-dependent process. Higher doses of the
   pteroylmonoglutamates, including folic acid, are absorbed
   via a nonsaturable passive diffusion process. The efficiency
   of absorption of the pteroylmonoglutamates is greater than
   that of the pteroylpolyglutamates.

   Because of the difference in absorption efficiency between
   natural food folate and folic acid, the concept of dietary
   folate equivalents (DFEs) has been introduced. Folic acid
   taken on an empty stomach is twice as available as food
   folate. Folic acid taken with food is 1.7 times as available
   as food folate. For example, 400 micrograms of folic acid
   taken on an empty stomach is equivalent to 470 micrograms of
   folic acid taken with food and is equivalent to 800
   micrograms of food folate. DFEs can be calculated as
   follows:

   1 microgram of DFEs = 1 microgram of food folate = 0.5
   micrograms of folic acid taken on an empty stomach = 0.6
   micrograms of folic acid taken with meals.

   Following absorption of physiological amounts of folic acid
   into the enterocytes, a certain percentage undergoes
   reduction. Reduced folate is transported to the liver via
   the portal circulation. Much of a pharmacological dose of
   folic acid is transported to the liver as such, without
   first undergoing metabolism in the enterocytes. The various
   natural pteroylmonoglutamate forms undergo some metabolism
   in the enterocytes to pteroylpolyglutamate forms, but for
   the most part are also transported as their unmetabolized
   forms via the portal circulation to the liver. The folates
   are taken up by the liver and metabolized to polyglutamate
   derivatives (principally pteroylpentaglutamates), via the
   action of folylpolyglutamate synthase. Folates are stored in
   tissue in their polyglutamate forms. Folate is metabolized
   to its various metabolic forms in the liver. The various
   pteroylpolyglutamate forms are the active cellular cofactor
   forms of folate. Folate polyglutamates are released from the
   liver to the systemic circulation and to the bile. When
   released from the liver into the circulation, the
   polyglutamate forms are hydrolyzed by gamma-
   glutamylhydrolase and reconverted to the monoglutamate
   forms.

   The principal folate in the plasma is 5-
   methyltetrahydrofolate in its monoglutate form. 5-
   Methyltetrahydrofolate circulates in erythrocytes in its
   polyglutamate form. Approximately two-thirds of folate in
   plasma is protein bound. All tissue forms of folate are
   polyglutamates, while circulating forms of folate are
   monoglutamates. When pharmacological doses of folic acid are
   administered, a significant amount of unchanged folic acid
   is found in the plasma. The liver contains approximately 50%
   of the body stores of folate, or about 6 to 14 milligrams.
   The total body store of folate is about 12 to 28 milligrams.

   Folate is excreted in the urine as folate cleavage products.
   Intact folate enters the glomerulus and is reabsorbed into
   the proximal renal tubule. Very little intact folate is
   excreted in the urine. Folate is excreted in the bile and
   much of it is reabsorbed via the enterohepatic circulation."

B12 is needed to convert circulating 5-methyltetrahydrofolate
(5-methyl THFA), omce inside the cell, to THFA, the active form
participating in folate-dependent enzymatic reactions. In the
absence of B12, folate is "trapped" as 5-methyl THFA.

The dietary folate is either monoglutamate or polyglutamate.  Most is
polyglutamate and it can not be absorbed at all. All supplement folic
acid is monoglutamate and it is absorbed very well. The human gut has
a peptidase that hydrolyzes all of the glutamate off the polyglutamate
to give the monoglutamate form. This enzyme will not work
without B12. Low B12 will cause a folate deficiency unless a folic
acid supplement is used. See the page

<http://www.feinberg.northwestern.edu/nutrition/factsheets/folate.html>:

   "... Only about half of the folate consumed from food
   sources has acceptable bioavailability. Folate occurs
   naturally attached to multiple glutamic acid molecules which
   must be removed by hydrolysis prior to absorption by a
   vitamin B12-dependent enzyme to form pteroylmonoglutamate.
   In general, foods with high proportions of the monoglutamate
   form have higher folate bioavailability irrespective of the
   total amount. ..."

So B12 is needed both for the absorption of dietary folate and for the
folate metabolism inside the cell.

See also

<http://www.emedicine.com/MED/topic802.htm>:

  "Folic acid is composed of a pterin ring connected to p-
   aminobenzoic acid (PABA) and conjugated with one or more
   glutamate residues. It is distributed widely in green leafy
   vegetables, citrus fruits, and animal products. Humans do
   not generate folate endogenously because they cannot
   synthesize PABA, nor can they conjugate the first glutamate.
   
   Folates are present in natural foods and tissues as
   polyglutamates because these forms serve to keep the folates
   within cells. In plasma and urine, they are found as
   monoglutamates because this is the only form that can be
   transported across membranes. Enzymes in the lumen of the
   small intestine convert the polyglutamate form to the
   monoglutamate form of the folate, which is absorbed in the
   proximal jejunum via both active and passive transport.
   
   Within the plasma, folate is present, mostly in the 5-
   methyltetrahydrofolate (5-methyl THFA) form, and is loosely
   associated with plasma albumin in circulation. The 5-methyl
   THFA enters the cell via a diverse range of folate
   transporters with differing affinities and mechanisms (ie,
   adenosine triphosphate [ATP]–dependent H+ cotransporter or
   anion exchanger). Once inside, 5-methyl THFA may be
   demethylated to THFA, the active form participating in
   folate-dependent enzymatic reactions. Cobalamin (B-12) is
   required in this conversion, and in its absence, folate is
   "trapped" as 5-methyl THFA.
   
   From then on, folate no longer is able to participate in its
   metabolic pathways, and megaloblastic anemia results. Large
   doses of supplemental folate can bypass the folate trap, and
   megaloblastic anemia will not occur. However, the
   neurologic/psychiatric abnormalities associated with B-12
   deficiency ensue progressively.
   
   The biologically active form of folic acid is
   tetrahydrofolic acid (THFA), which is derived by the 2-step
   reduction of folate involving dihydrofolate reductase. THFA
   plays a key role in the transfer of 1-carbon units (such as
   methyl, methylene, and formyl groups) to the essential
   substrates involved in the synthesis of DNA, RNA, and
   proteins. More specifically, THFA is involved with the
   enzymatic reactions necessary to synthesis of purine,
   thymidine, and amino acid. Manifestations of folate
   deficiency thereafter, not surprisingly, would involve
   impairment of cell division, accumulation of possibly toxic
   metabolites such as homocysteine, and impairment of
   methylation reactions involved in the regulation of gene
   expression, thus increasing neoplastic risks."

From
<http://users.umassmed.edu/martin.marinus/Mph200/FolicAcidMetabolism.pdf>:

   "*Increased excretion/loss: Increased excretion of folate
   can occur subsequent to vitamin B-12 deficiency. During the
   course of vitamin B-12 deficiency, methylene THFA is known
   to accumulate in the serum, which is known as the folate
   trap phenomenon. In turn, large amounts of folate filter
   through the glomerulus, and urine excretion occurs. Another
   mechanism of excess excretion occurs in people with chronic
   alcoholism who can have increased excretion of folate into
   the bile. Patients undergoing hemodialysis also have been
   known to have excess folate loss during procedures."

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