Did you know….

Folic acid supplements are associated with an increased risk of cancers?

And increased risk of cognitive decline in older people?

What many don’t realise is that folic acid and folate are different things.

Folic acid is a synthetic, inactive product not found in nature.

It must be converted into the active form to make new cells, neurotransmitters and much more, check out the ACN style stripped down, folate pathway (we keep stuff need to know not nice to know).

The enzyme that converts folic acid to the next form is saturated above around 400 mcg. So any more than that via supplements and fortified foods and you start to build up unmetabolised folic acid.


Now we know that folic acid is associated with a reduced chance of neural tube defects so it is not that folic acid is bad per se, it does raise the level of the active form if you shove enough down the pathway but at what cost?

The context, dose and duration of its use is important.

Also 10-15 % of the population has a genetic defect for an enzyme

(MTHFR) that results less conversion to the final active form of folate, METHYL folate.

The combination means high levels of unmetabolised folic acid and low levels of the active methyl form of folate.

High levels of unmetabolised folic acid means (according to some, though not all researchers) higher risk of cancer.



Methylation is a complex topic/concept, almost universally taught badly, here is the stripped down need to know info:


It just so happens the stuff you make, turn on and off is ludicrously important, like making myelin (think pain thresholds, pins & needles/numbness) and DNA (less new cells, think anaemia and poor collagen).

It is also intimately involved in neurotransmitters (think mood & behaviour issues aka depression and anxiety)

and much, much more.


It gets worse. With less methylation you get more of a toxic intermediary called homocysteine. 

Elevated homocysteine is a known to cause pain, inflammation, depression, brain fog, fatigue.

Check out the CSF homocysteine levels of CFS/fibromyalgia patients compared to controls:


Due to the inflammation it’s also associated with strokes, cancer and heart disease.


It is also a modifiable risk factor for dementia, hence B vitamins are “good” for dementia.



Less active folate also means less new cells (think blood cells = anaemia) and less neurotransmitters (think mood and behaviour aka depression).


The bad news doesn’t stop there.

Due to neural tube defects we also now fortify foods with folic acid.

If patients take folic acid and it’s converted into the active form, the folate masks the megaloblastic anaemia found in B12 deficiency.


NOTE: B12 deficiency will cause fatigue and neurological symptoms wayyyy before the patient gets anywhere near low enough for anaemia.

Which is another reason I never allow patients to buy supplements in the supermarket.

The overwhelming majority are the folic acid form, like the ever popular standard Pregnacare.

The good news is we can get the active form of folate (5-MTHF) in good quality supplements and avoid the risk.

So should you ever order a homocysteine test, when you get an elevated homocysteine blood test back from a patient you should do a little happy dance.


Because you know for sure you can get it down which means the patient is going to have:

More energy

Less pain

Enhanced moods

And reduced risk of cancer, strokes, heat attacks and dementia

Plus it will allow your neuro-mechanical intervention to work.

All of which makes you look like a hero to your patients.


– Always ask patients to bring in (or email photos in) supplements so you can check doses and forms.

– Either stock good quality supplements or refer out to sites like

www.naturaldispensary.co.uk where you can receive a commission. It is a win:win, they get results with quality supplements and you make a little extra income.

– Any patients with a family history of dementia or those worried about developing dementia, ask if they know there is a valid blood test which if positive, can reduce the risk of dementia plus increase energy and improve mood. It is an easy sell with incredible results.