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| Folinic Acid vs. Folate: Differences, Uses, and Which Is Better | ||
|---|---|---|
| Feature | Folinic Acid | Folic Acid (Folate Supplements) |
| Form | Active form of folate | Synthetic form of folate |
| Absorption | Quickly absorbed, effective in people with MTHFR gene variants | Requires liver conversion; less active initially |
| Availability | Prescription only | Over-the-counter supplements and fortified foods, also by prescription |
| Common Uses | Methotrexate toxicity rescue, specific cancers, folate deficiency anemia | General supplementation, pregnancy (preventing neural tube defects), folate deficiency |
| Dosing Limits | Oral doses above 25 mg not recommended due to reduced absorption | Safe upper limit: 1,000 mcg/day from supplements and fortified foods |
| Side Effects & Risks | Generally well-tolerated, with some studies reporting mild behavioral problems, diarrhea, constipation, and changes in behavior in children with autism | High doses can mask B12 deficiency; potential cancer risk at excessive doses |
| Which Is Better? | Best for specific medical uses and absorption issues | Best for general use, pregnancy, and preventing folate deficiency |
What Is Folinic Acid Used For?
Folinic acid is a prescription medication used to treat or prevent side effects from specific medications and medical conditions, including the following:
- Methotrexate toxicity: Methotrexate (brand name Trexall) is used to treat specific cancers and autoimmune diseases, but it blocks folic acid, leading to side effects such as mouth sores, nausea, and blood issues. Folinic acid helps reduce these effects.
- Megaloblastic anemia: This type of anemia occurs when red blood cells grow too large due to a folate deficiency. Folinic acid can help correct this imbalance by replenishing active folate levels in your body.
- Advanced colorectal cancer: In cancer care, folinic acid is often administered before fluorouracil (5-FU) to enhance its effectiveness and improve survival outcomes in advanced colorectal cancer.
- Preventing methotrexate side effects in other conditions: Folinic acid may be used with long-term methotrexate to reduce side effects and improve tolerance. Always follow the provided instructions.
- Supporting autism treatment: In children with autism who had trouble processing folic acid, folinic acid, in addition to standard care, showed noticeable improvements in symptoms. Another study found that folinic acid supplementation improved verbal communication in children with autism compared to a placebo. Further studies with larger sample sizes are needed to confirm the results.
Is Folinic Acid Safe for Me?
While side effects such as mild behavioral problems, diarrhea, constipation, and changes in behavior have been reported in children with autism, folinic acid is generally well-tolerated.
What Is Folate?
Folate is the natural form of vitamin B9, found in a variety of whole foods. Its synthetic counterpart, folic acid, is commonly used in dietary supplements and fortified foods.
- Why your body needs it: Folate is crucial for producing genetic material, as well as supporting healthy cell growth and division. It plays an especially vital role during pregnancy, infancy, and periods of rapid growth.
- How it is absorbed: Natural folate from food requires a two-step conversion in your gut, making it less bioavailable than some supplements.
- Food sources of folate: Natural folate is found in nutrient-rich foods like leafy greens, asparagus, fruits, nuts, beans, seafood, eggs, and meats.
- Folate in supplements: Folate supplements come in two primary forms: folic acid and methylfolate (5-MTHF). 5-MTHF is the active form and is better absorbed, especially by those with MTHFR gene variants.
What Are Folate Supplements (Folic Acid) Used For?
- Treating megaloblastic anemia caused by folate deficiency.
- Preventing neural tube defects, 400 micrograms (mcg) of folic acid daily during pregnancy lowers risk.
- Prevention of methotrexate toxicity in non-cancer-related conditions, just like folinic acid.
- Reducing the risk of autism in children with early pregnancy folic acid supplementation, although more research is needed to confirm this link.
Please avoid self-treating with folic acid during pregnancy; consult your healthcare provider for guidance.
Are Folate Supplements Safe for Me?
While folate is essential, too much, especially from supplements, carries risks:
- Masking vitamin B12 deficiency: High folate levels from supplements can mask vitamin B12 deficiency, potentially leading to irreversible nerve damage. Adults should limit their folate intake to 1,000 mcg per day. Avoid folinic acid for treating low B12-related anemia.
- Potential cancer risk: Some studies suggest that high doses of folic acid may increase the risk of colorectal and possibly other cancers.
- Allergic reactions: Although rare, severe reactions, such as hives or anaphylaxis, have occurred with folinic acid, whether administered orally or by injection.
- Medication interactions: Folate supplements may reduce the effectiveness of specific anti-seizure medications, including Dilantin (phenytoin), Tegretol (carbamazepine), and Depacon (valproate).
Always check with your healthcare provider before combining supplements with prescription medications.
Which Is Better?
There’s no clear winner. Consult with your healthcare provider to determine the best option for your specific needs.
- Use folinic acid as prescribed for specific conditions or if you have issues with absorption.
- Use folic acid for general supplementation, pregnancy, or to prevent deficiency—unless your healthcare provider advises otherwise.