Folinic Acid

[Aaron Hartman]

Dr. Woeller,

Could you briefly describe the difference of folinic acid compared to 5MTHF and the specifics of when you would use folinic acid verses 5-MTHF.

Thanks
Aaron Hartman MD

[DrWoeller]

Dr. Hartman,
Folinic acid has been around longer, at least a wide supplement distribution. Folinic acid is the primary form studied in Cerebral Folate Deficiency. It is reported to be slightly more versatile than 5MTHF because it isn’t dependent on the redox status of Methionine Synthase (MS) activity affecting methycobalamin. This seems to mostly be a problem in severe autism with high oxidation properties, i.e. heavy metals, chronic infections. Clinically, they both seem to work about the same, but there are certain cases based on trial use where one person does better with one versus the other and vice versa.

I personally tend to use the L-methyl-folate form anymore, particularly when MTHFR C677T has been documented to be +- or ++. There seems to be some movement in making folinic acid only available as a medical food prescription because of its link to Leucovorin.

Clinically, if you where going to folinic versus methyl-folate then it would be most appropriate in a child where there has been a lot of word done yet to lower oxidative stress. This would only be based on the presumed oxidation effects at the MS complex – as you can see these things are hard to measure.

In most cases it comes down to starting one and seeing how the child does, then switching if unsatisfactory or negative results are seen.

Dr. Woeller

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