L-Methylfolate vs. Folinic Acid: Which Lowers Homocysteine?
Quick Summary: A recent study found that both L-methylfolate and folinic acid can help lower homocysteine levels, a marker linked to heart health, in healthy adults. While both worked, the study also found that your genes might influence which one works best for you.
What The Research Found
This study looked at how two forms of folate, L-methylfolate and folinic acid, affect homocysteine levels. Homocysteine is a substance in your blood; high levels can be a risk factor for certain health problems. The research showed:
- Both forms of folate lowered homocysteine: People taking either L-methylfolate or folinic acid saw a drop in their homocysteine levels.
- Folinic acid boosted folate more: Folinic acid increased blood folate levels more than L-methylfolate.
- Genes matter: The study found that a specific gene variation (MTHFR C677T) could affect which type of folate worked best.
Study Details
- Who was studied: 272 healthy adults in Greece (mostly middle-aged).
- How long: The study lasted for 3 months.
- What they took: Participants took either L-methylfolate or folinic acid daily. Some people also received vitamin B12 shots if their B12 levels were low.
What This Means For You
- If you have high homocysteine: Talk to your doctor about getting your levels checked. L-methylfolate or folinic acid might be options to help lower them.
- Consider your genes: If you know your MTHFR C677T gene status, it could help guide your choice.
- If you have the 677CT genotype, folinic acid might be a better choice.
- Talk to your doctor: Always discuss any supplements with your doctor before starting them. They can help you decide what's best for your individual needs.
Study Limitations
- Specific doses weren't provided: The study didn't specify the exact doses of L-methylfolate or folinic acid used.
- Limited to one population: The study was done on Greek adults, so the results might not be the same for everyone.
- Short-term study: The study only lasted 3 months, so we don't know the long-term effects.
- B12 injections: Some participants received B12 shots, which could have also affected homocysteine levels.
- No placebo: The study didn't have a group that took a "dummy" pill (placebo), so it's harder to be sure the folate was the only factor.
Technical Analysis Details
Key Findings
Both folinic acid and L-methylfolate supplementation significantly reduced serum total homocysteine (tHcy) levels in healthy Greek adults with baseline tHcy ≥10 μmol/L. Folinic acid caused a greater increase in serum folate levels compared to L-methylfolate, but the tHcy-lowering effects were similar overall. The MTHFR C677T polymorphism influenced efficacy: individuals with the 677TT genotype had the greatest tHcy reduction, while those with the 677CT genotype experienced significantly greater tHcy reduction with folinic acid than L-methylfolate. No effect was observed for the MTHFR A1298C polymorphism.
Study Design
This was a randomized controlled trial (RCT) involving 272 healthy Greek adults (143 men, 129 women; mean age: 43.0 ± 15.3 years). Participants were assigned to either folinic acid or L-methylfolate supplementation for 3 months. Serum biomarkers (folate, cobalamin, tHcy) and MTHFR polymorphisms were assessed pre- and post-intervention.
Dosage & Administration
The study summary does not specify exact dosages of folinic acid or L-methylfolate. Supplements were administered orally for 3 months. Participants with serum cobalamin (Cbl) <300 pg/mL received 1 mg hydroxycobalamin intramuscularly twice weekly for the first month only.
Results & Efficacy
- tHcy Reduction: Both groups showed significant decreases in tHcy (p < 0.05), though no substantial difference in efficacy between folinic acid and L-methylfolate was observed overall.
- Genotype Influence:
- 677TT genotype carriers had the greatest tHcy reduction (p < 0.05 vs. CC/CT genotypes).
- 677CT genotype carriers had significantly greater tHcy reduction with folinic acid compared to L-methylfolate (p < 0.05).
- Serum Folate: Folinic acid increased serum folate more than L-methylfolate (p < 0.05).
- Cobalamin: Both groups saw significant increases in serum Cbl, likely due to hydroxycobalamin injections in deficient participants.
Limitations
- Dosage Unclear: The lack of specified doses limits practical application of findings.
- Population Specificity: Results apply only to Greek adults with elevated tHcy; generalizability to other demographics is uncertain.
- Short Duration: The 3-month intervention may not reflect long-term efficacy or safety.
- Cobalamin Confounding: Hydroxycobalamin injections in Cbl-deficient participants could have influenced tHcy outcomes independently.
- No Placebo Control: The absence of a placebo group prevents definitive attribution of tHcy changes solely to supplementation.
Clinical Relevance
For individuals with elevated tHcy, both folinic acid and L-methylfolate are effective in reducing levels. However, genetic testing for MTHFR C677T polymorphisms may guide personalized choices:
- 677TT genotype: Greatest tHcy reduction regardless of supplement.
- 677CT genotype: Folinic acid may be more effective.
- 677CC genotype: No significant difference between supplements.
Clinicians should consider baseline tHcy, genetic factors, and serum folate goals when selecting between these forms of folate. Further research is needed to determine optimal dosages and long-term impacts.
Original Study Reference
The effects of folinic acid and l-methylfolate supplementation on serum total homocysteine levels in healthy adults.
Source: PubMed
Published: 2023
📄 Read Full Study (PMID: 38056998)
