So you’re thinking of trying to conceive? And you’ve probably been told by your Doctor or a friend to “just to take Elevit for one month” and that constitutes preconception care?
Firstly, preconception care is so much more than just folate. Learn more in Starting Your Preconception Journey here.
Secondly, the ideal timeline is three months of preconception care for the female, as it takes 88 days for an egg to mature and three to four months for the male, as it takes this long for healthier sperm to appear in the ejaculate.
Thirdly, conception is 50/50. It’s obvious once you consider it, however so often the male’s role is only acknowledged after 6-12 months of trying to conceive.
Before we take a closer look at Elevit, folate and prenatal supplements in general, please know that I can not prescribe the right supplement for you without conducting a full case history and suite of preconception blood tests. Simply choosing any off-the-shelf preconception supplement often means that you end up taking 1) inappropriate amounts of the nutrients included; 2) poorly absorbable forms; or 3) forms that can be downright harmful, such as in the case of an MTHFR genetic variation (more on this to come).
Now, let’s get into it.
THE WHAT & THE WHY
Folate (vitamin B9) is an essential nutrient required for DNA replication, growth and the development of the foetus and the formation of the neural tube. As deficiencies are associated with congenital abnormalities such as orofacial clefts, anencephaly and spina bifida, it is recommended that all women take folate as part of a preconception preventative strategy.
While Elevit Pregnancy Multivitamin does contain more than just folate, its’ key feature is 800mcg folic acid, which is more than double many other prenatal vitamins you may have seen. Surely that’s a good thing, right? Wrong. Here’s why:
- Folic acid is not the same as folate.
- More is not always more.
What are the forms of folate?
- Folate is the form of folate naturally found in foods such as leafy green vegetables, eggs, legumes, liver and citrus fruits.
- Folic acid is the synthetic form of folate, that’s often in fortified foods or supplements.
- It is important to understand that neither of these forms of folate are metabolically active, meaning that they must go through processing by the body, to be able to used in the many biochemical reactions in which activated vitamin B9 is required.
What About Active Folate?
One form of active B9 is folonic acid. This needs to be metabolized in the body by a process called methylation, via the enzyme methylenetetrahydrofolate reductase (MTHFR), with the end result being the most active form of folate: 5-methyltetrahydrofolate (5-MTHF). You can read more about methylation here.
In as much as 50% of the population, genetic variations limit this conversion capability of folic acid. This ultimately results in the inability to convert inactive folate to active folate (5-MTHF). Tragically, for some, this can cause a build up of B9 in the body which can be dangerous to the developing foetus. A growing body of research indicates that this can be a contributing factor to recurrent miscarriage.
Outside of genetics, it is important to consider that this entire process occurs in the digestive system, before moving onto the liver, and out into the bloodstream. Not only is the conversion of inactive to active folate a very slow process, if the health and function of the digestive system and the liver is sub-optimal, then the conversion is slowed down even further. Ultimately, the result is reduced levels of active folate; which can actually worsen when high doses of inactive folate are prescribed.
How to choose the best prenatal for you
While the active form of folate, 5-MTHF is the most bio-available (meaning it will be the best absorbed and utilized by the body), it is often not tolerated by those with a genetic variation of the A1298C MTHFR gene. As such, please follow these three steps:
- Avoid folic acid. This means Elevit and many other common brands including Fefol, Blackmores and Swisse.
- Test, don’t guess. The type of folate you need depends on your MTHFR variation (if applicable) and the type of prenatal you need depends on additional markers of nutrient status including homocysteine, B12, active B12 folate, iron, vitamin D and iodine.
- Find your people. Investing in the right support team is one of the most important investments you will make. After all, what’s more important than your health and the health of your future child?
Learn more in my Preconception & Pregnancy Support program.
Listen to a podcast on this topic and more in ‘Pregnancy Insights with Steph Lowe’.
Patanwala I, King MJ, Barrett DA, et al. Folic acid handling by the human gut: implications for food fortification and supplementation. Am J Clin Nutr. 2014;100(2):593-599. doi:10.3945/ajcn.113.080507
Rai V. Methylenetetrahydrofolate Reductase C677T Polymorphism and Recurrent Pregnancy Loss Risk in Asian Population: A Meta-analysis. Indian J Clin Biochem. 2016;31(4):402-413. doi:10.1007/s12291-016-0554-0
Servy EJ, Jacquesson-Fournols L, Cohen M, Menezo YJR. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genet. 2018;35(8):1431-1435. doi:10.1007/s10815-018-1225-2
Zarfeshan Fard Y, Kooshkaki O, Kordi Tammandani D, Anani Sarab G. Investigation of the association between C677T polymorphism of the MTHFR gene and plasma homocysteine level in recurrent fetal miscarriage. J Obstet Gynaecol Res. 2019;45(8):1442-1447. doi:10.1111/jog.13989