Many are asking me, “Dr Ben, I am taking this ________. Is that any good for C677T or A1298C or…?”
I am finding that I am answering, “No” too often.
I have here all the top homocysteine-lowering medications which are prescribed commonly by doctors. Keep in mind that many doctors do not understand nutritional biochemistry. Nutritional biochemistry is extremely important to know especially when people are dealing with MTHFR mutations.
I’ll tell you right now: I am NOT impressed by 99% of the prescription drugs used currently for those with MTHFR mutations.
Let me show you the top drugs prescribed by doctors for MTHFR mutations first. Then, I’ll explain why I am not pleased with the formulations. You’ll totally understand by the end of this rant – and if you have any questions – please do comment below.
|Drug or Product||Folic Acid & Amount||B12 & Amount||B6 & Amount||Add’l Ingredients||Inactive Ingredients||Rx Only||Cost per Serving*|
|Folbee||Folic Acid 2.5 mg||Cyanocobalamin 1 mg||Pyridoxine HCL 25 mg||none||For Folbee Plus: Croscarmellose Sodium, Dicalcium Phosphate, Hypromellose, Magnesium Silicate, Magnesium Stearate, Microcrystalline Cellulose, Mineral Oil, Sodium Lauryl Sulfate, Stearic Acid, Titanium Dioxide and Triacetin||Yes||$0.93|
|Folplex||Folic acid 2.2 mg||Cyanocobalamin 1 mg||Pyridoxine HCL 25 mg||none||Dibasic Calcium Phosphate, Microcrystalline Cellulose, Modified Cellulose Gum, Crospovidone, Magnesium Stearate, Hypromellose, Titanium Dioxide, Polydextrose, Triacetin, Polyethylene Glycol, Iron Oxide Red, Iron Oxide Yellow||Yes||not found|
|CerefolinNAC||L-Methylfolate Calcium (as Metafolin) 6 mg||Methylcobalamin 2 mg||N-Acetylcysteine 600 mg||none||Microcrystalline Cellulose, Opadry II Blue 07F90856 (Hypromellose, Talc, Titanium Dioxide, Polyethylene Glycol, FD&C Blue #2-Aluminum Lake, Saccharin Sodium), and Magnesium Stearate (Vegetable Source)||Yes||not found|
|Deplin 7.5 mg||L-methylfolate Calcium (as Metafolin) 7.5 mg||none||none||none||Dibasic Calcium Phosphate Dihydrate, Silicified Microcrystalline Cellulose 90, Silicified Microcrystalline Cellulose HD 90, Opadry II Blue 85F90748 (Polyvinyl Alcohol, Titanium Dioxide [color], PEG 3350, Talc and FD&C Blue #2[color]),L-methylfolate Calcium, Magnesium Stearate (Vegetable Source), and Carnauba Wax||Yes||$3.19|
|Deplin 15 mg||L-methylfolate Calcium (as Metafolin) 15 mg||none||none||none||Dibasic Calcium Phosphate Dihydrate, Silicified Microcrystalline Cellulose 90, Opadry II Orange 85F43102, (Polyvinyl Alcohol, Titanium Dioxide [color], PEG 3350, Talc, FD&C Yellow #6[color], FD&C Yellow #5[color], FD&C Red #40[color] and FD&C Blue #2[color]), L-methylfolate Calcium, Magnesium Stearate (Vegetable Source), and Carnauba Wax.||Yes||$3.22|
|Folgard RX (Foltx, Homocysteine Formula||(not sure which form) 2.2 mg||25 mg (not sure which form)||1 mg (not sure which form)||none||Carnuba Wax, citric acid, corn starch, dicalcium phosphate, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate 80, riboflavin, silicone dioxide, sodium benzoate, sodium starch glycolate, sorbic acid, stearic acid and titanium oxide||Yes||$0.83|
|Folgard||Folic acid 800 mcg||Cyanocobalamin 115 mcg||Pyridoxine HCL 10 mg||none||Dicalcium Phosphate; Microcrystalline Cellulose; Starch; Sodium Starch Glycolate; Hydroxypropyl Methylcellulose; Stearic Acid; Titanium Dioxide; Magnesium Stearate; Polyethylene Glycol; Sodium Citrate; Citric Acid; Riboflavin; Blue 1 Lake; Polysorbate 80; Sodium Benzoate; Sorbic Acid; Silicon Dioxide; Carnauba Wax.||No||$0.28|
|Metanx||Metafolin which is L-methylfolate 3 mg||Methylcobalamin 2 mg||Pyridoxal-5-phosphate 35 mg||none||Dibasic Calcium Phosphate Dihydrate, Microcrystalline Cellulose 90, Microcrystalline Cellulose HD 90, Pyridoxal-5´-Phosphate, Opadry II Purple 40L10045 (Polydextrose, Titanium Dioxide, Hypromellose 3cP, Hypromellose 6cP, Glycerol Triacetate, Hypromellose 50cP, FD&C Blue #2, FD&C Red #40, Polyglycol 800), Microcrystalline Cellulose 50, Opadry II Clear Y-19-7483 (Hypromellose 6cP, Maltodextrin, Hypromellose 3cP, Polyglycol 400, Hypromellose 50cP), Lmethylfolate Calcium, Magnesium Stearate, Methylcobalamin, and Carnauba Wax.||Yes||$1.48|
|FABB (brand name: Folgard RX)||Folic acid 2.2 mg||Cyanocobalamin 1 mg||Pyridoxine 25 mg||none||Dicalcium Phosphate, Microcrystalline Cellulose, Croscarmellose Sodium, Stearic Acid, Silica, Magnesium Stearate, Hydroxypropyl Methylcellulose, Polyethylene Glycol||Yes||$0.73|
Dr Ben’s Comments
All homocysteine support prescription drugs are loaded with artificial ingredients such as coloring, preservatives, flow agents, caking agents and others.
Costs vary tremendously between all of them.
The prescription drugs for homocysteine support which do not use the active form of folate (L-methylfolate which is Metafolin) or 5-MTHF, are vastly inferior and should not be used in my opinion. Most people with elevated homocysteine likely have the MTHFR mutation in some fashion. That said, it is imperative that these individuals only take active forms of folate (Metafolin form) otherwise the homocysteine levels will not drop effectively and the individual will have elevated levels of folic acid. Having elevated levels of folic acid is not good and obviously having elevated levels of homocysteine is not good at all.
Having elevated blood levels of folic acid, which are unable to be metabolized (processed by the body), increases the growth of existing neoplasms (cancers). So, in my mind, taking prescription drugs such as Folplex and Folbee and Folguard are not good ideas – especially those individuals with MTHFR C677T mutations are they are unable to process folic acid properly causing folic acid to buildup.
I also do not like prescription drugs utilizing only active folate even if it is the Metafolin form of L-methylfolate. Typically, when one takes only folic acid, the danger of creating a vitamin B12 deficiency is significant and even more serious is the potential to not only create a vitamin B12 deficiency, but not be able to see it! Thus, one may have a vitamin B12 deficiency while taking only folic acid but the doctor will not be able to tell if they order standard labs – and most doctors do only standard labs.
Research is suggesting that L-methylfolate ‘may be less likely than folic acid to mask vitamin B12 deficiency. Folate therapy alone is inadequate for the treatment of a vitamin B12 deficiency.’ This is taken right from the precautionary section from the package insert of Deplin, a well-known high-dose L-methylfolate prescription only product. The package insert is citing five research articles so their information is accurate.
Research is constantly evolving and finding new things out on a daily basis. If current research states that L-methylfolate ‘may be less likely than folic acid to encourage the rate of growth of existing neoplasms,’ that is great. But what is the true definition of ‘may be less likely?’
If the whole point of adding L-methylfolate, vitamin B12 and vitamin B6 is to reduce homocysteine levels in the individual, then I believe finding the lowest optimum amount of each ingredient is a necessity.
Homocysteine is also lowered by more than just L-methylfolate, methylcobalamin and pyridoxal-5-phosphate. Homocysteine is directly lowered by trimethylglycine known as betaine or TMG. Why don’t these prescription medications use TMG? I don’t know.
It is also known that riboflavin, vitamin B2, is required to help reduce elevated homocysteine levels in those with homozygous C677T MTHFR mutations. One may say that adding riboflavin is not needed because the homozygous C677T mutation is not significant in the population. I absolutely disagree.
Riboflavin is inexpensive and if one is going to such an expense to help lower their homocysteine levels, then why not add the most active form of riboflavin possible?
My key point is this:
The main goal here is to lower homocysteine levels safely and effectively with the lowest cost to the individually financially and physically.
That said, if a homocysteine formula contains nutrients which enhance the breakdown of homocysteine from all possible angles, wouldn’t that be the safest option?
Why take more of L-methylfolate if it is not needed? L-methylfolate can only process so much homocysteine as it approaches homocysteine metabolism from one angle.
Adding TMG is a great idea as TMG completely reduces the need for high dose L-methylfolate as TMG bypasses the genetic mutation in MTHFR and is able to lower homocysteine directly. This means, that if a formula has added TMG, then the ability to lower the amounts of L-methylfolate and active B6 is possible to do.
Not only is the potential risk lessened, but the out of pocket expense is lessened as well. L-methylfolate is very expensive. TMG is not very expensive.
An often overlooked issue with prescription drugs for lowering homocysteine is they contain a ton of ‘garbage’ ingredients. These ‘inactive ingredients’ do not benefit the body at all and, in fact, may do harm especially for individuals who have problems in their methylation pathway. I know that MTHFR mutations cause defects in methylation pathways. If there is a defect in methylation, then toxins do not get metabolized well and they end up accumulating in the cells, nerves, fat and bones of the individual. The last thing a person suffering with MTHFR is more chemical burden.
Let’s summarize what we know about standard folic acid:
- taking only high levels of folic acid now is dangerous as it may speed the rate of growth in existing cancer cells.
- taking folic acid in the inferior forms is not smart as all who have the C677T MTHFR mutation cannot do anything, or if they can, very little gets processed.
- a vitamin B12 deficiency may be hidden by taking high levels of folic acid tops it off as a no-no to take alone.
- Keep in mind how many foods are fortified with standard folic acid. A ton. Breads, cereals, drinks, formulas and more.
Let’s summarize what we know about L-methylfolate:
- taking high levels of L-methylfolate is safer than standard folic acid or folinic acid in terms of enhancing the growth of neoplasms.
- L-methylfolate is rapidly utilized by those with MTHFR mutations as this form of folic acid readily bypasses the genetic mutation thereby lowering homocysteine levels. This is outstanding.
- is less likely to mask a vitamin B12 deficiency when compared to standard folic acid
Let’s summarize what we know about lowering homocysteine:
- inactive standard form of folic acid doesn’t work well at all for those with MTHFR mutations – especially the C677T mutation
- active L-methylfolate works very well in lowering homocysteine as it bypasses the genetic defect of the MTHFR C677T mutation
- TMG, also known as Betaine or Trimethylglycine, works well in lowering homocysteine safely and effectively
- Vitamin B2, known as riboflavin, is needed by homozygous C677T MTHFR mutations in order to lower homocysteine effectively.
- Vitamin B12 is needed in order to prevent a vitamin B12 deficiency and to also help lower homocysteine by donating a methyl group. This is why methylcobalamin is the preferred form of vitamin B12. If the individual takes an already methylated form of vitamin B12, the ability for it to help donate a methyl group in the reaction to lower homocysteine is immediate. Basically, methylcobalamin helps transform homocysteine to methionine. There is a less commonly known MTHRR mutation (MTRR A266G) which requires methylcobalmin in order to get homocysteine levels dropped.
- Vitamin B6, the active form, is the backbone to get L-methylfolate and vitamin B12 to actively lower homocysteine. Without vitamin B6, this reaction does not take place. That said, vitamin B6 helps lower homocysteine.
If I had to choose one prescription drug to help lower homocysteine: Metanx.
However, I prefer getting the job done of lowering homocysteine with the least force possible and covering all angles in as pure and inexpensively as possible.
Please do share which prescription drugs you are taking to lower homocysteine and to reduce your MTHFR symptoms. I will add them to the comparison form above.
Sources updated on 9/12/2011
*Pricing sources found at Amazon.com and Drugstore.com