Colin MacKenzie M.D.
October 28, 2020

Folate, or vitamin B12, is a critical part of a safe and effective alcohol withdrawal regimen.  Folate is a molecule needed to help certain enzymes function properly many of which are important in the many biochemical reactions required for the production of DNA, RNA, neurotransmitters, and cell division. Humans need about 400 mcg per day to maintain health and since it cannot be produced by the body, it must be consumed in the diet, especially dark, leafy, green vegetables where folate is found in high concentrations. 

What are they talking about? 

Folic acid has to be converted into a biologically “active” form in order to be utilized by enzymes.  These “active” forms of folic acid include various forms of tetrahydrofolate (THF).  One form of THF called L-methyl-THF is used in the methionine-homocysteine-SAMe cycle which is important for the production of neurotransmitters like serotonin, dopamine, and norepinephrine.  L-methyl-THF is synthesized by an enzyme called methylene-tetrahydrofolate reductase (MTHFR).  Some people have mutations of the MTHFR gene that can cause reduced activity of the MTHFR enzyme and possibly reduced amounts of L-methyl-THF.  This is hypothesized, though not strongly supported, to predispose some people to depression. Thus, some practitioners recommend taking L-methyl-THF (or L-methyl-folate) as a supplement (in the event that they are not producing enough) in order to support the production of neurotransmitters.  

People with alcoholism become deficient in folic acid due to poor dietary intake of folate sources such as green vegetables and whole grains that are often fortified with folate.  It is also thought that alcohol inhibits folate absorption in the gastrointestinal tract.  Folate deficiency can lead to glossitis, diarrhea, confusion, lethargy, oral lesions, and a type of anemia called megaloblastic anemia.  In pregnant women, folic acid deficiency can lead to neural tube defects and abnormalities in brain development in the fetus. 

At TelePsychiatry Associates, all individuals are started on folic acid, or L-methyl-THF if needed,  at the proper doses and frequency before alcohol detox begins to prevent the consequences of folate deficiency. 


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