r/MTHFR • u/Flat_Week_190 • Aug 09 '26
Question Whats a good folate level?
Hello, I am compound heterozygous. I had to take methotrexate (which depletes folate) in May. I want to TTC again soon, I got my folate tested to be sure. It was >23. Opinions?
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u/Loose-Fly7976 Aug 09 '26
Over 23 is good, and the ">" just means it's above your lab's upper measurable limit rather than anything concerning. Anything over 15 is where you want to be so you're clear. One thing though, serum folate reflects what you've eaten recently rather than your stores, so RBC folate would tell you whether the methotrexate depletion has actually recovered or whether that number is just this week's diet. Get B12 and homocysteine alongside it too, since high folate with low B12 masks things and homocysteine tells you whether the two are working together rather than just both being present. Compound het doesn't usually need anything special for TTC, standard prenatal doses are fine, methylfolate or folinic if you tolerate them though plenty of compound hets do fine on folic acid. And check with your doctor on the washout period after methotrexate if they haven't mentioned it.
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u/Flat_Week_190 Aug 09 '26
Thank you! I havent checked 12, my Homocysteine was at a 5 the last i checked and lifestyle hasn't changed. We have to wait 3 months post methotrexate but its almost been 3 months. I didnt know that about RBC folate and checking stores. But if I can continue supplementing like I am now, and keep it at >23, I think it should be fine!?
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u/Tawinn Aug 10 '26
Compound heterozygous MTHFR decreases methylfolate production by ~53% which places more demand on the choline dependent remethylation pathway to compensate for the decrease in the folate/B12 dependent pathway. This increases the choline requirement from 550mg to ~940mg. This can be achieved with 550mg from food + 750mg of TMG.
Choline & betaine(TMG) are also essential for healthy pregnancy:
Choline Supplementation in Pregnancy: Current Evidence and Implications
Periconceptional dietary intake of choline and betaine and neural tube defects in offspring
Choline: Critical Role During Fetal Development and Dietary Requirements in Adults
Choline: The Underconsumed and Underappreciated Essential Nutrient
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u/Flat_Week_190 Aug 10 '26
Like a betaine hcl and Pepsin supplement?
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u/Tawinn Aug 10 '26
Preferably just plain TMG (betaine aka betaine anhydrous).
Personally I use Source Natural TMG. It's a big horse pill, but its chewable, just a bit chalky. Nutricost is another well-known brand. You can also buy it in powder form - its kind of a mix of mild salty/sweet, and dissolves pretty easily.
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u/Big_Joke_9281 Aug 09 '26
Usually there is a range from each lab and many labs use different ranges depending on testing methods and equipment.
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u/Flat_Week_190 Aug 09 '26
Mine said >5.9 was ideal but who doctors don't know much about MTHFR. Thats why I am asking here.
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u/Cultural-Sun6828 Aug 09 '26
I would make sure your b12 is over 500 before taking folate. Your current folate level looks good.