I developed folate deficiency (V2.3 contains more folate than in April 2017)

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I have blood tests done every 3 months. I received results of a blood test done last week.

The results:

Only one deficiency identified:

Serum folate level 3.09 μg/L. Below normal range, 5.38 μg/L is the low reference limit.

There is a relationship between folic acid, vitamin B12 and iron levels, so here are the other values:

Serum ferritin level 123.2 μg/L.
Serum vitamin B12 level 535.0 ng/L.

They are within normal range. All other tests within normal range too.

The timeline:

I have been eating 2000kcal/day of Unflavored/Unsweetened Huel 3 meals a day for around 1 year now as my only source of nutrition. I use kitchen scales to measure out Huel accurately. I did not eat Huel v2.0 - I had some reserves of v1.2, then made my own mix for about 2 months, and then started eating Huel v2.1 in the first week of January. I did not eat anything else but Huel since then, no exceptions (well, except 3 Huel bars).

For reference, my folate levels have been in the normal range before, in January its level was 5.49 μg/L. This means that the amount of folic acid in Huel is insufficient for me. The source of folic acid has changed between Huel v1.2 and Huel 2.1, but I don’t know if that would cause this effect.

My conclusion:

Overall, I think this is a positive result for Huel because no other deficiencies have developed. So that’s good news for us who eat Huel exclusively.

My questions:

Obviously, these results apply only to me, so I don’t know if the level of folic acid in Huel is low or if something else in Huel interferes with the absorption of it. I have been prescribed Folic acid 5mg tablets, take one daily, 90 tablets. This feels like a too large amount (it is above the upper limit of recommended dietary intake), so I will need to discuss it with my other doctor. Is there any problem with taking this additional folic acid? Will it reduce absorption of something in Huel? Should I take it at the same time as eating Huel or apart? Any other advice? When I asked the doctor about why I developed folate deficiency, he said that it is likely because it is not a sufficient part of my diet, and could not answer my other questions. Maybe someone on these forums can advise, perhaps even @JamesCollier

About me:

I am a man, 35 years old, 80kg, 175cm tall. I was 90kg before I started Huel a year ago.

Supplements:

  • 5g of creapure creatine to Huel in the morning every day for mental and physical benefits.
  • 5g of inulin to Huel in the morning every day because Huel does not contain any FODMAPs and I believe they are beneficial.
  • one 1000μg methylcobalamin tablet every day in the morning with Huel because Huel only contains cyanocobalamin and I want to cover my bases.
  • one 125μg vitamin D3 tablet every day in the morning with Huel because Huel only contains vitamin D2, and there are enough proven benefits of both higher vitamin D intake than what is in Huel, and of vitamin D3 vs Vitamin D2.
  • one probiotic pill every day in the morning 10 minutes before eating Huel, because I believe probiotics are beneficial.
  • one 200mg caffeine pill every day at lunchtime with Huel for the neuroprotective effects of caffeine.

My lifestyle:

I ride a bike 12km daily 7 times a week, and do progressive bodyweight exercises 2-3 times a week with at least 1 day rest in between. I do not smoke. I do not drink alcohol. I do not drink coffee nor tea. I only drink water (only tap water), no other drinks. I sleep 6 hours every day. I do not suffer from stress. I am not taking any medication. I do not have any disease. I do 16:8 intermittent fasting every day. I donate whole blood 4 times a year.

Why Huel?

I eat Huel for the convenience, and because I hope it can keep me healthy.

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Hi @rikefrejut - thanks for the info.

The amount of folate in Huel meets the EU NRV and there is nothing in Huel that should adversely affect the bioavailability of folate. Obviously this is just one result on one individual and is no cause for alarm. However, I do need feedback like this as it’s always neccessary to address everything.

Re folic acid supplement - that is quite a high amount (although I suspect they’ve prescribed this amount to correct the low reading) and bear in mind that high levels of vitamin C can promote the absorption of folic acid supplements and Huel has a high amount of vit C.

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Obviously I’m not a doctor but this source suggests that the range is 2-20ng/mL = 2-20ug/L.

I’ve noticed that the American value is twice as high as the EU NRV. Does this suggest more may be better for some people?

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Have you taken any medication in the last three months? (For your reference, i’m not expecting an answer)

http://www.umm.edu/health/medical/altmed/supplement-depletion-links/drugs-that-deplete-vitamin-b9-folic-acid

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This should make a noticeable difference in the texture/thickness of the mix, does it? You are fortunate in not being one of the small fraction of people for whom inulin causes gas/bloating. (Possibly the probiotics are helping there.)

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Hi James, thank you for the reply. I am very enthusiastic about Huel and am putting my trust in it - I really view the latest blood test results as a positive thing for Huel.

Obviously my lifestyle is very different from others, which is why I would not be representative of those of us who eat Huel 100% of the time. However, I still feel it is important for the Huel guys to know how some people eat Huel as part of their life and how people modify it (and why).

I discussed the folic acid prescription with my other doctor, and he was not very enthusiastic about it. Folic acid is the synthetic form of folate, which should not exceed 1mg/day, instead of something better like l-methylfolate. In light of all other test results being in normal ranges, he finds it very strange that my folate level has dropped significantly. He is recommending not using the prescription, and waiting for my next set of blood tests - because the current low level of folate is not “dangerously low” just “worryingly low”.

This doctor is very enthusiastic about Huel too and is kind of using me as a guinea pig before he goes 100% too - he did however recommend I try to add some meals with dark leafy greens (which are a good source of folate) to my diet in the meantime. Maybe I could blend them with Huel?

I have seen that range too, but most up-to-date references state that >5ng/mL is the optimum level, and indeed the UK recommendation is >5ng/mL.

Thank you for that reference, I was aware of those interactions and discussed them with both of my doctors. I have not used any medication in the past many years (not even painkillers or other common medications), which is why the folate deficiency is so perplexing.

I cannot really tell. I add 300ml of water to the Huel shaker, then 666kcal of Huel, then add the creatine and inulin, then a bit more water, then shake it by hand, then top off with water so that there is ~750ml of water, then shake again. It has many lumps that I then often need to chew on, but I don’t really care because this is my only food.

Indeed. Maybe the probiotics help. I am looking to play around with some resistant starch, glucomannan and psyllium eventually too.

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When it comes to deficiencies, it’s worth bearing in mind that the RDAs are designed, by definition, to meet the nutrient needs of 97.5% of the population - that means 2.5% of the population will need more than the RDA. You may be one of those people, and you may be best hitting the US RDA of 400 micrograms instead of the EU one of 200 micrograms. I wouldn’t stay on the tablets you’re on currently long-term, just until levels are normal again, because that is way above the UTL.

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I would be much happier if Huel started using 400μg of L-Methylfolate instead of just 200μg. It likely has something to do with cost, because Huel is using the superior (and much more expensive) L-Methylfolate instead of some synthetic folic acid, and doubling the amount could double the cost for Huel (for this particular ingredient).

I have not started those prescribed pills exactly due to concerns with the excessive amount, and the synthetic form of folic acid - both as my choice and recommendation of the second doctor.

There is a lot of fascinating literature and studies out there regarding folate and its many forms and effects on health. I truly applaud Huel for using L-Methylfolate :slight_smile:

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L-methylfolate, whilst being a hell of a lot more expensive than folic acid (~1000x more), is used on such a scale that the daily price wouldn’t be hugely affected by the change.

I always aim for 200mcg of folic acid and 200mcg of l-methylfolate as I have no issues with methylation and this certainly ends out being plenty for me. However perhaps all l-methylfolate would be best for those with issues with folic acid.

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I was checking out the axcho mix used in your product and was not sure why there is a mix of L-methylfolate and folic acid. There does not appear to be any benefit to folic acid when L-methylfolate is available, so why not go 100% L-methylfolate?

I am checking out various L-methylfolate supplements to discuss it with my doctors. I cannot tell if the 1mg limit is applicable only to the synthetic folic acid or whether it applies to L-methylfolate too. Most literature suggests that there is no limit to folate when consumed from food.

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I haven’t studied folate in much depth as we’re currently getting it from that mix, but axcho’s reasoning is in this thread post: http://www.reddit.com/r/soylent/comments/4gx8bb/full_details_on_upcoming_micronutrient_mix_from/d2mexpd

In short, aside from cost, his research has led him to believe (be it correctly or not) that folic acid is actually absorbed better (ie has a higher bioavailability) than l-methylfolate.

I can’t really comment much on the issue at this point (I’m far more knowledgable on minerals than vitamins for now), but I trust he researched thoroughly. Once I research more, I may push up the l-methylfolate I use and make daily total 600mcg, but I want to be sure before I make such a change.

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Very interesting read so far with quality sources. We have several members with MTHFR mutations in my family (including me) and the level of folate in our blood is seen as critical by some doctors.

I would like to see @JamesCollier revise a bit the Huel formula with increased folate dose as I see it to be marginally low especially if the l-methylfolate form is not considered as bioavailable as the folic acid one which is clearly indicated also by the lab results of @rikefrejut (i.e. he developed folate deficiency when Huel changed the folate source).

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Your other doctor has a fair point about folic acid, not that folic acid is ‘bad’ because it’s artificial. However, I would consider some supplementation if your blood levels are not in normal range because there may be something going on that warrents it.

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Also, guys, I’m always happy to revise the Huel formula, but it has to be based on sound evidence and not just a few people’s thoughts. Yes. L-methyl folate calcium is expensive, but this is not the issue because the amount that we use is so tiny, the additional cost to one pouch of Huel is negligable. I will be looking into the folate amounts.

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I found the following study which quotes the following in terms of bioavailability of the two:

“The bioavailability of food folate is commonly estimated at 50% of folic acid bioavailability when establishing food recommendations [2,12], but this should be considered a rough estimate, as data on the bioavailability of food folate vary between 30% [13] and 98% [14].”

2: NNR. Nordic Nutrition Recommendations NNR 2004 Integrating Nutrition and Physical Activity. Nordic Council of Ministers; Stockholm, Sweden: 2005.

12: CDC. Water-Soluble Vitamins & Related Biochemical Compounds. Centers for Disease Control and Prevention; Atlanta, GA, USA: [(accessed on 13 July 2009)]. Available online: http://www.cdc.gov/nutritionreport/part_1.html.

13: Hannon-Fletcher M.P., Armstrong N.C., Scott J.M., Pentieva K., Bradbury I., Ward M., Strain J.J., Dunn A.A., Molloy A.M., Kerr M.A., McNulty H. Determining Bioavailability of Food Folates in a Controlled Intervention Study. Am. J. Clin. Nutr. 2004;80:911–918. [PubMed]

14: Brouwer I.A., van Dusseldorp M., West C., Meyboom S., Thomas C.M.G., Duran M., van het Hof K.H., Eskes T.K.A.B., Hautvast G.A.J., Steegers-Theunissen R.P.M. Dietary Folate from Vegetables and Citrus Fruit Decreases Plasma Homocysteine Concentrations in Humans in a Dietary Controlled trial. J. Nutr. 1999;129:1135–1139. [PubMed].

So overall it seems like a difficult one. Some people will get near enough identical absorption of l-methylfolate as folic acid, while others will get less than half, and yet others (with issues with methylation) will get way more absorption from l-methylfolate.

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You are right. I am definitely looking at doing something about it, but do not wish to make a rushed decision. I certainly do not wish to have an excessive amount of unmetabolized folic acid floating around in my system (which is linked to negative health outcomes) as a result of a prescription for a large amount of folic acid. Unfortunately, for prescriptions it looks like all pharmacies in UK carry only folic acid instead of the biologically active form of folate (such as L-Methylfolate Calcium). This means I need to look at the folate supplements - unfortunately I have no idea which brands are reliable and actually contain what they promise (and in the correct amount). Regulation of the supplement industry is very poor in UK.

If anyone has any recommendation for a supplement, I’d be glad to hear it.

I would say that the USA recommendation is certainly not based on just a few people’s thoughts :slight_smile:

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This is true. However, as RDAs are enough to meet the nutrient needs of 97.5% of a population, and both the EU and US have done extensive studies to work out what the RDA should be, we can not rule out that there is some sort of environmental or genetic factor at play that makes those from the US need a higher folate intake than those of us from the EU.

With that said, there’s certainly no harm in consuming 400mcg per day of l-methylfolate, but I understand the desire to ensure it’s a necessary addition before changing the formula.

It would be interesting to know the rates of folate deficiency in those consuming 200mcg per day of l-methylfolate, as well as folic acid (or just use folate equivalents to avoid the need for two separate datasets).

Regarding your earlier point about whether l-methylfolate contributes to the 1000mcg upper limit that folic acid has, the research I have done today leads me to believe it does not. However the reason for this upper limit is simply to reduce the risk of a high folic acid intake hiding the signs of a B12 deficiency (especially in the elderly who are often B12 deficient), and not actually because of negative effects. Those occur at a much higher intake level.

Then again with that said, entirely separate from the establishing of an upper limit for folic acid was another study that showed a consumption of 800mcg per day of folic acid resulted in a seven-fold increase in certain cancers, though consumption of less than 800mcg per day led to no increase of incidence at all. There’s quite a lot of conflicting data, but for the most part it seems l-methylfolate does not have an upper limit (or at least not until an intake of several milligrams or so at least).

There’s some good information on this page.

Regarding supplementation, Solgar have a very good reputation for their supplements. I can’t comment specifically on this one, but their other products are great. So you may be interested in this. That’s the cheapest price I found for it, and that website has a price match guarantee so if you find it cheaper anywhere else, contact them and they’ll lower the prices. Hope that helps.

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Sure, but the US recommendations are very different to the EU’s on almost all micronutrients

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Yeah, it’s really odd how much variance there is.

For those interested, I made a spreadsheet which contains various RDAs from round the world. There’s very rarely agreement amongst the EU and the US on these things.

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I guess it all depends on how much lobbyist money goes into these scientific reports lol