Folate makes me crazy. But we want to get pregnant sometime soon.
June 13, 2016 7:57 PM   Subscribe

Folate makes me tense and irritable and unhappy. But I know it's important before/during pregnancy. What might I be able to do to balance the need for folate and the need to not be extra crazy?

Thank you all again for your help with my iron difficulties (1, 2). Things seem to be better on that front - yay!

So now I bring you an even weirder question.

Folate makes me tense and irritable and unhappy. In general, I feel more anxious, more OCD, and significantly less rational when taking it. I also get jaw tension, neck tension, and what I think of as a "Prozac headache." I've tried it in a prenatal, I've tried it by itself, I've tried methylfolate (I'm heterozygous for two MTHFR mutations). I've tried taking it in the morning, I've tried taking it at night. I usually stop taking it before two weeks is up, due to side effects.

Ordinarily, I'd say "oh well" and eat more spinach and lentils - except that we want to get pregnant soon. I know (from answers to this question and lots of other reading) that folate is considered pretty essential before conception, at conception, and during the first trimester. Obviously, I don't want to do anything that would hurt a possible future baby. I also don't want to be extra neurotic from now until whenever we have a baby.

I have OCD and take 20 mg Prozac daily for it. It's pretty well controlled under normal circumstances - not gone but at least a 70% improvement from my worst OCD days. I know that it's possible for methylfolate to enhance the response of SSRIs, and I'm a special special snowflake whose OCD/anxiety gets worse if I increase my Prozac dose, so maybe that's what's going on here? But I really have no idea. And while I'm 90% sure this isn't psychosomatic, I'm scrupulously honest/self-aware enough to know it's a possibility. Having side effects with folate does not seem to be a thing in most cases.

My GP (who is sympathetic but puzzled by the reaction) seems to think I can get by with just a metric ton of spinach. I love my GP but am not (yet?) completely convinced that's true. My mom's best friend has a son who's been paralyzed from the waist down since birth from spina bifida, so I extra don't want to mess around. But being rational and sane and happy is also a prerequisite for getting pregnant, at least as far as I'm concerned.

Has anyone else had a reaction like this to folate? Any formulations that have been specifically easy to tolerate? Could I just eat 8 million bowls of spinach and lentils? Or could I wait till we're actively trying (probably a month or two out) to start, stop it for two weeks each month if I don't conceive (I'm taking my BBT, so I can keep an eye on this), and then stop it after the first trimester if we do get pregnant, to minimize how long I'm taking it?

Most importantly, how do I make decisions about things like this going forward, where conventional wisdom/pregnancy books say "The world will end if you do not do X!" but X is quite uncomfortable? How can I balance a possible future baby's needs with my own?

Thank you!
posted by bananacabana to Health & Fitness (9 answers total) 2 users marked this as a favorite
I don't live in your skin but I can tell you in my perspective that there is nothing that is just "quite uncomfortable" that is worth the possible health of my (future) child. If we were talking about something that was not just "quite uncomfortable" but actually dangerous to my health that would be another story entirely.
posted by teamnap at 8:37 PM on June 13, 2016 [2 favorites]

It sounds like you have a reaction to pills but not to folate in foods?

Many Indian people eat dal at least once (and often twice) a day. You can make it in many different ways to keep things interesting, as the link shows.

If you are really cramming folate in your diet, you can ignore the recommendation to take a supplement - they are chiefly directed at people whose diet doesn't naturally provide enough folate.

And I disagree with the above poster - your comfort is important and deserves to be cared for.
posted by splitpeasoup at 8:48 PM on June 13, 2016 [14 favorites]

IANAD... but I am a pregnant scientist, who likes to stay abreast of pregnancy research - slightly paranoid but striving to be rational.

The CDC advises that you should get .4 mg (400 micrograms) per day of folic acid, though higher doses upwards of 4 mg (4000 micrograms) are frequently recommended by doctors - in a "more hasn't been proven harmful and it even probably helps" approach. (My doctors have advised 1 mg FWIW) but it looks like your minimum target should be .4 mg.

how much folate were you taking when you had bad reactions to it? What about figuring out how much folate you CAN tolerate in pill form? Half a .4 mg pill? Possibly worth figuring out.

Here's a list of folate-rich foods with their amount of folate. Looks like the diet route isn't half bad. Also, marmite could be your friend.
posted by lizbunny at 8:53 PM on June 13, 2016 [5 favorites]

I don't know how much of this is true/valid, but the author discusses how they "pulse" methylfolate to avoid side effects. What if you took it less frequently, is that an option?
posted by cabingirl at 8:53 PM on June 13, 2016 [1 favorite]

As to the folate, it really shouldn't be too difficult.

The CDC and Institute of Medicine recommend:
"the Food and Nutrition Board of the National Academy of Sciences Institute of Medicine (IOM) recommended that to reduce their risk for an NTD-affected pregnancy, women capable of becoming pregnant should take 400 micrograms of synthetic folic acid daily, from fortified foods or supplements or a combination of the two, in addition to consuming food with folate from a varied diet." [I added the italics] - on preview, as lizbunny has noted.

Does eating cereal have the same effect on you? because if it were me I'd go to eating a bowl of Special K cereal every day until the end of the first trimester and just leave it at that. And remember that because of the general practice of fortifying flours and cereals with folate, the incidence of spinal cord defects has dropped significantly. Even if you look at a country, let's say, in sub-Saharan Africa where people don't have ready access to prenatal vitamins or to fortified foods, you still don't find an overwhelming incidence of such defects. That's more just to reassure your anxiety - of course I still think you need to take the folate.

As for decision making in pregnancy, it's impossible to give hard and fast rules - it all depends on your own personal calculus of risk and benefit. I highly recommend Emily Oster's Expecting Better, because she evaluates a number of the common recommendations and while presenting the evidence for and against them, basically describes her methods which could be replicated by anyone if a further question needed answering. You will find that conventional wisdom has very little if anything to back it in many cases, and in some cases there is significant evidence against the conventional wisdom, so although it would be easy to say "just avoid everything 100% because why risk your baby's health"? That attitude doesn't make much sense ini a situation where the risk might be either nonexistent or at least less risky than some other less scrutinized thing that you do every day, like driving in your car. When you've got something with such solid evidence behind it as folate supplementation (which is rarely the case with other pregnancy recs) then although your comfort is generally important, it would be foolish not to follow the recommendations if the cost to you is only 4 months of feeling irritable - after all, having a child with a neural tube defect would not be comfortable for you either.
posted by treehorn+bunny at 8:55 PM on June 13, 2016 [4 favorites]

Have you tried fortified processed foods like bread?
posted by bq at 9:03 PM on June 13, 2016 [1 favorite]

I think I might dig deeper into the 10% that wonders about a psychosomatic reaction. Do you have a partner or friend who you trust completely, who could set you up on a believable placebo/non-placebo regimen? Perhaps grinding pills with a mortar and pestle so you spent a week or so taking a benign powder, and the other week taking folate.
posted by kmennie at 11:54 PM on June 13, 2016 [5 favorites]

I couldn't take prenatal vitamins. After day three, I would get pains in my knees. After day four, my legs would stop working. I had three, healthy babies without taking any vitamins. I threw up for the first several months of all pregnancies, and a McDonald's Happy Meal, which is basically poison garbage, was the only thing that would stay down some days. My children are all fine. They are all three well above average in both intellect and attractiveness.

Yes, sometimes terrible things happen and it is hard to not worry. My very non-pc way of dealing with worry was, whenever I was about to drink a coke or eat one too many french fries, was to tell myself that even crack whores have healthy babies. I'm going to be okay. And I was.

Babies have been born since the beginning of time without moms popping pills. Don't take anything that makes you feel worse. You could be having a mild allergic reaction to one of the ingredients of the pill and that is not good for you or the baby. It's okay if you don't take folate.
posted by myselfasme at 7:05 AM on June 14, 2016 [2 favorites]

Thank you all so much. This gives me a range of ideas and experiences that is really helpful. I haven't noticed any problems with folate or folic acid in food, so I'll try the cereal route first (she says as she eats a bowl of Total). Thanks!
posted by bananacabana at 9:03 AM on June 15, 2016

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