Prof. Pall adds 5-methyl tetrahydrofolate to his protocol

Discussion in 'Fibromyalgia Main Forum' started by richvank, Mar 22, 2010.

  1. richvank

    richvank New Member

    Hi, all.

    Professor Martin Pall has recently recommended in the Townsend Letter that 5-methyl tetrahydofolate [aka FolaPro or Metafolin] be added to his protocol, and he has also reiterated that hydroxocobalamin should be continued as well.

    With this combination, Prof. Pall's protocol has come into agreement with the essence of the Simplified Treatment Approach, which has been directed at lifting the partial methylation cycle block.

    Prof. Pall and I continue to disagree as to what the fundamental mechanism of the pathogenesis of CFS actually is, and he gives a different rationale for using these two supplements. However, I think the important thing from the standpoint of PWCs is that the NO-ONOO and GD-MCB based treatments are converging. I'm hopeful that people who are following Dr. Pall's advice will experience a significant benefit from this change.

    Best regards,

  2. Sceptical

    Sceptical New Member

    Why is folinic acid included in your simplified treatment approach? That is only an active form of folic acid. If methyl tetrahydrofolate has a stimulating effect on me can I expect the same effect from folinic acid? Ordinary folic acid does not possess any such effect.

  3. Lono83

    Lono83 New Member

    Here's a link to Dr. Pall's article in the Townsend Letter (referenced by richvank):

    How Can We Cure NO/ONOO? Cycle Diseases?: Approaches to Curing Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, Fibromyalgia, Multiple Chemical Sensitivity, Gulf War Syndrome and Possibly Many Others by Martin L. Pall, PhD

    Note that I also posted a link to the article on the multiple chemical sensitivity (MCS) message board because Dr. Pall mentions that several doctors (including William Rea and Ritchie Shoemaker) have had some success alleviating MCS symptoms using the vasoactive intestinal peptide (VIP) medication called aviptadil.
    [This Message was Edited on 03/23/2010]
  4. richvank

    richvank New Member

    Hi, Sceptical.

    Folinic acid is a chemically reduced form of folate, and it can normally be converted into the coenzyme forms of folate, including 5-methyl tetrahydrofolate. Whether or not it will have a stimulating effect on you depends on whether or not you have genomic polymorphisms in the enzymes that normally do the conversions, and of course, I don't know that.

    Generally speaking, one of the biggest hurdles in the folate metabolism is the conversion of folic acid into tetrahydrofolate, which requires two sequential reactions catalyzed by the enzyme DHFR (dihydrofolate reductase). This enzyme has been found to range in activity by a factor of five in different people, and this reaction is very slow in some.

    Some people have polymorphisms in the MTHFR (methylene tetrahydrofolate reductase) enzyme, which cause its reactions to run slower, also. Its reaction is one of those involved in the conversion of folinic acid into 5-methyl tetrahydrofolate.

    Folinic acid is also called leucovorin, and it has been used for many years in cancer treatment, to support beneficial parts of the folate metabolism, including support for the methylation cycle, while a chemotherapy drug is used to block the DHFR enzyme as a means of hindering the production of DNA by cancer cells.

    The DAN! (Defeat Autism Now!) doctors commonly use folinic acid to treat autism, which has many of the same biochemical issues as CFS.

    Prof. Pall has also suggested that folinic acid can be used in his protocol, but if so, the dosages should be larger than he is recommending for 5-methyl THF, which is 300 micrograms per day.

    The reason I included folinic acid initially was that it was part of Dr. Amy Yasko's protocol, from which I extracted the Simplified Treatment Approach. However, I still believe that it is beneficial, because it can support parts of the folate metabolism that cannot be directly supported by 5-methyl THF, until it participates in the methionine synthase reaction and is converted to THF. Since this reaction is partially blocked in PWCs, at least at the beginning of treatment, I think that folinic acid can be helpful, especially early on.

    The other parts of the folate metabolism support the synthesis of purines and thymidine, which are important for making new RNA and DNA and other important substances in the body, and they also help in the metabolism of histidine.

    Best regards,

  5. 4LEL

    4LEL Member

    Hi there Rich,

    Thanks for all your informative posts on this issue. I'm a bit of a newbie to the whole topic and quite frankly am finding the complexity of it quiet daunting. Out of respect for your time, I'll be brief though...

    Very simplistically, and genetic complexities aside, would folinic acid then potentially be a better alternative than 5-methyl tetrahydrofolate for someone with low uric acid (and elevated nitric oxide)...Attempting to increase it for the antioxidant benefits? I realize that Martin Pall has added the 5-methyl tetrahydrofolate to his protocol for lowering nitric oxide but for some reason my symptoms seem to worsen even with a very low dose (200mcgs) of 5-methyl tetrahydrofolate.

    Any light you can shed on this would be much appreciated.

    Thanks much in advance for your response.