What if the very nutrient celebrated for preventing neural tube defects is now tipping into excess, disrupting biochemistry, fuelling anxiety, and shaping the health of the next generation?

In this thought-provoking conversation, clinician–researcher Carolyn Ledowsky - now nearing the end of a four-year PhD - shares her evidence-based re-evaluation of folic acid, methylfolate, and the overlooked role of men in preconception care.

Carolyn unpacks why folic acid isn’t the villain, but why unchecked intake poses real risks. We explore unmetabolised folic acid and methylation bottlenecks, the stability challenges of methylfolate, and why folinic acid may offer a practical interim solution. She outlines a pragmatic public health roadmap: cap daily intake at 400–500 mcg, remove voluntary fortification to prevent hidden excess, and individualise care with methylfolate plus B12 and cofactors where needed.

This conversation also delves into recurrent pregnancy loss and the striking results of tailored protocols - removing folic acid, lowering fortified foods, using methylfolate, testing MTHFR/DHFR status, and including the partner. Importantly, Carolyn brings men into focus, highlighting emerging evidence that male folate metabolism and genetics directly influence fertility and pregnancy outcomes.

And in a surprising clinical insight, she reveals how elevated B6 often normalises quickly with lysine - reshaping how we think about nutrient “toxicity” in the post-viral era.

If you care about smarter prenatal nutrition, realistic fortification policy, and giving couples the best chance of healthy conception, this episode provides a science-led roadmap for clinicians, policymakers, and future parents alike.

Connect with Carolyn: mthfr support

Read Carolyn's Paper: 

Health effects of excess folic acid use and high blood folate during preconception and pregnancy: a systematic review

Shownotes and references are available on the Designs for Health website


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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health