EP 79. Excess Fructose: A Health Hazard.

Hellooo :)In this latest episode of the season, we discuss one of the most frequent (and misunderstood) topics in medical consultations: the chronic use of proton pump inhibitors (PPIs) like omeprazole, pantoprazole, esomeprazole, as well as H2 blockers like famotidine, often for gastrointestinal issues such as dyspepsia or reflux. But first, I'll explain which cells produce acid, why we need it, and what can happen when we block it for too long. I'll also cover the causes behind symptoms like reflux, dyspepsia, or heavy digestion, and when it makes sense to use PPIs on a short-term or longer-term basis.Additionally, I'll try to review the diagnostic algorithm for different clinical cases (reflux, esophagitis, functional dyspepsia, eosinophilic esophagitis) with you, and we'll discuss situations where dietary supplements or lifestyle adjustments might be helpful.Everything with a clear goal: neither to demonize nor idealize these medications, but to understand well how and when to use them.I hope you enjoy it and, above all, find it very useful :)For more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me https://ivbwellness.comFor more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My Website

High Ferritin: Understanding the Link to Fatty Liver and Insulin Resistance Hello, I am Dr. Isabel Viña Bas, a physician and Scientific Director of IVB Wellness Lab. In my clinical practice, high ferritin is one of the findings that causes the most uncertainty. My mission is to help you "know more to fear less and choose better," and that starts with understanding that ferritin, in addition to storing iron, is a messenger of your metabolic state. Frequently, elevated ferritin levels are an acute-phase reactant: a distress signal emitted by the body in the face of chronic inflammation and oxidative stress, rather than a reflection of the iron you consume in your diet. This protein is a direct window into the health of your liver and the efficiency of your metabolism. What does it really mean to have High Ferritin? Medically, ferritin is an intracellular protein that stores iron safely. However, when there is cellular damage or a systemic inflammatory response, ferritin "leaks" into the bloodstream and raises its levels in blood tests. Having high ferritin is a "red flag" that forces us to look beyond the blood. It indicates that there is a process of metabolic pressure, focused primarily on the liver and glucose management. It is a symptom that the redox balance (the scale between oxidation and anti-oxidation) has tipped dangerously toward cellular damage. The Metabolic Triad: Ferritin, Fatty Liver, and Insulin Resistance To address the root of the problem, we must understand how these three pillars interact beneath the surface. The liver under pressure and cellular inflammation The current lifestyle, marked by stress and caloric overload, generates an accumulation of fat in the liver. This hepatic tissue, when saturated, activates chronic inflammatory responses mediated by the NF-κB pathway, a molecular switch that triggers the production of inflammatory cytokines. This state of "liver under pressure" damages hepatocytes, alters the extracellular matrix, and releases ferritin in response to tissue damage. Insulin Resistance: The "distracted" liver Insulin resistance makes this inflammation chronic. A critical factor here is the consumption of alcohol and sugars. Alcohol is a potent hypoglycemic agent, but the most dangerous thing is that it "distracts" the liver. While the liver is focused exclusively on detoxifying us from alcohol, it becomes unable to respond to hormones like glucagon, and this prevents the proper release of glucose into the blood. This constant metabolic stress exhausts cellular reserves and perpetuates the inflammation signal that raises ferritin. Direct relationship The increase in ferritin is, ultimately, the body's response mechanism to lipotoxicity (excess fat) and glucotoxicity. It is the smoke that warns us of an ongoing metabolic fire. Lifestyle Strategies to Reduce Hepatic Inflammation Recovering liver health is a matter of applying science to daily habits: Run from "miracle diets": be wary of claims of losing 3 kg in 24 hours. Glycogen (the way we store carbohydrates in muscle and liver) retains 3 times its weight in water, while salt retains 4 times its weight in water. Diets that drastically eliminate these elements only cause the loss of "intracellular water," not fat, and this stresses the liver even more. Hydroelectrolytic Balance: prioritize foods rich in potassium (avocado, spinach, tomatoes) to naturally balance fluid levels and reduce inflammation. Whole Carbohydrates: are necessary as a source of fiber to improve insulin sensitivity and modulate the inflammatory profile. Physical Activity and Markers: exercise is vital, but it must be modulated. An excess of load without recovery can falsely elevate markers such as CK (creatine kinase), LDH, and, especially, AST (the most abundant transaminase in muscle), which can be confused with liver damage in blood tests. Advanced Approach: Science-Based Supplementation When we seek real recovery, we need active ingredients with high bioavailability that reach where others cannot. Metabolic-Max and Insulin Sensitivity The key to this supplement is the phytosomal Berberine Berbevis®. Unlike traditional berberine, which often "breaks" and becomes inactive in the intestine or liver and causes gastric discomfort, the phytosome system guarantees 10 times higher bioavailability. Effect: improves fat utilization and blood sugar control. It optimizes mitochondrial efficiency and attacks insulin resistance at the root. Anti-OX Global and Hepatic Cellular Protection Anti-OX Global works as a comprehensive strategy against inflammaging: it acts on several fronts at once. Tomato Lycopene: unlike fungal versions, our tomato-derived lycopene contains 11 conjugated double bonds, one of the most potent protectors against fatty liver and LDL oxidation. Astaxanthin (Astabead®): extracted with supercritical CO₂ from microalgae (H. pluvialis) grown in pure Icelandic waters (with very low heavy metal profiles). It integrates into the cell membrane, protects the lipid bilayer, and modulates the NF-κB pathway. NordicCherry®: this tart cherry extract is fundamental for reducing damage markers such as AST, CK, and LDH, so the body recovers without suppressing the positive adaptations of exercise. Coenzyme Q10 (100 mg): optimizes hepatic mitochondrial energy and regenerates vitamins C and E. Recommended Synergy: combining both products makes sense: while Metabolic-Max optimizes glucose metabolism, Anti-OX Global protects the cellular environment and the liver's extracellular matrix and reduces the inflammatory signal that keeps ferritin elevated. Dosage and Safety Guidelines For solid metabolic results, continuous use of at least 3 months is recommended. Product Recommended Dosage Key Instructions Metabolic-Max 1 capsule before main meals Avoids intestinal inactivation; maximum metabolic efficiency. Anti-OX Global 2 capsules daily Take together with a fat-rich meal. Do not open the capsules (to avoid acidity or gastric inactivation). Important Warnings Contraindications: not suitable during pregnancy. Interactions: do not use if you are under treatment with anticoagulants such as acenocoumarol (Sintrom) or warfarin (Aldocumar). High ferritin is an opportunity to pay attention to your metabolic health; there is no need to be alarmed. Optimizing your liver and your insulin sensitivity requires evidence-based tools and consistency, not luck or quick fixes. Transforming your health is a matter of applying science with consistency, day by day. You have in your hands the knowledge necessary to balance your metabolism and regain your vitality. Author: Dr. Isabel Viña Bas  I hope you like it :)For more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My website

Hola :)En el podcast de hoy os explico qué hay detras de las menstruaciones abundantes.Empezaremos por definir qué es una regla abundante ( pista, si crees que tus menstruaciones son abundantes, probablemente lo sean)Cuales son las principales causas de reglas abundantes: miomas, polipos, endometriosis, problemas tiroideos, cáncer, enfermedades autoinmunes..Cómo saber qué es lo que a ti te causa esas reglas abundantesQué tratamientos disponibles hay ( fármacologicos, complementos alimenticios y procedimientos quirurgicos)Espero que os guste :)Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabas En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.comPara mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabasEn mi canal de YouTube Canal YoutubeY los suplementos formulados por mi en mi web Mi web

Hello :) In today's episode, and thanks to your loyalty, we are celebrating episode number 100 after more than two years together!!How time has flown... a thousand thanks to everyone who has been with me for however long you've been sharing moments and letting me show you everything I believe can add value to your lives within the complex world of health and medicine.In this special episode, we once again have the presence of Doctor Juan Viña, Doctor and professor of biochemistry and molecular biology at the University of Valencia, and above all: my father.In today's episode, we answer the questions:What are essential amino acids and why are they called "essential"?What role do ghrelin and leptin play as appetite control hormones?What is choline and why is it a key nutrient during pregnancy and breastfeeding?What is S-AMe and what is its key role in metabolism?How has medicine advanced in the last 50 years and the role of artificial intelligence in current medicine? I hope you enjoy it very much :) Let us know :)For more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me https://ivbwellness.comFor more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My website

Lipoprotein(a): What It Is, Values, and How to Reduce Your Cardiovascular Risk Hello, I am Dr. Isabel Viña Bas, a physician and Scientific Director of IVB Wellness Lab. When we talk about cardiovascular health, almost everyone stops at two words: cholesterol and triglycerides. We focus on LDL, celebrate if HDL is good, and think that's the end of the story. But there is a particle that may have been circulating in your blood for years without anyone ever asking for it in a blood test: Lipoprotein(a), or Lp(a). And this is one of those cases where knowing more doesn't mean living with more fear, but rather making better decisions. Lipoprotein(a) has a huge genetic component, affects approximately 1 in 5 people, and can raise your cardiovascular risk even when the rest of your lipid profile is fine. You don't choose the genes you are born with, but you can certainly get to know them. What is Lipoprotein(a) and why isn't it just "another bad cholesterol"? Lipoprotein(a) is a particle that transports lipids through the blood. At first glance, it looks like other cholesterol-related particles, but it has a plus: in addition to transporting fats, it behaves as an inflammatory and oxidizing agent in its own right. With traditional cholesterol, we talk mostly about diet, exercise, body composition, or metabolism. With Lipoprotein(a), the weight of genetics is much greater: more than 90% of its levels are genetically determined. And this avoids two very common mistakes. The first: thinking "if it came back high, it's because I'm doing something wrong." Not necessarily. The second, falling into the opposite extreme: "since it's genetic, I can't do anything." Also not true: you can work on everything surrounding it. The marble and gum analogy: why Lipoprotein(a) sticks so easily To explain its structure, I'm going to use a very simple mental image. Imagine a traditional cholesterol particle as a smooth marble circulating in the blood. Lipoprotein(a) is that same marble, but with a piece of "gum" stuck on top. That gum is apolipoprotein(a). It makes the particle different and gives it a greater capacity to adhere and participate in inflammatory and oxidative processes on the vascular wall. Counterintuitively, the smaller that apolipoprotein(a) is, the greater the associated risk can be; larger forms usually carry less risk. I like this metaphor because it makes one idea clear: we are not simply talking about "having more cholesterol." We are talking about a particle with its own characteristics that deserves to be evaluated specifically. Why should you measure Lipoprotein(a) at least once in your life? Precisely because it is so conditioned by genetics, you don't need to chase it in every blood test as we do with other markers that change with lifestyle. The 2022 consensus of the European Atherosclerosis Society recommends measuring Lipoprotein(a) at least once in your life for the general population. The logic is simple. If the value comes back low, you now know one more piece of your cardiovascular risk puzzle, and since it depends so much on genetics, there is no need to repeat it continuously. If it comes back high, you have discovered a predisposition that allows you to act sooner. Ideally, this information should be known from young adulthood. Not to medicalize a healthy person, but because a genetic exposure that acts over decades is much better prevented over time than it is discovered after a cardiovascular event. What are the normal values for Lipoprotein(a) and when do they indicate risk? One of the points that causes the most confusion is that laboratories express Lipoprotein(a) in different units. I work with two references: Low values: below 30 mg/dL or 75 nmol/L. In this range, Lp(a) does not add that genetic risk component we talked about. High values: above 50 mg/dL or 125 nmol/L. From here on, we are talking about a cardiovascular risk factor that must be integrated into your overall assessment. And here is the keyword: overall. An isolated value does not decide whether you are going to have a heart attack. It serves to build a much more complete risk map. What risks does high Lipoprotein(a) have for your heart? Elevated Lipoprotein(a) functions as an independent risk factor: it can add risk even if the rest of your cholesterol is fine. It is related to events such as myocardial infarction, stroke, and heart failure. It also has an interesting relationship with the aortic valve, because it promotes calcification that can end up narrowing it and causing aortic stenosis. That is why I don't like to reduce all cardiovascular prevention to "having good or bad cholesterol." The heart does not get sick from a single figure: lipid particles, blood pressure, glucose and insulin, smoking, inflammation, the state of the arteries, and, in some people, a genetic predisposition like Lp(a) all come into play. My Lipoprotein(a) came back high: what do I do now? The first thing is not to panic or try to lower the number with randomly chosen food supplements. If Lipoprotein(a) is elevated, I recommend that the assessment continue with cardiology. One of the tests that can be used is the echocardiogram, which allows you to see the heart valves and check if the aortic valve shows narrowing or calcification. Another tool is the coronary Angio-CT and the assessment of arterial calcium using the calcium score. I use a guiding scale: a score of 0 is the ideal scenario; between 1 and 99 there is some calcification; above 100 the risk gains relevance, and above 300 we are talking about a very high calcium load. These tests are not something you should order on your own because you read an article. They serve for a specialist to integrate your Lp(a) with your complete clinical situation. Statins and Lipoprotein(a): the paradox that shouldn't make you abandon treatment Here appears one of the doubts that scares people the most when they research on their own on the internet. There are reviews in thousands of patients where statins can raise Lipoprotein(a) between 10% and 20%. Does that mean you should stop a statin if Lp(a) is high? No. And this is extremely important: never stop a statin on your own for that reason. The cardiovascular benefit it provides far outweighs that small increase in Lp(a). If your cardiologist considers that the treatment should change, there are other pharmacological strategies for cholesterol (such as bempedoic acid, ezetimibe, or PCSK9 inhibitors) that are assessed individually. It is not about choosing a molecule by reading a list, but about treating the complete risk. Today there is no approved drug whose specific indication is to lower Lipoprotein(a), although there are therapies in advanced stages of research. Some treatments used for other lipid alterations, such as PCSK9 inhibitors or lomitapide, can reduce it indirectly. If genetics don't change, change the rest of the cards in the cardiovascular "bingo" This is probably the most important idea in the entire article. Having high Lipoprotein(a) is not equivalent to having a written destiny. Cardiovascular disease is like a brownie: it doesn't appear because of a single ingredient. If you already know you have that genetic predisposition, your goal is not to add avoidable risk factors. That means being demanding with smoking, alcohol, blood pressure, excess sugar, insulin resistance, body composition, and a sedentary lifestyle. Strength training has a very interesting role here, because building muscle improves the metabolic environment and helps manage glucose and insulin better. You don't train to "lower Lp(a)" directly; you train to reduce the metabolic and inflammatory terrain. Sugar, insulin, and arterial wall: why protecting the vessel matters as much as watching cholesterol Another comparison I use a lot: when Coca-Cola falls on a surface, it remains sticky. A sustained excess of blood sugar damages the structural proteins of the vascular wall and worsens endothelial health. If the arterial wall is deteriorated and, at the same time, a particle with great inflammatory and adhesive capacity is circulating, you are adding ingredients you don't want to combine. That is why controlling glucose and insulin is part of the same problem. I also often talk about microplastics, whose presence within arteriosclerosis plaques has been linked to greater instability of those plaques. Modern cardiovascular risk is built by accumulation of exposures. Fiber, microbiota, and antioxidants: how to support your cardiovascular terrain through nutrition When genetics cannot be modified, nutrition ceases to be a tool to "correct the gene" and becomes a way to improve the scenario in which that gene is expressed. Fiber is one of the pieces that interests me the most. Fibers like partially hydrolyzed guar gum, xylooligosaccharides, baobab, inulin, or fructooligosaccharides help the gut and can also support the metabolism of glucose and lipids. That is why Fiber Total fits so well into this approach when the diet does not cover fiber needs. It combines Sunfiber® (partially hydrolyzed guar gum), PreticX® (xylooligosaccharides), and Inavea® (baobab and acacia gum), three types of fiber that work on the microbiota from different pathways. Not just any probiotic works for any goal. For the lipid profile, I specifically use Lactobacillus reuteri LRC, originally known as NCIMB 30242, in an amount of 2.5 × 10⁹ CFU: specific strains studied for specific functions. Berberine, silymarin, and antioxidants: how to reduce the risk you can modify Another strategy I use is to work on glucose and lipid metabolism with tools like berberine and silymarin, especially when there is insulin resistance, dyslipidemia, or metabolic alterations that add cardiovascular risk. With that logic, we formulated Metabolic-Max: it combines berberine in phytosome form Berbevis®, silymarin, Gymnema sylvestre, and chromium. It is not intended to "cure" a genetic Lipoprotein(a), but to act on modifiable metabolic factors. The second front is oxidative stress. Coenzyme Q10, vitamins C and E, astaxanthin, lutein, quercetin, glycine, NAC, and lycopene are antioxidant support tools. Anti-OX Global brings together several of those compounds within a strategy aimed at cellular protection. The idea is not to build a tower of food supplements. It is to identify which risk factors you actually have and prioritize. If your Lp(a) is high but the rest of your profile is controlled, the approach will be very different from that of someone who also smokes and has hypertension. High Lipoprotein(a): a signal to better understand your risk, not to live in fear Lipoprotein(a) summarizes very well how I understand preventive medicine. There are things we don't choose: genes, family history, certain predispositions. But knowing them allows us to stop playing blind. Asking for it at least once, interpreting its values well, and, if it is elevated, assessing the real state of your cardiovascular system transforms a scary piece of data into useful information. Then comes the important part: protecting the arterial wall, controlling the rest of the cholesterol, not smoking, training muscle, and taking care of fiber. You cannot peel the genetic "gum" off the marble, but you can certainly make the path it travels along much better protected. Transforming your health is a matter of applying science with consistency, day by day. You have in your hands the necessary knowledge to better understand your cardiovascular risk and make decisions with criteria, without alarmism and without ignoring important signals. I hope you like it :) For more information, you know you can find me on my Instagram @isabelvina where I share daily content My TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/@isabelvinaAnd the supplements formulated by me https://ivbwellness.com

Hello :)In today's episode, I'll tell you why osteoporosis is a disease that begins to develop in childhood and goes unnoticed until it manifests with a fracture. That, in Spain, osteoporosis is responsible for 33 fragility fractures every hour and why everyone should know the importance of maintaining bone mass so that prevention becomes a reality.I also tell you which medications and diseases are associated with osteoporosis and therefore require special attention, emphasizing lifestyle measures such as strength and impact physical exercise, adequate nutrition, and cessation of toxic habits.How osteoporosis is diagnosed, even allowing you to assess your risk with the free and universal online tool FRAX (for each country)What supplementation measures can help usWhat medications are currently available, their pros and cons :)I hope you like it and, above all, learn something : )For more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me https://ivbwellness.comFor more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My website

Hola :)Hoy vamos a hablar de la salud biliar Espero que este episodio del podcast sobre la salud biliar os aporte luz y claridad sobre un tema tan importante… y a menudo tan olvidado.A lo largo del episodio aprenderás dónde se produce la bilis, cuáles son sus funciones, cuál es su composición y por qué es tan importante su almacenamiento en la vesícula biliar.También te contaré qué estímulos provocan su liberación, cómo es el metabolismo intestinal de la bilis una vez secretada, y por qué es clave la microbiota, el consumo de grasas saludables y fibra para mantener el equilibrio del metabolismo biliar… y del metabolismo global.Asimismo, hablaremos de qué fáctores pueden favorecer la aparición de calculos biliares como el exceso de estrogenos o de colesterol hepatico.Y, por supuesto, hablaremos de algunos complementos alimenticios que pueden ayudar a optimizar el flujo de la bilis, como la taurina, la glicina, el extracto de alcachofa, el cardo mariano o el conocido ácido TUDCA.Espero que os guste y sobre todo os ayude a saber mas para temer menos y elegir mejor :)Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabas En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.com-Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabasEn mi canal de YouTube Canal YoutubeY los suplementos formulados por mi en mi web Mi web

Hello :)In today's episode, I try to explain why chronic stress (both mental and physical) can directly affect our reproductive axis and, at the same time, indirectly affect other hormonal axes like the thyroid axis and prolactin, contributing to the worsening of stress-related reproductive symptoms by perpetuating the stress cycle --> lack of adequate GnRH synthesis --> FSH and LH --> regular menstruation, ovulation, testosterone production...I also talk about several supplements that ALWAYS follow lifestyle measures and do not replace them, which are:Stress: magnesium, omega 3, glycine, theanine, reishi, rhodiola, schisandra, ashwagandha, B vitamins like B12, B6, B9...Thyroid function: myo-inositol, CoQ10, selenium, iodine, vitamins B1 and B3..Prolactin: vitex agnus (chasteberry) and magnesiumI hope it's helpful :) a kissFor more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me https://ivbwellness.comFor more information, you know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My Website

Hello!!In today's podcast episode, I'm talking about hypertension, but not just any kind, rather the one associated with an excess of a little-known hormone: aldosterone.I'll explain what signs might indicate that our high blood pressure is due to an excess of this hormone. How to assess it analytically, what tests would be necessary if blood tests reveal high aldosterone levels. What specific treatments exist, what lifestyle measures to follow: how much fiber, exercise, salt, or potassium to consume… Supplements that can help us, such as taurine, magnesium, olive leaf extract (standardized in oleuropein), hawthorn extract, or citrulline. How to correctly measure blood pressure, and much more. I hope you like it and, above all, find it useful : )For more information, you know you can find me on my Instagram @isabelvina where I share daily content.My TikTok @isabelvinabasOn my YouTube channel https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQAnd the supplements formulated by me at https://ivbwellness.comFor more information, you know you can find me on my Instagram @isabelvina where I share daily content.My TikTok @isabelvinabasOn my YouTube channel YouTube ChannelAnd the supplements formulated by me on my website My website

Vitamin B9 and Folic Acid: Why They Are Not Exactly the Same Hello, I am Dr. Isabel Viña Bas, physician and Scientific Director of IVB Wellness Lab. The vitamin B9 is one of those nutrients that almost everyone automatically associates with pregnancy. And yes, it is essential during this stage, but reducing it to "the vitamin that pregnant women take" is only seeing a small part of the story. B9 is involved in processes that happen every day, whether you are trying to get pregnant or not: blood cell production, homocysteine metabolism, neurotransmitter synthesis, nitric oxide production, collagen formation, and liver detoxification reactions. In addition, there is a huge confusion between two terms that we use as if they were synonyms: folate and folic acid. My goal here is to help you understand that difference and, above all, to know what you should actually look for when reading the label of a food supplement. Because in vitamin B9, as is so often the case in nutrition, it's not just about how much you take: the form in which it reaches your body matters immensely. Vitamin B9, folate, and folic acid: are they really the same thing? When we talk about vitamin B9 or folates, we are referring to a family of natural and active molecules. The base form is tetrahydrofolate, from which other functional forms derive, such as 5-methyltetrahydrofolate, one of the most important in our body. El folic acid, on the other hand, is a synthetic molecule created in a laboratory and used for decades to fortify foods and manufacture low-cost food supplements. The fundamental difference is that our body cannot use it directly: it first has to transform it. I like to think of it like buying a piece of furniture that still needs to be assembled. Active folate is already assembled and ready to go into the room and do its job. Folic acid arrives in pieces, and the liver has to assemble it before useIf that assembly line is slow or limited, some of the material is left waiting. The folic acid bottleneck: why the supplement form matters To convert synthetic folic acid into forms that the body can use, the liver requires several enzymatic transformations. One of the main ones depends on the enzyme dihydrofolate reductase, o DHFR. This enzyme has a limited capacity, around 300 micrograms dailyTherefore, if a person takes larger amounts of inactive folic acid, it may not all be converted with the same efficiency. Here is one of the reasons why I insist so much on reading the label. If we are looking to provide vitamin B9, it is much more interesting to find already active or pre-activated forms: names like this may appear on the packaging 5-methyltetrahydrofolate, 5-MTHF, Quatrefolic®, Metafolin®, or Lederfolin®. It's not about obsessing over technical words. It's about understanding that two products can declare "400 micrograms of vitamin B9" and yet, do not provide the same molecular form. MTHFR: why your genetics make choosing active folate even more important There are also people who have a reduced ability to convert folate due to variants of the MTHFR gene. I am speaking specifically of the C677T polymorphism, which can significantly decrease the ability to produce 5-methyltetrahydrofolate. This turns the previous process into a sort of highway with fewer lanes: the nutrient may be present, but the body has more difficulties to bring it to its final usable form. These variants are especially common in the Mediterranean population. That is why, for people in this situation, it makes even more sense to choose a B9 shape already activated instead of relying solely on the metabolic conversion of folic acid. Where do we find vitamin B9 in food? Vitamin B9 is highly present in plant-based foods: unfortified nutritional yeast, sunflower seeds, legumes, leafy green vegetables, asparagus, broccoli, Brussels sprouts, and avocado, orange, banana, and wheat germ. But there is a small problem: folate is a rather heat-sensitive That is why it makes sense to combine cooked vegetables with other gentler preparations: raw leafy greens when well tolerated, uncooked avocado, and techniques such as vapor rather than very long cooking times. Eating folate is not enough: zinc, alcohol, and digestive acidity also matter Another idea that I think is very important is that a diet rich in folate does not automatically guarantee that we are going to use them well. Antes de absorberlos, nuestro aparato digestivo tiene trabajo que hacer. The folates present in food usually appear in forms called polyglutamates. To process them, we need an intestinal enzyme, the folate hydrolase, cuya actividad depende del zinc. Además, el alcohol puede inhibir esta enzima. Then comes the absorption phase. In the proximal small intestine, there is a transporter called PCFT that functions best in an acidic environment. This is why drugs that intensely reduce gastric acidity, such as some proton pump inhibitors, can interfere with this route of absorption. It is a good example of why, when a deficiency appears, we should not only look at "how much folate you eat." We must look at diet, digestion, medication, alcohol, and metabolic capacity Vitamin B9 and homocysteine: why does it work as a team with vitamin B12? One of the most important functions of folates occurs in homocysteine metabolism. The homocysteine, when it accumulates, is associated with a more inflammatory, oxidative, and procoagulant environment. work in tandem with vitamin B12. Folate and B12 work together in a sort of metabolic pathway that allows homocysteine to be transformed and continue generating essential molecules. From this pathway comes, among other things, SAMe (S-adenosylmethionine), a methyl group donor essential for many reactions: synthesis of melatonin and catecholamines, maintenance of the myelin Here is an important clinical warning: if we detect a folate deficiency, we must also assess vitamin B12. Giving B9 in isolation can mask signs of a B12 deficiency From serotonin to nitric oxide: how far does B9 really go? Another reason why I say vitamin B9 matters much more than we think is that it is involved in the production of tetrahydrobiopterin. This molecule acts as a cofactor in essential pathways for producing nitric oxide, serotonin, and dopamine. Nitric oxide is one of the body's major vasodilators. That is why I link an adequate availability of folates with the vascular health, with blood pressure regulation, and with erectile function. In the brain, those same pathways are involved in the production of serotonin and dopamine. When folate is lacking, symptoms may appear that seem non-specific (fatigue, irritability, headache, or mood changes), but make sense when we understand everything this vitamin does to biochemical level. Collagen, glutathione, and bile: the unexpected connection with glycine There is a connection with vitamin B9 that is almost never explained: its relationship with the wisteria. El tetrahidrofolato participa en la transformación de serina en glicina, y la glicina es uno de esos aminoácidos pequeños que termina apareciendo en muchísimos procesos. We need it to manufacture glutathione, one of the body's main antioxidant systems, to conjugate bile acids, for phase 2 liver detoxification reactions, and for build collagen. I like to use a very graphic fact: glycine is constantly repeated in the helical structure of collagen. That is to say, even when we think of skin, joints, or connective tissue, the B9 metabolism keeps appearing behind the scenes. Folic acid and pregnancy: why you need to start before a positive test? Here we come to the most well-known function of vitamin B9, and also one of the most important. I recommend starting an adequate intake of folate approximately three months before before starting to trying to conceive. The reason is simple: embryonic development begins long before many women even know they are pregnant. The neural tube closes around the first weeks of gestation, so wait for a positive test can mean arriving late to that initial phase. But the relationship with fertility no es exclusivamente femeninaIn men, folates contribute to the maintenance of sperm DNA integrity preconception preparation, tiene sentido pensar en la pareja y no únicamente en la mujer. It is also associated with adequate folate status during pregnancy with fetal development, the placenta, and intrauterine growth. Again, the key lies in arrive with adequate reservations before gestation begins, rather than trying to correct them once the process is already underway. How much vitamin B9 do we need and what should you look for in a supplement? The recommended amounts range between 400 and 600 micrograms daily for the general population and pregnancy, and between 800 and 1,000 micrograms for twin pregnancies. A maximum safety limit of 1,000 micrograms daily is also established. Rather than chasing huge doses, my advice is to look at the form first. If a label simply says "folic acid," you are looking at the synthetic form that needs activation. If 5-MTHF, 5-methyltetrahydrofolate, or an equivalent form like Quatrefolic® or Metafolin® appears, we are talking about already activated folate. meet needs in a useful and secure way, do not stack food supplements without context. How to know if you are deficient in vitamin B9? A sustained deficiency can eventually lead to megaloblastic anemia, with symptoms such as fatigue, shortness of breath, or palpitations. Headaches, irritability, and digestive issues may also occur. Analytically, it follows a very useful sequence: first, serum folate may drop; next, homocysteine may rise; later, intraerythrocytic folate (which better reflects the reserves of recent months) may decrease; and, finally, there appears the anemia. That is why it is not advisable to wait until you have overt anemia to start investigating. In people with symptoms, restrictive diets, intestinal problems, celiac disease, SIBO, or pharmacological treatments that interfere with this pathway, it makes sense interpret the markers within the complete clinical context. So, what is the most important thing to remember about vitamin B9? That "vitamin B9" and "folic acid" they are not exactly the sameThat molecular form matters. That your genetics, your digestion, and certain medications can change how much you benefit from it. And that its function doesn't end with pregnancy: it plays a role in blood vessels, neurotransmitters, collagen, glutathione, homocysteine, and cell division. If I had to summarize it in a single idea, it would be this: when you read a label, don't just look at the number of micrograms. Also ask yourself what form of folate it contains much more informed decisions I hope you like it :) For more information, you know you can find me on my Instagram @isabelvina, where I share daily content with you My TikTok @isabelvinabas YouTube ChannelAnd the supplements formulated by me on my website My website