Many people are confused about the difference between folic acid and folate.
Folate is a naturally occuring B-vitamin.
Folic acid is a synthetic version of folate, which is produced in a lab.
Many women are told to supplement with folic acid when planning to become pregnant and during the early weeks of pregnancy. Though some may not know why it’s necessary.
Adequate folate is necessary to help the baby's neural tube (which becomes the central nervous system, including the brain and spinal cord), to develop properly, as well as prevent a major birth defect, spina bifida, from occurring — by up to 70%.
Because our bodies don’t store folate, consuming adequate amounts regularly is something we need to be aware of.
Folic Acid – What You Need To Know
Something very important you may not yet understand is the important difference between naturally occurring folate and the synthetic form of folate, folic acid.
Let's go over the two forms of vitamin in more detail.
What Is Folate?
Folate is a water soluble B-vitamin also known as B9. Just like vitamin C, our bodies do not store folate, instead excreting any unused vitamin through the urine.
This means we need to regularly eat foods that have folate in them, such as:
- Vegetables (spinach, lettuce, parsley, cauliflower, broccoli, beetroot, asparagus)
- Fruits (orange, mangoes, grapefruit, papaya, strawberries, raspberries)
- Beans, peas and lentils
- Seeds and nuts
- Beef and chicken liver
- Whole grains (quinoa, wild rice, millet).
Folate works with vitamin B12 and vitamin C to help our bodies break down, utilise and make new proteins. It also helps red blood cells to form and produce DNA. Our DNA carries genetic information in our body.
Folate plays a very important role in the healthy development of babies during pregnancy, especially in the very early weeks when the neural tube is forming. At around days 21-28 after conception, the neural tube formation is complete.
Folate Versus Folic Acid
Folic acid is the synthetic, manufactured form of folate. It’s the form used in supplements and is added to food that we eat, particularly bread and cereal products.
Folate and folic acid are not equal.
Folate from food and synthetic folic acid are utilised differently in the body.
Folate is metabolised in the stomach, while folic acid is metabolised in the liver.
In the 1980s, researchers looked at the blood work of women who had babies with neural tube defects (NTDs) and discovered they were deficient in certain micronutrients, particularly folate. Later research showed supplementation with folate before conception reduced the occurrence of NTDs.
However because many pregnancies are unplanned, women were still not getting enough folate at the critical time of pregnancy, and NTDs continued to occur. As a result, many countries worldwide have introduced mandatory folic acid fortification to certain foods such as flour.
Most government health websites state that all women of childbearing age should be supplementing with folic acid, in an attempt to prevent NTDs in the case of an unplanned pregnancy. It’s assumed most women do not eat a balanced diet, and would not be able to consume enough folate in natural form.
The current recommendation for women planning to become pregnant or currently pregnant is to take 400mcg of folic acid daily, at least one month prior to conception and then ongoing during the first trimester.
Too Much Of A Good Thing?
While the occurrence of NTDs has been reduced since mandatory folic acid fortification was introduced in many countries, there are concerns that high levels of folic acid are not safe.
There have been studies reporting the presence of unmetabolised folic acid in the blood after consumption of folic acid supplements or fortified foods. Folic acid is metabolised in the liver, which becomes saturated quite rapidly, leading to excess spilling into the bloodstream. Excess folic acid can reduce the effectiveness of natural killer cells.
Studies have suggested high levels of folic acid may increase the odds of developing cancer.
Research from Norway, where there is no folic acid food fortification, showed increased cancer outcomes linked to folic acid. Patients with heart disease who were treated with folic acid and vitamin B12 had a higher risk of developing and dying of cancer.
Yet another study suggests women who take folic acid supplements may be at risk of developing and dying of breast cancer.
There is also the issue surrounding those women who are unable to properly absorb synthetic folic acid because they have a genetic mutation of the MTHFR gene. The MTHFR gene mutation is very common, and is said to occur in almost 1 out of 2 people mildly and 1 in 4 seriously. So the chances you have this mutation are very high.
Synthetic folic acid is converted into methylfolate via a process called methylation. This process requires a certain enzyme created by the MTHFR gene. When these genes are mutated, the result is a defective enzyme that can’t convert folic acid into methylfolate.
MTHFR is not commonly tested for, and if you are not aware you have this genetic mutation, it's possible that any folic acid supplements you take will have little effect. You can ask your doctor to be tested, however.
Should I Skip Folic Acid Supplements?
While there is no doubt that folate deficiency can have devastating effects on the development of babies, synthetic folic acid may be causing more harm than good.
The best way to increase your folate level is to consume a variety of foods that are rich in naturally occurring folate and to be aware of how much fortified food you are eating. Many flour products have added folic acid, which can mean pregnant women are consuming well above the recommended levels of folic acid.
Be an informed and active participant in your care before and during your pregnancy. While recommendations and guidelines can sometimes be helpful, your personal circumstances are unique. Choosing a maternity care provider familiar with folate and folic acid, and one that provides individualized care can also help you in making informed decisions about your diet and any supplements.
Recommended Reading: For more information about the MTHFR gene mutation and what you need to do if you have it, see our article, MTHFR – How 1 in 4 Pregnancies May Be Affected.