Folic Acid vs. Folate

Folate vs folic acid during pregnancy Folic Acid vs. Folate

I’ve gotten several questions lately about folic acid vs. folate, especially during pregnancy. Folic acid and folate are often used interchangeably and even many doctors will not be able to tell you the difference if you ask.

The body needs folate, especially during pregnancy and folate is the form found in foods. You’ll often hear that folic acid is simply the supplemental form of folate, but there are some key differences. Recent research is supporting the fact that folate should be used in place of folic acid.

What’s the difference?

Chris Kresser breaks down the important difference between folate and folic acid in this article:

“Folate is a general term for a group of water soluble b-vitamins, and is also known as B9. Folic acid refers to the oxidized synthetic compound used in dietary supplements and food fortification, whereas folate refers to the various tetrahydrofolate derivatives naturally found in food. (1)

The form of folate that can enter the main folate metabolic cycle is tetrahydrofolate (THF). (2) Unlike natural folates, which are metabolized to THF in the mucosa of the small intestine, folic acid undergoes initial reduction and methylation in the liver, where conversion to the THF form requires dihydrofolate reductase. The low activity of this enzyme in the human liver, combined with a high intake of folic acid, may result in unnatural levels of unmetabolized folic acid entering the systemic circulation.

Several studies have reported the presence of unmetabolized folic acid in the blood following the consumption of folic acid supplements or fortified foods. (3) Human exposure to folic acid was non-existent until its chemical synthesis in 1943, and was introduced as a mandatory food fortification in 1998. (4) Food fortification was deemed mandatory due to overwhelming evidence for the protective effect of folic acid supplementation before conception and during early pregnancy on the development of neural tube defects (NTD) in newborns.”

I’d recommend reading his full article, but research is supporting the idea that too much synthetic folic acid can increase risk of some types of cancers (source) and it may not even be as effective in preventing neural tube defects.

Folate (the natural form) has some very important functions in the body:

“What is the role of folate?  Folate is necessary during rapid cell division and growth. In fact, pregnancy is known to actually double the need of dietary folates.

Folate deficiency has been reported to be the most common vitamin deficiency in the US, and is associated with such conditions as:

  • Anemia
  • Incidence and recurrence of Neural Tube Defects (serious birth defects of the spinal cord and the brain which arise during the early development of the embryo, most common being spina bifida)
  • Increased risk of certain cancers
  • Elevated Homocysteine, a risk factor for cardiovascular disease, stroke and many other health conditions

Potential Causes of a Folate Deficiency

  • Inadequate dietary intake
  • Increased requirement, as in pregnancy and lactation
  • Malabsorption
  • Altered hepatic (liver) metabolism
  • Increased elimination of folate” (source)

 

How to Get Enough Folate:

Unfortunately, even high quality prenatal vitamins often contain folic acid instead of folate. I’ve had to create my own supplement regimen for pregnancy to find the natural forms of all the needed nutrients including folate.

Folate is found naturally in foods like liver and spinach. It is also possible to find a natural supplemental form of folate that can be taken in place of folic acid.

Though the recommendation for pregnancy is 400-600mcg of folate/folic acid, this is the minimal amount needed to prevent birth defects. When using folate instead of folic acid (thus removing the added risks to mom with the synthetic form), it is often advisable to take more than the minimum. As always, check with a doctor or midwife before taking or changing anything, especially during pregnancy, but do your research on this one!

What I do: Before and during pregnancy, I take 800-1200 mcg of folate. I have used Pure Encapsulations Folate (slightly higher quality) and Solgar Folate (less expensive) with good results. The one downside to folate is that it isn’t as easily absorbed, so it is often necessary to take more and to get it from real food sources. I also eat liver at least once a week during pregnancy.

Additional Reading:

Designs for Health Article on Folate

Chris Kresser on Folate vs. Folic Acid

Possible link between synthetic form and cancer

Do you take folic acid or folate during pregnancy? How do you make sure to get enough?

Reader Comments

  1. Charmaine Taylor says

    I am coming off birth control this week and was advised to start prenatal vitamins again in case we conceive. I am looking into a well rounded b-vitamin to help me detox too. I also suspect I have a MTHFR defect, so folic acid is number one on my supplement list this week!
    I am glad both of the folate supplements you recommended are methylated. I had Thorne Research’s 5-MTHF on my wish list since it is therapeutic level and clean. But expensive! I’ll research your recommended brands too. Thank you!

  2. Emily Phillips says

    So will folate help you get pregnant? Sorry if that’s a stupid question, but it didn’t seem to be stated clearly in the post. Great post though!

  3. Erika Krumbeck, ND says

    Remember that there is a difference between folic acid and activated (or methylated) folic acid. 20-40% of the population has a defect in the MTHFR enzyme, which is what tags that methyl group onto the folic acid. That methyl group then gets transferred to B12, SAMe, and ultimately leads to the activation of your neurotransmitters and many other metabolic products in the body (CoQ10, creatine, and more). So it is extremely important to use the methylated form of folic acid if you have an MTHFR defect or suspect you do. I recommend using it under a physician’s guidance, though, because if you have other genetic defects it can trigger anxiety, depression, or bad detoxification reactions.

    A little bit more about safety of vitamins (and other factors involved) on my own blog: http://www.mtwholehealth.com/2013/05/skip-the-centrum-a-guide-to-a-good-multivitamin

    ~Dr. Erika

  4. says

    Thank you for your very informative post. I frequently hear folic acid in almost all commercial food advertised, but now I know that it may cause harm if someone intake that more than necessary. How much folic acid can a body accommodate before it can expose your body in diseases such as cancer?

  5. Amber McDowell Jones says

    So should I take my prenatal vitamin (with folic acid) and an additional folate supplement? Or us that too much? If I just take the folate, I don’t want to miss out on the other stuff in my normal prenatal vitamin.

  6. Anna says

    You mentioned that you created your own supplement regimen for pregnancy to find the natural forms of all the needed nutrients do you mind sharing what you take in addition to the folate?

    • says

      I will try to post the whole list soon, but typically: a whole food multi, folate, fermented cod liver oil, omega-3s, tons of probiotics, liver pills, magnesium, and gelatin with some others added at different times in the pregnancy.

      • Jacque says

        Yes! That future post would be so helpful. I am almost 6 weeks pregnant and have not seen my doctor yet, but when I do I would like to talk to him about the different options other than “taking a prenatal vitamin.”

        Thank you in advance!!

      • Andrea says

        Love your site. I have been reviewing several different posts while my husband and I are deciding exactly when to start trying for our first baby. The info is incredibly helpful!

        Like Anna, I would love to see your exact supplement regiment and possibly a detailed list outlining a suggested day/week of eating while pregnant.

        I’m one of the few members of my family (immediate and extended) whom cares about doing things as naturally as possible (in all aspects of my life), so your website has been incredibly encouraging and informative. Thanks so much!

  7. Mandy says

    I’ve been looking around, and I know that Garden of Life Vitamin Code (I think there’s a Prenatal) that has folate, I believe, as does MegaFood Baby & Me (but that’s expensive), and Thorne Research has a Basic Prenatal that has it too. Thorne doesn’t look too terribly expensive.

    I picked up Sisu (a Canadian brand) Prenatals (I had a coupon from the Healthy Shopper) before I read about this, so I’ll finish that off and try to order Thorne.

    Another Canadian brand, Trophic, has several multis that contain folate instead of folic acid, and they seem less expensive too.

    Right now we’re at the trying to conceive stage, having some fertility issues.

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