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I’ve gotten several questions lately about folate and folic acid, especially during pregnancy. These two are often used interchangeably and even many doctors will not be able to tell you the difference if you ask.
The body needs this important nutrient, especially during pregnancy and folate is the natural form of this nutrient found in foods. You’ll often hear that folic acid is simply the supplemental form, but there are some key differences. Recent research is supporting the fact that folic acid should be avoided and the natural form should be preferred.
What’s the Difference Between Folic Acid & Folate?
Chris Kresser breaks down the important difference 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 natural form 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:
“It is necessary during rapid cell division and growth. In fact, pregnancy is known to actually double the need of dietary folates.
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
Unfortunately, even high quality prenatal vitamins often contain folic acid instead of the natural folate-forms. In the past, I’ve had to create my own supplement regimen for pregnancy to find the natural forms of all the needed nutrients (though there is now a high quality prenatal that contains the natural methylated form)
Folate is found naturally in foods like liver and spinach. It is also possible to find a natural supplemental form 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 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. UPDATE: I now take this prenatal instead which contains adequate levels.
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? Share below!
Paleo Cookbooks Review
Liver is high in vitamin A and should not be taken in pregnancy
Hi Fardos, I’m curious why you say liver should not be eaten during pregnancy. It is my understanding that beef liver is one of the healthiest foods humans can eat; how does this change for a woman during pregnancy?
Hello Katie,
As always amazing info on your website!!
I have a question for you – my folate blood result is high – 45.1 nmol/l (reference 10.4 – 42.4) and I’m pregnant, in my first trimester.
Should I be concerned by this level?
It seems my body can’t clean it no matter what, I haven’t taken folate containing supplement in a year(took it for a few months year and a half ago, methylated version, no folic acid, I only have homozygous MTRR A664A, no MTHFR).
I eat clean, Paleo, so no synthetic folic acid on my table.
If you know some hacks on how to get rid of it? or at least to reassure me it’s not going to be such a harm for my baby! thanks, Dia
I understand there isnt too many studies to prove that supplementing with folate (instead of FA) prevents NTD, which is crazy to me since folate is natural. My obgyn just asked me to supplement for at least the first 3 months with FA (until the NT closes) since this has indeed been proven as prevention.
He also said that he doesnt recommend an MTFHR test for me (i read that the risk of carrying the mutation is 40%) even though i told her my 1st baby was born with tongue tied and a benign sacral dimple. He said these midline defects are too common for babies to blame the mutation. Why do these have to be common and us be ok with it?!
Btw, i read that too much preformed vitamin A, such as liver, can cause birth defects. I guess once a week is ok(?)
It IS difficult to be healthy when there is so much controversy. I wish things were more simple!
What’s up with the warning on the prenatal that has a substance banned in CA?
This explains a bit: https://wellnessmama.com/349297/california-prop-65/
What about methyl folate? I have MTHFR and have just learned that I should avoid folate as well and not just Folic Acid and instead take the active form of folate–methyl folate. Would love to hear your thoughts!
Hello, I found your article regarding folate v folic acid very interesting indeed and very informative. I decided also to take folate instead due to the fact it’s better for your body. I’m currently 7 weeks pregnant and have been taking solgar 1000mcg folate daily for a few weeks since I found out I was pregnant, however I’m just slightly concerned it was too high of a dose as in UK it states 400mcg daily for pregnancy so I have now decreased to solgar 400mcg folate daily, but now I’m worried it’s too little as I can’t find an in between dosage as I’m UK based. I’d be interested in what you would advise on this. I do try and eat as well as I can too ie fruit and veg etc. Many thanks.
Hi! I was reading about this prenatal from Seemimg Health and someone said that : The bottle says the product has a chemical known to cause birth defects or reproductive harm.
Did you know about that? I’m kind of worried now
https://wellnessmama.com/349297/california-prop-65/
Thank you – this post was very helpful. I saw that you take 800-1200 when you are trying and pregnant, but what do you recommend for a daily dose for someone who is neither? I have read multiple studies saying all fertile women should take it “just in case” and I am in that boat. We are not quite TTC but not trying as hard not to anymore…. so I want to be safe and supplement with folate. Would the 800 in the folate you recommended here be good – or is that too much if not actively trying?
Hi Katie – I tried to take the prenatal that you recommend in this article with my first pregnancy, and for some reason it made me really, really sick – have you heard of this happening before? Do you have any recommendations as to other prenatals that also have the methylfolate? or what I could take to kind of make up for what you get in yours? I really trust your research, and I’m actually planning in advance this time for #2! Thanks for your time.
HI,
Love your blog. I want to get the folate you recommend but everytime I click the link it sends me to Amazon with a while list of different brand. Can you tell trlk the exact name of the prenatal you take? Also is there a particular liver pill you buy? Is there a such thing as grass fed liver pills?
Thanks!!
Lisa
Here are the links… Pure Encapsulations Folate (slightly higher quality) and Solgar Folate (less expensive) But I now take this prenatal instead which contains adequate levels.