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:
- 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
- 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.
-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!
Discussion (126 Comments)
Hi Katie, great information! I think it is wonderful that you are sharing so much crucial and fairly unknown information with the public. You are helping so many people out there!
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.
I am taking vitamins call mega food , baby and me. Are they good? Are there better ones? Thank you, Nilda
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?
Katie - Wellness Mama
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.
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!!
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!
I know this was posted last year, but your info was so helpful to me and answered some questions I have!
If you take liver pills, is it still necessary to take folate in supplement form? And how many ounces of the liver pills would you consume per day? I am building my pre-conception health and nutrition.
I take liver pills and also get folate in my prenatal https://www.amazon.com/Vegetarian-Development-BreastFeeding-Seeking-Health/dp/B00EKWVLC0/ref=as_li_ss_tl?ie=UTF8&linkCode=ll1&tag=wellnessmama-20&linkId=800d35d43788b3584591e93192616502&language=en_US which I also take before pregnancy
Amber McDowell Jones
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.
Erika Krumbeck, ND
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: https://www.mtwholehealth.com/2013/05/skip-the-centrum-a-guide-to-a-good-multivitamin
You don’t get a better answer than that.
Tina Fehr Redecop
Thank you so much Katie for all the helpful info! Yours is my favorite blog 🙂 God bless!
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!
no, it prevents the fetus from getting neural tube defects…
I know this is an old post so hopefully you’ve had your baby by now, but for others ending up here I thought I’d comment. I’m not a doctor and I don’t know anything about you, your congenital predispositions or what condition your lifestyle has left you in, but I can say that if anything natural can help it would be this…
A diet completely void of grains, vegetable oil, and sugar (basically a low carb, primal/paleo diet) abundant in healthy fats such as mono-unsaturated and saturated (loads of pastured eggs, grass-fed butter, coconut oil, avocado oil, avocados, grass-fed fatty cuts of meat) and non starchy vegetables (particularly those leafy greens).
A lifestyle low in stress, high in restful sleep (that means undisturbed sleep in a very dark room, without bright lights or the use of glowing screens i.e no TV /iPad/computer/Phone within 2 hours before bed, of course it might help not to drink caffeinated drinks in the afternoons) with lots of very-low strenuous exercise (such as walking), a small amount of body-weight exercise (pull-ups, push-ups, squats and planks) and very tiny amounts of high intensity (literally a 7-10 minute session of sprint-rest-sprint-rest-sprint-rest) once every 7-10 days. No chronic cardio exercise 7 days a week!!
This goes for both partners but it’s particularly important for the female. After all, nobody will deny that most the hard work creating babies is done by the female.
One thing’s for sure, any pharmaceutical fertility support offered by doctor will stand a much greater chance of success following this advise.
Oh and just to re-iterate, the grass-fed/pastured part above is very important, grain-fed/CAFO meat is high in omega-6 and low in omega-3.
I don’t know if links work in this forum, here’s the link: https://www.youtube.com/watch?v=I0WOqaTTzaI If it doesn’t work just search YouTube for “dietdoctor fertility” and look for the interview with Michael D. Fox, M.D.
Good Luck! 🙂
Ooops, should’ve included fish in there too with the meat and veg!
I think that’s a great diet unless you suffer from some conditions like Gilbert’s syndrome (very common condition) and or Porphyria (which according to Dr S.Rochlitz is more common than we think) I didn’t know I had these conditions and I tried the diet mentioned above for a long time with really bad results 🙁 After getting super sick I discovered that what it works for me and for many is a high carb, low protein and super low fat diet. BTW I really like meat but it makes me super sick. I guess one size does not fit all when we talk about diet. cheers,
I love me some b-vitamins. They make me feel so good inside. Thanks for the info.
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!
Hi–I had a wild bad reaction to Thorne’s 5-MTHF, I was basically a zombi for a week, really scary foggy mind. The weird thing is that I don’t have bad reactions to Folic Acid, I’ve no clue why…
The difference between the two is one is methylated the other is not. Some of us with MTHFR defects actually have too much methyl already (google overmethylation) and don’t need additional methyl. Mensah Medical is a great place to start for more info on over and undermethylation. I am overmethylated and Dr. Mensah has me taking folic acid. I hope that helps!
“Folinic acid” (form in between folic acid and methylfolate) is better if you are MTHFR and sensitive to methyl donors (I am too. I am COMT++). I wouldn’t take any folic acid if you are MTHFR. You shouldn’t overmethylate on folinic acid and won’t get the “build up” of folic acid.
The prenatal recommended in the article has the “CAL PROP 65 WARNING: This product contains a chemical known to the State of California to cause birth defects or other reproductive harm.” (near the top of the lable on the back under the CAUTIONS section).
I will look for more recent posts that contain the recommended list of specific items to take during pregnancy though to compare it to what I am taking. I think Dr. Mercola has a great “Women’s Multi” that contains Folate in lieu of folic acid and he also has a Folate capsule for increased Folate so I plan to discuss that with my doctor. I also take Liver capsules (Grass-Fed), Mercola’s Krill Oil, etc but would like to review & compare with your list as well. Thank you for all of the info
Everything has a “Prop 65” warning in California: https://wellnessmama.com/349297/california-prop-65/