Hamburger black

Folate vs. folic acid: it pays to know the difference

Folate and folic acid—two different forms of the essential vitamin B9—are used interchangeably so often that most people assume they are the same. In fact, even many doctors and nutritionists remain unaware that folate and folic acid have vastly different paths in the body. According to recent studies, ingesting the wrong form may have unintended negative effects in some people.

We’ve researched what the latest science has revealed about the differences between folate and folic acid. Now that you’re aware of this common misconception, learn how to avoid any undesirable side effects from choosing the wrong form for you. Here’s what you need to know to make an informed decision about your supplementation.

The difference between folate and folic acid

Folate is the common form of vitamin B9 present in many whole foods, including leafy greens, beans, eggs, citrus fruit, avocados, and beef liver. On the other hand, folic acid is a synthesized version of vitamin B9 that is added to processed foods and the common version used in supplements. Folic acid has a molecular structure that is nearly identical to folate. Due to their close resemblance, folic acid and folate are widely considered to be the same.

In 1998, the FDA required that grain products be “enriched.” From that came foods such as flours, breads, and breakfast cereals, being fortified with folic acid. The goal of this regulation was an attempt to reduce the prevalence of Neural Tube Defects (NTDs), a common birth defect that had shown some connection to the mother’s vitamin B9 intake. According to a 2011 paper in the scientific journal Reviews in Obstetrics and Gynecology, there was a decrease in the prevalence of NTDs in newborns within mere months of the fortification program. For this reason, folic acid is included in many prenatal vitamin formulations. However, the story doesn’t end there.

With time, scientists have learned more about folic acid’s effects on the body. As some recent studies have shown, the very tiny differences between folic acid and folate have a huge impact on how the body can process them.

Let’s get technical

For those eager to understand the scientific details, here is more about how the body typically processes folic acid, and what makes it potentially dangerous.

Before folic acid can be utilized by the body, it must undergo two conversions—to dihydrofolate (DHF) first and then tetrahydrofolate (THF). Only then, can THF be converted to L-methylfolate, which is the end form of folate that the body requires for many key functions.

Methylenetetrahydrofolate reductase (MTHFR), is the key enzyme that regulates this conversion process. However, it is estimated that up to 60% of Americans have genetic variations that reduce their ability to convert L-methylfolate from folic acid on their own. For those who have this genetic variation, supplementing with folic acid may lead to varying amounts of the converted L-methylfolate form, potentially leaving the body with less than it requires. Furthermore, it could lead to a build up of the folic acid form in the body.

In terms of providing the body with available nutrient, dietary folate—the form found in whole foods—is preferable to the synthetic folic acid found in supplements and processed foods. It is both more readily available to the body, and it does not pose the same potential risks of build up. This is why supplementing with L-methylfolate can also be considered superior to using folic acid for those that may not get enough from the diet.

When someone’s intake of folic acid exceeds their capacity to process it, it can overwhelm the liver and potentially end up in the bloodstream. The unmetabolized folic acid that remains in the bloodstream has been associated with serious health risks that are worth noting.

Excessive folic acid intake is correlated with significant health risks

Recent research shows a correlation between elevated levels of folic acid and an increased risk of cancer. The results from a double-blind, placebo-controlled study conducted between 1994 and 2004 suggested that those supplementing with 1 mg/day of folic acid showed an increased risk of cancer. A 2012 study published by the NIH questions whether fortifying foods with folic acid may be contributing to the increase of prostate cancer in the population.

A 2005 study published by The Journal of the American Medical Association found that older adults taking more than the daily recommended value of 400 mcg of folic acid experienced faster cognitive decline than adults who didn’t supplement.

It is important to remember that folic acid started to be widely consumed only recently. While the risks of too much folic acid are alarming, the danger of too little folate is also quite serious. There is still plenty of research that must be done before we have an accurate understanding of the pros and cons. It likely will lead to recommendations that are based on an individual’s unique genetics and ability to convert folic acid into its active form versus allowing it to build up. They will need to be balanced according to one’s lifestyle, health goals, diet and the accessibility of L-methylfolate supplements.

Dr. Jeffrey Gladd, an integrative physician, says: “Know that in the right person, folic acid as the supplement form poses no risk, and therefore would be a perfectly fine form to take. The problem lies in most not knowing their folate handling genetics and so the ‘potential’ for it not being helpful, and possibly harmful exists. That being said, we have no data to suggest that there are any negative effects of taking the folate form, even if you are good converter. Therefore, I guide most patients to take the folate form just to be on the safe side.”

Depending on your unique circumstances, folic acid (in moderation) may be advisable, especially if you are pregnant. Fortunately, folate-rich foods and methylfolate supplements are available. With proper knowledge and planning, you may be able to avoid the need of a vitamin B9 supplement altogether. Read on to learn more.

The importance of folate

When your diet includes adequate levels of folate, you are supporting the smooth execution of some miraculous cellular functions: namely DNA formation and cell division. Folate is crucial to these functions, and many more.

For many, it is possible to meet the body's folate requirements through a healthy, varied diet. However, certain dietary restrictions or health conditions may increase the risk of folate deficiency, and associated symptoms.

It is commonly believed that women of childbearing age need increased amounts of folate, as folate deficiency during pregnancy can contribute to low birth weight and neural tube defects (including spina bifida). If you are planning to become pregnant or pregnant already, folate is highly important for avoiding common birth defects. This is why it is a common ingredient in many prenatal vitamins. Women expecting to become pregnant should aim for 600 mcg (0.6 mg) of folate daily.

People with a history of alcohol dependence or digestive disorders are also at an increased risk of folate deficiency. If you think that you might be at risk of folate deficiency, keep an eye out for these common signs: anemia, changes in the pigmentation of the skin, hair, and nails, and ulcers of the oral lining.

Recognizing that you may be at risk is the first step towards making positive changes to your diet, and deciding whether supplementation might be necessary. The National Institute of Health recommends a daily intake of 400 mcg (.4 mg) for adults and children older than 4 years old.

Fill your plate with these folate-rich foods

Folate is found naturally in a wide variety of foods, including some vegetarian options. A 3-oz. serving of beef liver contains over 50% of the daily recommended intake for folate, making it an excellent source. If you’re vegetarian, you can actually get 33% of your daily folate intake with a ½-cup serving of boiled spinach.

A ½-cup serving of avocado offers up approximately 15% of your daily intake. Other dark green vegetables such as broccoli, asparagus, and mustard greens aren’t far behind. They supply approximately 13-22% of the daily recommended folate intake. (Estimates courtesy of the National Institute of Health.)

Many grain products, such as bread and cereal, are fortified with folic acid. However, as previously noted, the body will potentially synthesize and absorb folic acid less efficiently than folate. For this reason, consuming fortified foods may not necessarily increase the levels of L-methylfolate your body needs.

Supplement with folate to optimize your health

If you tend to consume plenty of folate-rich foods, then you are likely well on your way to adequate folate consumption. However, we all need a bit of a B-vitamin boost now and again. This is especially true for expecting mothers. You can safely increase your folate intake if you carefully avoid supplements labeled folic acid—look instead for methylfolate, a superior form of folic acid for most.

If you are concerned about whether you are getting sufficient folate, speak to your doctor or take an online survey for a personalized recommendation.