“Make sure you get enough folic acid!” is a pretty standard advice these days for all pregnant women and those trying to conceive.
The WebMD states:
“Folic acid is a pregnancy superhero! Taking a prenatal vitamin with the recommended 400 micrograms (mcg) of folic acid before and during pregnancy can help prevent birth defects of your baby’s brain and spinal cord. Take it every day and go ahead and have a bowl of fortified cereal, too.”
According to ACOG (American College of Obstetricians and Gynecologists):
“Folic acid, also known as folate, is a B vitamin that is important for pregnant women. Before pregnancy and during pregnancy, you need 400 micrograms of folic acid daily to help prevent major birth defects of the fetal brain and spine called neural tube defects.”
I’m not going to argue the importance of folate.
Folate is an essential nutrient for good health and particularly important during pregnancy.
Inadequate folate status during pregnancy is associated with an increased risk of fetal neural tube defects (birth defects that affect the baby’s brain, spine, or spinal cord). The two most common neural defects are spina bifida (a condition in which the spinal cord is exposed) and anencephaly (severe underdevelopment of the brain).
Neural tube defects happen in the first month of pregnancy, often before a woman is aware she’s pregnant. That’s why folate status is important not only during pregnancy but also before conception.
But here’s the thing. Despite of being used interchangeably…
Folate and folic acid are not the same thing.
Folate vs. Folic Acid – What’s the difference?
What is FOLATE?
Folate is the natural form of an essential nutrient otherwise known as vitamin B9.
Folates are found naturally in some foods and play a key role in many metabolic pathways.
What is FOLIC ACID?
Folic acid is a synthetic form of vitamin B9, made in a lab. This is the form of folate commonly added to dietary supplements including prenatal vitamins.
Following a mandate from 1998, folic acid is added to conventional (and even some organic) enriched grain products in the U.S. (bread, rolls, pastries, pasta, breakfast cereal, rice, cornmeal, etc.) with the intention to increase folate levels in the population, especially in the females of childbearing age.
Unlike natural folate, most of the folic acid is not converted into 5-methyltetrahydrofolate (5-MTHF) in the digestive system.
Why is the population deficient in folate?
In order to answer this question, we have to go back in time.
(I didn’t want to leave this information out, but I’ll try to keep it as brief as I can. Promise!)
The wheat flour has changed.
The way grain is milled has changed dramatically from the olden days and so has the flour we use.
Wheat is made up of three components:
- the BRAN;
- the GERM; and
- the ENDOSPERM.
The BRAN is the outer part of the kernel and contains large amounts of B vitamins, some protein, phytonutrients, trace minerals, and dietary fiber. The GERM is the sprouting part of the kernel and contains healthy fats, many B vitamins, protein, and minerals. Last but not least, the ENDOSPERM is the largest portion of the kernel and contains high amounts of carbohydrates, protein, and small amounts of vitamins and minerals.
Originally, small-operation stone milling powered by wind or water was the only way to turn grain into flour. The flour milled in this way used all three vital parts of the kernel and retained much of its nutritional value. It also had a relatively short shelf life for which the GERM was responsible since it contains the most fat. (Oils speed up the oxidative spoiling which results in rancidity.)
Looking for means to mass produce, automated flour mills have been gradually introduced. The steam roller mill invented in 1865 changed the flour forever – for better and for worse. During processing, the grain was stripped of its outer parts (the bran and the germ) and only the endosperm was used.
PRO: This resulted in a dramatically extended shelf life.
CON: The flour was stripped of much of its nutrients which are contained within the bran and germ.
The results of modern industrial milling led to higher profits and increase in production but also to a surge in health issues including miscarriages and birth defects.
The government knew and had to do something.
Instead of reverting back to using whole grains though, the U.S. federal government launched a flour enrichment program in 1941, calling for an addition of iron and some B vitamins (thiamin, riboflavin, and niacin) lost in the milling process.
In 1998, folic acid became the most recent addition to the mandate.
And here we are. We’re still producing flour that’s more marketable and less healthy.
Why folic acid may not be the best form of folate…
Until fairly recently, it was widely believed that synthetic folic acid is much better absorbed by the body and more efficient than naturally occurring folate.
New research shows, however, that the bioavailability of natural folates is approx. 80% (much higher than previously assumed) and that consuming a diet rich in naturally occurring folates is much more effective than once believed.
While fortification of foods with synthetic folic acid may have been somewhat successful in reducing neural tube defects in newborns, it has also brought health concerns for the general population.
Studies have shown the presence of unmetabolized folic acid in the bloodstreams.
Unmetabolized folic acid is folic acid that doesn’t convert and simply stays in the blood in its original form.
How does that happen?
Research (1, 2) shows that the majority of synthetic folic acid is NOT converted to 5-MTHF (5-methyltetrahydrofolate, aka methylfolate) in the digestive system (like it occurs with natural folate) but rather converted by the liver.
When folic acid and/or fortified foods are consumed, several processes and cofactors are required to play out in concert in order to convert folic acid into 5-MTHF.
It can happen. But it takes a while.
For some of us, the conversion may not happen though.
Folic acid has to be converted by enzymes into more active forms. This conversion involves a number of enzymes, including MTHFR (the acronym for methylenetetrahydrofolate reductase).
In a significant portion of the population, however, the MTHFR enzyme is not very efficient due to specific deficiencies.
An estimated 30-50% of the population carries a mutation in the MTHFR gene.
We’re all born with the MTHFR gene. It is passed down to us from our parents. The MTHFR gene is responsible for producing the MTHFR enzyme that helps convert folic acid into methylfolate, a biologically active form of folic acid.
Some of us carry a mutation in the MTHFR gene. There are several common mutations that can happen with this gene, and possibly more to be discovered.
Even if you have inherited an MTHFR mutation, however, it’s not always triggered. It’s possible to have no related health issues while having the gene mutation. Genetics only play one part. The environment we live in and our lifestyle choices and diet are just as important, if not more.
What does this mean?
It means that a certain percentage of the population doesn’t produce enough of the MTHFR enzyme and may not be able to absorb folic acid properly. It’s difficult to estimate how many of us simply carry the gene mutation and how many have to live with the consequences of a triggered MTHFR.
If you fall into this category, you may be at risk of folate deficiency without realizing it regardless of how much folic acid you consume.
Most pregnant women don’t know if they’re carrying a mutation in the MTHFR gene.
That means that some pregnant women may not be getting the protective benefits against neural tube defects regardless of their folic acid intake.
Are there health risks associated with taking folic acid?
Scientists are increasingly wondering if the scale of folic acid fortification and supplementation we see today is necessary, and whether it could cause more harm than good. There is growing concern that high folic acid intake could result in detrimental effects, particularly in susceptible individuals.
Although controversial, just like low folate status has been shown to be a risk factor for cancer, high folate status as a result of folic acid fortification or supplementation appears to increase the risk as well (1, 2, 3, 4, 5, 6).
While the Recommended Dietary Allowance (RDA) for folate is 400 mcg/day, the actual folic acid intake from both mandatory and voluntary folic acid supplementation tends to be much higher.
For the average person in the U.S. on a Standard American Diet consuming well above the suggested serving sizes AND taking multivitamins, it’s easy to go over the upper intake level of 1,000 mcg/day.
(Folic acid has been identified as a potential risk factor for cancer and cardiovascular disease in both standard and elevated doses, but more research is needed.)
What’s the solution?
If you’re concerned about your MTHFR status, you can get tested for MTHFR gene mutations.
The test can be done either through your healthcare provider (your insurance may cover the cost) or independently through a private lab (with a saliva or blood sample).
23andMe is probably the most popular company for private genetic testing, but you will need to run your raw data file through a genetic reporting service like Genetic Genie, NutraHacker, or something similar to access the methylation profile.
Other than that, regardless of your MTHFR status, I strongly believe that natural is always better.
- Avoid or reduce the consumption of fortified foods.
- Avoid dietary supplements containing folic acid.
- Consume whole nutritious foods that contain natural folates.
While you CAN potentially hurt your body (and your baby) by consuming folic acid, you CAN’T hurt your body (and your baby) by eating more of the natural folate. Unlike synthetic folic acid, it comes in an optimal bundle of micronutrients that the body recognizes and efficiently regulates.
What are the best natural sources of folate?
Legumes are a great source of folate, with a cup of cooked lentils in the lead and providing 90% of the daily value of folate.
Folate can be also found in nuts and seeds, animal liver, or wheat germ.
Are prenatal vitamins containing folic acid harmful?
There is no easy answer to this question.
Unless you have had your enzyme activity tested which confirmed that you CAN metabolize folic acid, it might be wise to avoid folic acid supplementation, especially before and during pregnancy.
Prenatal vitamins with FOLATE (not folic acid)
It can be tricky looking for the right box of prenatal vitamins when it comes to folate/folic acid.
Many labels show folate but actually contain folic acid.
Even some high quality prenatal vitamins contain folic acid instead of natural folate.
Frustrating, isn’t it?
With a little search though, prenatal vitamins containing folate CAN be found!
The product links in this article are affiliate links. Our affiliate disclosure can be found here.
If you’re pregnant and don’t take prenatal vitamins for whatever reason and don’t eat many high-folate foods (or aren’t pregnant but are interested in boosting your folate levels because you feel like your dietary folate intake isn’t optimal), you can supplement with just folate.
To sum this all up:
4 reasons to AVOID folic acid – even if you’re PREGNANT
- Natural folate and synthetic folic acid (both available in dietary supplements) are two different forms of vitamin B9, converted by the body in different ways. The process of converting natural folate is much simpler than the conversion of folic acid.
- Natural folate has significant advantages over synthetic folic acid. It is well absorbed, and its bioavailability is not affected by metabolic defects.
- Unless you’ve had yourself tested for MTHFR mutations, you don’t know your MTHFR status. If you don’t know your MTHFR status, supplementing with folic acid may be causing a folate deficiency instead. Therefore, some pregnant women may be at an elevated risk of giving birth to a child with certain birth defects if they rely on folic acid.
- There are studies that suggest that synthetic folic acid is cancer-promoting, whereas natural folate from food is cancer-preventive.
Disclosure: This article is not intended for the treatment or prevention of any disease or as a substitute for a medical treatment. Always consult your medical provider.