Folate vs. Folic Acid? What's the Difference and Which Do You Need?

 

Do you take a prenatal vitamin? Maybe you take a standard multi-vitamin, or if you’re a little more specific with things, a B-complex? If you take any of these in addition to what you get from the end of your fork, listen up! There’s a nutrient in these and many other supplements that’s very important when it comes to fertility, healthy babies, healthy mamas, and to every body. That includes you, dads-to-be! It’s a vitamin that you all need, but you may not be getting it from these supplements in the form that’s best for your body. What am I talking about?

FOLATE.

Folate is the naturally-occurring form of vitamin B9. I’ve talked previously about biotin, which is vitamin B7, another member of the B family. Folate, like biotin, is water-soluble and it’s essential for multiple processes in your body.

 

Why Do I Need Folate?

You can’t live without it! Folate is required for red blood cell production, tissue development, cellular growth, and DNA formation. You need folate to metabolize certain fatty acids, detoxify unwanted chemicals, encourage optimal nerve functioning, help regulate melatonin production, and folate can reduce levels of your circulating homocysteine. If it’s not already clear, folate is an essential nutrient for optimal health!

You may also know folate by a similar name—folic acid. This is the synthetic form of folate, and while their names are used interchangeably, folate and folic acid are distinctly different forms of vitamin B9. Let’s take a look.

 

What’s the Difference Between Folate and Folic Acid?

Folate is the natural form of B9, and its real name is 5-methyltetrahydrofolate (5-MTHF). I know, that’s a mouthful! We’ll stick with 5-MTHF for short. When you eat folate-containing foods, most of that dietary folate is converted into 5-MTHF in your digestive tract before it enters your bloodstream. That’s because it needs to be in this active form to complete all the health-promoting that were mentioned above.

Folic acid is the synthetic form of B9, also known as pteroylmonoglutamic acid. Folic acid was formulated when the food industry began enriching and re-fortifying (mostly grain-based) foods after they had been stripped of their naturally occurring nutrients. You might see folic acid on the ingredient list of white breads, crackers, pastas, baby cereals, and other refined grain products. It’s also frequently used in vitamin-mineral supplements, added to vitamin waters, hydration boosters, and protein powders.

Unlike folate, folic acid isn’t readily converted to the active 5-MTHF in your digestive tract. Instead, it depends mainly on your liver, and this is a slow and inefficient process for many. For those with the MTHFR genetic variant (that’s about 40% of us), this conversion is even more impaired. As a result, folic acid isn’t completely absorbed or metabolized, so it stays circulating through your bloodstream. This is unusable to your body, and high levels of circulating folic acid are associated with increased risk of cancers, decreased immunity, and an increase in cognitive difficulties.

In short, your body knows exactly what to do with natural folate, and it does those things well. It rarely uses folic acid in the same way, and when too much is left unconverted, it can have damaging consequences.

 

How Can I Tell if I Have a Folate Deficiency?

True folate deficiencies are rare. Especially if most of your intake comes from a colorful, real-food diet. The problem is in the supplementation. Because many rely on folic acid-containing supplements and fortified foods, even if you’re taking in adequate folic acid, your body isn’t doing anything with it! You can’t metabolize the folic acid down to the usable form, so it’s as if you weren’t taking in any at all. So basically, you are deficient along with the added harmful effects of too much folic acid.

While folate levels can be evaluated with a blood test, most don’t have this checked. You can’t always see or feel a folate deficiency, but you can see some of its effects.

Folate deficiency is associated with many health risks and diagnoses, and if you’re pregnant, these conditions aren’t just your own. Because you don’t have adequate folate, you likely won’t have enough for baby. As a result, the health concerns because of deficiency are passed along to baby as well. Here are some of those most commonly seen:

  • Anxiety. Folate is needed to produce serotonin and dopamine, two neurotransmitters that bring about calm and relaxation. Without enough folate, anxiety and worry can increase, you may feel jittery, and you may even be hungrier more often.
  • Infertility and pregnancy complications. When you don't have the ability to produce DNA and new tissue at the rapid rate that a growing baby demands, there's going to be a huge risk. You may be able to support growth up to a certain point, but eventually, your body won’t be able to keep up with the process. Infertility and miscarriages are more common in those deficient folate or in those taking too much folic acid without the ability to convert it to the usable 5-MTHF.

    Lack of adequate folate can also result in brain and spinal cord malformation, congenital heart defects, infants with low birth weight, cervical dysplasia, and even miscarriage.

  • Anemia. Without adequate folate to produce enough red blood cells, you can develop anemia, underdeveloped or a low number of red blood cells. This in turn can lead to iron deficiencies, constant fatigue, irritability, and decreased oxygen to all of your tissues. When you’re pregnant and/or have a thyroid condition, all of these symptoms can be exponentially magnified!
  • Attention disorders. Women with low or depleted folate during pregnancy have higher rates of children with ADHD, social anxieties, and other attention deficits. This loops back to increased anxiety in similar ways. Baby pulled all he could from mom’s folate stores in utero, but whether she didn’t have enough or could only provide unconverted and unusable folic acid, he started out life with a greater tendency toward anxiety and behavior difficulties.
  • Neurological conditions. Similar to how folate deficiency contributes to attention disorders, inadequate stores can also increase incidents of autism, schizophrenia, and depression. Those who suffer from migraine headaches, memory loss, Parkinson's disease, restless leg syndrome, and multiple sclerosis are commonly deficient not only in folate, but in the whole spectrum of B vitamins.
  • Risk for heart disease. Folate is needed to reduce homocysteine levels. This is an amino acid that, when elevated, can tighten up your vessels, increase blood pressure, encourage blood clots, and increase your overall risk for heart disease and stroke.
  • Decreased immunity. Your body’s ability to detoxify is greatly reduced if you have a folate deficiency or the genetic inability to convert to 5-MTHF. This can lead to increased incidents of cancers, chronic constipation, and respiratory conditions like asthma and allergies.

 

What Causes a Folate Deficiency?

Many factors can contribute to folate deficiency or your inability to convert folic acid to the usable form of folate. Some of those include:

Genetics. Many people have a genetic variation that prevents them from converting supplemental folic acid and some dietary folate into the usable 5-MTHF. If you’re one of the 40-60% who has this genetic impairment, it’s essential that you use a methylated form of folate if you’re supplementing beyond your dietary intake. If you don’t know your genetic tendency, it’s still best to take folate in it’s active, methylated form and avoid supplements and foods that use synthetic folic acid.

Diet. If you’re not eating enough of what your body needs, you’ll end up deficient. Foods rich in folate include liver (#1 source by far), dark leafy greens, avocados, asparagus, legumes like peas, lentils, and dried beans. I recommend avoiding processed grain-based foods that are enriched with folic acid.

Disease. Many gastrointestinal diseases can inflame or injure your gut tissue, and this damage reduces absorption of folate and many other nutrients in your gut. Some of these diseases include Crohn’s disease, celiac disease, ulcerative colitis, and GI cancers. Constipation can also reduce folate absorption, and clogged pipes that lead to a host of other health problems as well! Making gut-health a priority can ensure that you’re absorbing folate and other nutrients as best you can.

Medications. Many medications reduce your blood levels of folate. Some of the more common ones include: methotrexate, sulfasalazine, phenytoin and other anti-epileptic medications. If you’re on any of these medications, you need to speak with your physician before you start or change a folate supplement. Not only can these medications  folate supplements can reduce blood levels of these medication! If you’re on any of these, it’s important to talk with your

 

Should I Supplement With Folate…and How?

Including foods rich in folate on a daily basis can help ensure that you’re getting enough for you and your baby. Pregnancy has a way of altering your desires for certain foods, however, and your intake of nutrient-dense foods may not always be what it should. Decreased intake, along with possible genetic variations and the greater demand put on your body while it creates another human, are reasons why many women are recommended an additional folate supplement before, during, and after pregnancy. It’s in every prenatal for a good reason!

Folate intake during pregnancy should be at least 400 micrograms, and sometimes up to 1000 micrograms.

If your doctor has recommended that you supplement with folate or folic acid, check your current prenatal to see what form it provides. If it says “folic acid” I would definitely recommend you switch to a brand (like this one) that uses a methylated form of folate.

 

Essential Takeaways for This Essential Nutrient

Folate is the naturally-occurring form of vitamin B9, and folic acid is the synthetic form. Folic acid must be converted to the active 5-MTHF before your body can use it, and about 50% of people can't complete this conversion. Folate is essential for optimal overall health, it reduces your risk of numerous diseases, and adequate folate is required during pregnancy and for a healthy baby.

If you're planning for pregnancy, currently pregnant, or are looking to enhance your daily intake, try to include folate-rich foods daily. If you take a supplement, look for a prenatal vitamin that contains methylated folate and avoid supplements and foods that use synthetic folic acid.

 

If you'd like to talk more about your multi-vitamin, folate supplementation, or other pregnancy-related health concerns, you can schedule a time for us to talk here.

 

References:

https://www.ncbi.nlm.nih.gov/pubmed/24944062

https://www.ncbi.nlm.nih.gov/pubmed/17209196

https://www.ncbi.nlm.nih.gov/pubmed/25943647

https://www.healthline.com/health/mthfr-gene#variants

https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/#en149

https://forum.parkinson.org/topic/19008-parkinsons-b6-b12-and-folate-whats-the-connection/

https://www.sciencedirect.com/science/article/pii/S0271531711002764

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