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Seeking HealthConventional prenatal advice says that pregnant women need folic acid supplementation to prevent birth defects. But this actually misses a key aspect about folic acid: it's not methylated or active. The body must go through several conversion steps to make it usable.
So why do doctors continue to recommend and even prescribe folic acid supplements? Because that's how it's always been done. But newer research, as well as practical examples of how folate and folic acid behave in the body, illustrate the point that just because something has "always" been done, doesn't mean it's the optimal way.
Here's what you need to know about folic acid versus folate, how they behave in the body, and what you should do to support optimal levels during pregnancy (including diet and supplementation).
Folic acid is often used to mean the same thing as folate, sometimes referred to as vitamin B9. But they are not the same nutrient.
While some doctors will argue that folic acid and folate are the same thing, there is a major difference: one has been made by humans and one exists in its nature-made form. Folic acid has similarities to the natural version, but for people who have methylation or other genetic issues, folic acid is an ineffective way to support the body's demand for natural folate.†
Folic acid is often found in fortified grain-based foods. Fortification of breakfast cereals, breads, and other enriched grain products was established in 1998 by the FDA. (1) This was done to help reduce the occurrence of neural tube defects like spina bifida and anencephaly. These can occur when a pregnant mother does not have enough folate available in early pregnancy, often before she knows she has conceived. If someone is not already supplementing with any form of vitamin B9, the risk for these neural tube defects would be significantly higher.
Folic acid is also found in many multivitamins, prenatal vitamins, and other dietary supplements or prescription formulations. Why is it preferred over the natural form of folate? In part, because it has customarily been used as a cheaper alternative or just the standard go-to. But folic acid is not the same as natural folate, and is definitely not the same as a pre-methylated, active form of folate, like L-5-methyltetrahydrofolate (L-5-MTHF). Folic acid can come with many side effects.†
The term "folic acid" is often used interchangeably with "folate." But on the biochemical level, they are quite different. Folic acid can actually block folate receptors leading to a folate deficiency!†
Are you getting too much folic acid in your diet? Click here to find out.
Folate, as mentioned above, refers to natural forms of vitamin B9. But here's where things can get a little complicated. There are many different types of folate—all of which are different from folic acid.
Folate is a water-soluble B vitamin found in leafy green vegetables, lentils, and other food sources. It is essential not just for a healthy pregnancy, but also for mood, heart health, cognition, and much more.†
Maintaining adequate folate levels is a vital part of having a healthy methylation cycle. Methylation plays a major role in how your DNA functions and how cells replicate and divide. You also need folate to facilitate the breakdown of the amino acid homocysteine. Elevated homocysteine levels have been correlated with increased heart disease risk. Your body needs folate for healthy red blood cells, which are essential for transporting nutrients throughout the body. You need folate for a healthy nervous system, energy, and mental clarity. Without enough folate, the body will struggle in many key areas!†
Your body needs true folate for healthy methylation, DNA replication, homocysteine regulation, nervous system and fetal health, and much more.†
Methylation sounds complicated, but it's actually just the process of adding a methyl group to a compound to change its function. Natural folate acts as a methyl donor by providing the methyl groups needed for methylation. The result is cell, enzyme, and DNA growth, change, and transformation. Methyl groups basically support most of the DNA and cell-level processes that are happening all the time.†
When you don't have enough methyl groups, these processes start to work sub-optimally. In those early weeks of pregnancy, the result of neural tube defects and other pregnancy-related complications are one very serious way that folate deficiency can play out.
Do you eat fortified foods or take a folic acid supplement? These do not guarantee you will be getting enough folate into your cells where it’s needed. While some people's bodies can put folic acid through a few cycles of conversion to get folate, as much as 60 percent of the population has some form of MTHFR genetic variants that may make this process slow or inefficient. The result can be low levels of folate in cells, even with more than enough folic acid intake.
Folate deficiency differs based on genetics, but is more common in low-income populations, especially women of reproductive age. (2) Why is this? Women of this age tend to need more folate, but if they do get pregnant, the body suddenly has a lot more work for this folate to do, so deficiencies are more notable.†
The RDA for women of reproductive age (for dietary folate intake) is 400 mcg DFE per day. But since folate is such a vital nutrient for pregnancy, the RDA increases to 600 mcg DFE per day. (3) For some women, this is hard or even impossible to get from diet alone. Not to mention, all of the vitamins that we eat from food are not necessarily absorbed, depending on various digestion-related factors. The American College of Obstetricians and Gynecologists recommends a prenatal vitamin or additional folate to ensure that all nutrient needs are met.
There are many foods that are excellent sources of folate. These include things like dark leafy greens, asparagus, Brussels sprouts, avocado, and broccoli. However, sometimes pregnant women struggle to eat these. Getting enough folate is so important that even if you think you're eating enough, you should also take a prenatal vitamin. Your doctor may also want you to take extra folate. This is where it's important not to assume that extra folic acid is the same thing as extra folate. Remember, folic acid is an artificial form of folate.†
L-methylfolate and folinic acid (bioactive forms of folate) are thought to be more bioavailable than food folates.†
The nutrients that you get from food are in their optimal bioavailable forms, especially when they come from whole foods. The nutrients in food are designed to be extracted along with the other nutritional components, like fiber, protein, fats, and so on. However, research finds that folate from supplements (again, folate, not folic acid) might be more bioavailable than even the folates that you get from food.† (4)
Your MTHFR enzyme converts food folates into the active form of folate, methylfolate. This bioavailable form is also known as L-methylfolate, or more correctly, L-5-methyltetrahydrofolate (5-MTHF).Over 50 percent of the population is thought to have a genetic mutation in their MTHFR gene. Thus, they may not be achieving adequate folate levels from food alone.†
Do you have MTHFR variants? Are you pregnant or trying to conceive? How can you make sure you're getting enough of the right form to support optimal health for you and your baby?
According to Dr. Ben Lynch, who has researched folates for more than a decade:
Pregnancy is best supported when you use two forms of folate: folinic acid (also known as calcium folinate) and L-methylfolate (L-5-MTHF).†
Both of these forms of folate are needed to support an optimal pregnancy. L-methylfolate supports methylation and folinic acid supports DNA base production. While you can get both forms from food, your body has to extract it and then activate it. By supplementing with a prenatal vitamin that utilizes both of these bioavailable forms, such as Optimal Prenatal or Prenatal Essentials, you support all possible folate needs for your body without requiring extra effort.†
Even if you don't have MTHFR genetic variants, you might still require activated forms. This is because the enzymes that help your body make and use folate can experience epigenetic changes that decrease their effectiveness.†
Shop Bioavailable Prenatals Here†
Pregnancy (or the time while you're trying to conceive) can be exciting, but also overwhelming! With so many details to focus on, you don't want to worry about getting the right kind of folate. The easiest way to ensure that you're getting enough folate is to take a prenatal vitamin that contains methylfolate and folinic acid (calcium folinate).†
Choosing a prenatal vitamin can feel overwhelming, with many factors to consider. You can learn how to choose the best prenatal for you in this blog post. The basic goal is to ensure that you have a prenatal vitamin with active forms of folate.†
If your OBGYN recommends additional folate, you can add individual supplements of either methylfolate or folinic acid. If you are sensitive to methylated nutrients and feel overstimulated from them, then folinic acid (or calcium folinate) is less likely to produce unwanted effects.†
Folate is a vital nutrient for a healthy pregnancy. It is often discussed as being the same thing as folic acid, but these are very different nutrients. When you want to support a healthy prenatal outcome, supporting your body's folate needs is an essential first step.†
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