Should I take Folic Acid or Folate?
Updated: Nov 14
As soon as you start trying for a baby or get pregnant, you're told to start supplementing with folic acid. However, did you know that folic acid is a synthetic version of folate (vitamin B9)? The UK’s number one pregnancy multivitamin uses folic acid, as do a myriad of ‘consultant approved’ fertility supplements, so why would you know this? In fact, all GP’s, gynaecologists, and IVF consultants will still tell you to take folic acid despite the knowledge that up to 40% of the population cannot convert folic acid into its active form (folate). Folic acid Vs folate is a topic that can feel confusing to navigate when you are being told one thing by a professional yet reading conflicting information online. It can feel scary to challenge them on this but hopefully this blog will answer some of your questions around this debate and lead you to make the right decision for you.
What’s the difference between Folate, Methyl-Folate, Infolic Acid, and Folic Acid?
Folate is a water-soluble B vitamin (B9 to be precise) that is essential for many important bodily functions, including cell growth and repair, DNA synthesis, and red blood cell production, all of which are key for both female and male fertility. As I’m sure you are aware, folate is also important for pregnant women, as it helps to prevent birth defects such as neural tube defects, which is why folic acid is recommended to all pregnant women. Here, I will deep dive into each form of folate for clarity:
Folate, also known as Vitamin B9, is an essential nutrient important for DNA synthesis, cell division, and overall growth. In its natural food form, folate is found in a variety of foods. Leafy green vegetables like spinach, kale, and broccoli are excellent sources. Other rich sources include legumes (such as lentils and chickpeas), asparagus, avocados, and certain fruits like bananas and citrus fruits. A diet rich in these foods can help maintain adequate folate levels, crucial for fertility and methylation.
Methylfolate (5-methyltetrahydrofolate, 5-MTHF)
This is the active form of folate that is found in the body and is used in most biochemical reactions. Methylfolate is readily absorbed and utilised by the body and does not require any metabolic conversion. A recent study found that methylfolate supplementation was associated with a reduced risk of neural tube defects in pregnant women. Since up to 60% of the population do have the MTHFR SNP (genetic variation) which means they cannot convert folic acid to folate as efficiently or at all, it may be an idea to consider the Methylfolate form of folate to ensure that you and your baby are protected.
This is the most talked about and well known, yet it is a synthetic form of folate that is less well-absorbed and utilised by the body than methylfolate or infolic acid. Folic acid must be converted to methylfolate in the body before it can be used. As mentioned, many people may not be able to make this conversion and so they may be at risk of neural tube defects even if they are supplementing with folic acid. In high-risk pregnancies such as a those with a higher BMI, older maternal age or those with a history of miscarriage may be prescribed up to 5g of folic acid as it may be assumed that they need more folic acid as they may not be able to convert this into folate as well.
Infolic acid (L-methylfolate)
This is another synthetic form of methylfolate, however, unlike folic acid, it is readily absorbed and utilised by the body making it a better option than standard folic acid. It is used in dietary supplements and fortified foods because of its increased stability and bioavailability compared to natural folate.
Folic acid plays a crucial role in DNA synthesis, repair, and methylation, and is vital for cell division and growth. It is particularly important during pregnancy for fetal development and reducing the risk of neural tube defects. Regular intake of folic acid is also beneficial for heart health, as it helps lower homocysteine levels, a risk factor for heart disease.
I’ve been tested for MTHFR Gene & it’s positive, what does this mean?
As mentioned, up to 40% of the general population may have this genetic mutation called MTHFR C677T, which can impair the body's ability to convert folic acid to methylfolate. If you have this mutation, it may cause you to have higher levels of unmetabolised folic acid in your blood, which has been linked to an increased risk of miscarriage, infertility, and other health problems. So, it should be recommended that anyone with the MTHFR C677T mutation take methylfolate supplements instead of folic acid supplements. However, considering the stats on the number of people affect by this SNP, it would be prudent for most of us to take methyfolate over folic acid. Yet, we do still find that it is largely folic acid that is still being recommended as the preferred option, often in more of a medical setting rather than methylfolate.
How well do we absorb Methyfolate Vs Folic Acid?
Bioavailability is the amount of a nutrient that is absorbed and used by the body. Methylfolate and infolic acid have better bioavailability than folic acid, meaning that they are more easily absorbed and utilised by the body. In, fact, one study found that methylfolate was absorbed 70% better than folic acid. Another study found that infolic acid was absorbed 50% better than folic acid. So, we can see that in terms of bioavailability, methyfolate is far superior to folic acid and that infolic acid is a better choice than folic acid! Hopefully you are starting to understand this more now!
What are the implications of taking folic acid?
Methylfolate, infolic acid, and folic acid are all generally safe when taken at recommended doses. However, there are some potential concerns about taking high doses of synthetic forms of folate, such as folic acid. One concern is that high levels of unmetabolised folic acid in the blood may increase homocysteine levels in the blood, which can actually increase the risk of miscarriage. Another concern is that folic acid supplements may mask the symptoms of vitamin B12 deficiency. Vitamin B12 is another essential nutrient that is needed for folate metabolism. A deficiency in vitamin B12 can lead to serious health problems, such as nerve damage and anaemia. For this reason, it is important to get enough vitamin B12 from your diet, especially if you are taking folic acid supplements.
How much should I be supplementing?
The recommended daily intake (RDI) of folate for adults is 400 micrograms (mcg), which is what is generally found in most prenatal and pregnancy supplements. For pregnant and breastfeeding women, needs are slightly higher though so it’s important to not rely on your supplement alone. Remember that the best way to get folate is from your diet. Folate is found in a variety of foods, including leafy green vegetables, beans, lentils, nuts, and seeds (see more below). If you are unable to get enough folate from your diet, or if you have the MTHFR C677T mutation, you may want to consider taking more folate in supplement form.
If you are considering taking a folate supplement, it is important to talk to a Registered Nutritional Therapist first. We can help you choose the right prenatal supplement and folate dosage for you.
Rich Food Sources of Folate
There are two main types of folate found in foods - natural folate and fortified folate. Natural folate is found in foods such as leafy green vegetables, beans, lentils, nuts, and seeds. It is the most easily absorbed and utilised form of folate. Fortified folate is a synthetic form of folate that is added to processed foods such as cereals, bread, and pasta. It is less bioavailable than natural folate, meaning that it is not as easily absorbed and utilised by the body. Several studies have shown that natural folate is more beneficial than fortified folate. For example, one study found that natural folate was more effective at lowering homocysteine levels than fortified folate. Another study found that natural folate was associated with a reduced risk of neural tube defects in pregnant women.
Good sources of natural folate include:
Leafy green vegetables – such as spinach, kale, collard greens, turnip greens, cabbage and mustard greens.
Beans and lentils – such as black beans, kidney beans, pinto beans, lentils, and chickpeas.
Nuts and seeds – such as almonds, walnuts, sunflower seeds, and pumpkin seeds.
Citrus fruits – such as oranges, grapefruit, lemons, limes, and kiwi fruit.
Fortified foods (although remember this is synthetic) - cereals, bread, and pasta.
How to increase your intake of natural folate
There are a few things you can do to increase your intake of natural folate:
1. Eat more leafy green vegetables. Leafy green vegetables are packed with folate, as well as other important nutrients such as vitamins A, C, and K, and minerals such as calcium and iron. Aim for two portions of dark green leafy veg per day. A nice way to increase intake is to buy organic spinach or broccoli and add to a berry smoothie. Otherwise, steam these veggies and add to your main meals.
2. Add beans and lentils to your diet. Beans and lentils are another great source of folate, as well as protein and fibre. Beans can be added to almost anything. I am a huge fan of adding these to veggie soups to up the protein value and to get in some extra folate!
3. Snack on nuts and seeds. Nuts and seeds are a convenient and healthy way to get folate, as well as other important nutrients such as protein, healthy fats, and fibre. Aim for a handful of nuts per day and around 2-3 tbsps seeds per day. Seeds can be added to almost any dishes to add some crunch and texture such as soups, salads, stews and more!
4. Include citrus fruits in your diet. Citrus fruits are a good source of folate, as well as vitamin C. Squeeze lemon juice on top of dishes or use it within a dressing. Go for what’s in season too – as we approach winter, clementines and oranges are a lovely snack or addition to a winter salad.
Some of the studies used for this post:
Carboni L. Active Folate Versus Folic Acid: The Role of 5-MTHF (Methylfolate) in Human Health. Integr Med (Encinitas). 2022 Jul;21(3):36-41. PMID: 35999905; PMCID: PMC9380836.
Cirillo M, Coccia ME, Attanasio M, Fatini C. Homocysteine, vitamin B status and MTHFR polymorphisms in Italian infertile women. Eur J Obstet Gynecol Reprod Biol. 2021 Aug;263:72-78. doi: 10.1016/j.ejogrb.2021.06.003. Epub 2021 Jun 15. PMID: 34167037.
Miraglia N, Dehay E. Folate Supplementation in Fertility and Pregnancy: The Advantages of (6S)5-Methyltetrahydrofolate. Altern Ther Health Med. 2022 May;28(4):12-17. PMID: 35653630.
Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-8. doi: 10.3109/00498254.2013.845705. Epub 2014 Feb 4. PMID: 24494987.