Folate Trumps Folic Acid

Folate and folic acid are often used interchangeably but there are significant differences.

Folate, the natural form of vitamin B9, is more bioavailable than folic acid and found in a wide variety of foods. According to the National Institutes of Health, the foods with the highest natural folate levels are beef liver, spinach, black-eyed peas, and asparagus. Folate can also be found in green vegetables such as brussels sprouts, lettuce, mustard greens, and green peas; fruit, including oranges, bananas, cantaloupes, and papayas; as well as nuts, seafood, kidney beans, avocados, eggs, dairy products, and poultry. The recommended daily amount of folate for adults is 400 mcg.

Folate helps make red blood cells, form DNA and RNA, and metabolize protein. It is a critical nutrient for pregnant women and for both men and women who are trying to conceive. A lack of folate can lead to miscarriages, because of insufficient DNA from the father or the mother, as well as birth defects such as spina bifida and anencephaly. Women who are pregnant, planning pregnancy, or could become pregnant are advised to get 400–800 mcg per day.

Maintaining an adequate level of folate is also important to avoid the risks of several chronic diseases. Folate works with vitamins B6 and B12 to control high levels of homocysteine in the blood. Elevated homocysteine levels are linked to an increased risk of cardiovascular disease. Some research suggests that folate might also reduce the risk of various cancers and be helpful in treating depression.

Observational data suggests that there is a higher risk of children developing autism spectrum disorder if the mother had inadequate folate levels during the period before and immediately after conception. However, additional research is needed before firm conclusions can be drawn.

Folic acid is a man-made synthetic form of folate. In 1998 the Food and Drug Administration (FDA) began requiring that cold cereals, flour, breads, pasta, bakery items, cookies, and crackers be fortified with folic acid to help prevent birth defects. However, folic acid is processed in the liver, and due to low amounts of the enzyme dihydrofolate reductase in the liver, most folic acid does not get processed. Excess unmetabolized folic acid has been linked to the development of colorectal and other cancers. In addition, a study suggests that the intake of folic acid may slow the absorption of folate from healthy foods, thereby reducing–rather than increasing–metabolized folate.

Folate deficiency can also occur in people with conditions such as celiac disease, which prevents the small intestine from absorbing nutrients from foods, and in those who consume even moderate amounts of alcohol (one eight-ounce glass of red wine per day), which can significantly decrease serum folate concentrations. 

It is challenging for women who are pregnant or trying to conceive to get the FDA’s recommended daily amount of folate through diet alone. Therefore, most women need supplementation and should consider folate in the form of either folinic acid or methylfolate (5-Methyl-THF) and avoid bread, pasta, cereals, and other products fortified with folic acid.