Folic acid vs. folate

broccoliYou’ve heard a lot about the importance of folic acid. Recently, a pregnant woman wrote to us and asked exactly what she would need to eat in order to get all her folic acid needs from food instead of a vitamin. Good question…complicated answer.

The first thing you need to know is that the natural form of folic acid is called folate. Folate is found in lentils, spinach, black beans, peanuts, oranges and orange juice, legumes, romaine lettuce, leafy green veggies and broccoli. But, you have to eat a lot of these foods to get the right amount of folic acid (400 mcg per day). Cooking and storage can destroy folate, so even if you have the best intentions, your plans may be foiled. To make matters worse, according to the Institute of Medicine (IOM), your body only absorbs about 50 % of folate from food. Not much!

Fortunately, there is a way around having to eat tons of lentils and broccoli every day. The manufactured or synthetic form of folate is called folic acid. Many grain products in the United States are fortified with folic acid (meaning folic acid is added to them). The best part of this is that your body actually absorbs folic acid better than it absorbs folate. In fact, your body absorbs approximately 85% percent of the folic acid in fortified foods and 100% of the folic acid in a vitamin supplement. (I like these numbers a lot more!) That is a whole lot more than only 50% your body absorbs from foods with folate.

So where can you find these fortified foods? Enriched is the magic word. Enriched flour, rice, pasta, bread and cereals are examples of fortified grain products. You can check the label to see if a product is enriched and to see how much folic acid each serving contains.

Here’s even better news…Many studies have shown that the synthetic form of folic acid helps prevent NTDs (neural tube defects) – a kind of birth defect. This is why the IOM, the Centers for Disease Control and Prevention (CDC) and the March of Dimes recommend that all women of childbearing age consume at least 400 micrograms a day of the synthetic form of folic acid.

A simple solution…

You can eat a serving of fortified cereal that contains 100% of the daily value of folic acid every day. Or…(drumroll please…) you can pop a vitamin. Of course, a healthy diet is very important, but taking a daily multivitamin that contains at least 400 mcg of folic acid (or at least 600 mcg if you are pregnant) is key in ensuring that you are getting and absorbing the folic acid that your body needs – whether you are planning on getting pregnant or not. It really couldn’t be easier.

Updated January 2016

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17 Responses to “Folic acid vs. folate”

  1. Stacy Says:

    I take a prenatal vitamin that has 600 mcg of folate. I’m a little concerned about the amount of folate I’m getting now that I’m 7 weeks pregnant. Do I need to switch pre-natal vitamins or is it too late?

  2. Barbara Says:

    Hello Stacy,
    Thanks for your comment. Most pregnant women need a prenatal vitamin that contains at least 600 mcg of folic acid. This is a typical amount to take and is found in many prenatal vitamins. But, we suggest you check with your doc to see if you may need more, based on your health history and pregnancy. Don’t take more than 1000 mcg (1 mg) of folic acid without your doctor’s approval.

  3. lexi Says:

    Your “simple solution” is not a good solution for everyone. Folate is better for you than commercial folic acid, which is synthetic. Folic acid is a GABA receptor antagonist and has been linked to higher autism rates, folate has a milder effect.

    The mom who wrote to you about getting folate from natural sources has the right idea.

  4. Barbara Says:

    Hi Lexi – Thank you for your comment. We agree that natural sources of folate are best, but most people do not get enough from their diet. Since folic acid is so important in preventing neural tube defects, it is recommended that women take a multivitamin that contains folic acid. At the moment, there has not been enough research done to definitively link either too much or too little folic acid to higher autism rates. More studies are needed.

  5. Emily Says:

    I was a bit concerned, too, because I cannot hold down folic acid products (even still in second tri). I can, however keep down folate products. I assume if folate isn’t as easily asorbed to take a little more. So the product I take says a dose is 1 – 2 gummies. 1 gummy has 400 mcg of folate. It is suggested to take 600 mcg folic acid, so I just take two of the folate products to make up for the difference (800 mcg). Plus, I can’t stop eating clementines and try to have cereal or whole wheat bread nd leafys. I feel like this is better than just yarfing it all up every day.

  6. Lindsay Says:

    Emily – Sorry to hear that you’re “yarfing it up” every day. :o( It sounds like you have worked out a plan that sits well, however, and that’s good. I hope your stomach settles down soon. Thanks for stopping by.

  7. Meg Says:

    Question…folic acid was invented when? Prior to this was the amount of folate women consuming not enough? Our species survived without folic acid so why SO necessary NOW??!

  8. Barbara Says:

    Hi Meg,
    We now know that folic acid helps to reduce certain birth defects. Years ago, we did not know this info. Since the early 1990s when the association between folic acid and NTDs (including spina bifida) was established, there has been a reduction in the number of cases of babies born with NTDs. In fact, the American Academy of Pediatrics notes that “Evidence to date suggests that supplementation with a multivitamin containing 400 (0.4 mg) μg of folic acid prevents the occurrence of >50% of NTDs when it is taken before conception and continued throughout the first trimester pregnancy.”
    I hope this helps!
    Barbara
    March of Dimes

  9. Jess Says:

    I just recently had a baby girl in May ( @ 40w she lived 2 hrs and 7 min) with a NTD (Anencephaly) and was taking 800mcg +a complex B vitamin. I understand that there are other factors that could come into to play besides just taking folic acid with a NTD, but I’m really torn on this “up the dosage to 4mg + a prenatal to hopefully prevent it in the future.” I’ve read tons of research claiming how horrible this is for our body and that taking folate is much safer. I also read that folate doesn’t have to do any converting to it’s bio-active form, which folic acid does. This is supposed to help people who have difficulty converting it to an active form. If that’s the case and people don’t know whether their bodies have difficulty in the conversion, how is taking folic acid helpful? I suppose my doctor should just check my homocysteine levels. I’m majorly confused. =/

  10. Barbara Says:

    Hello Jess,
    First of all, we are so sorry to learn of the loss of your baby girl. This is heartbreaking news. If you would like for us to send you our bereavement materials, send your mailing address to us at AskUs@marchofdimes.com and I will put one in the mail to you. You may also want to join our online community, Share Your Story where you will find other women who have suffered a similar loss. It is a very supportive community that may be very helpful in dealing with your grief. Please go to http://www.shareyourstory.org.

    You are right that there are other factors that influence NTDs – it is not only folic acid. But, it is very hard for a woman to eat enough foods that contain folate to meet the required amounts. This is why supplementation is recommended.

    We don’t know which articles you are reading that contain this information. We suggest you take these articles to your health care provider so that you can discuss them with him/her. He will be able to determine what is right for you based on your health and past pregnancy.

    Again, our deepest condolences.

  11. Alex Says:

    It seams to me that you have avoided to answer Lexi’s, Stacey’s and Jesse’s question. I think it’s clear to all of us that the right amount of folate its hard obtain from our regular diets. However I think what they are asking is whether supplementing with folate from a multivitamins that contains folate (not folic acid) in addition to our diet, could be better or equal to taking folic acid.
    Sorry if I come across harsh but I sense you are bias towards folic acid. Unless you have a reason you haven’t explained that folate from supplements is not good or good enough.

  12. Lindsay Says:

    The term folate is generally used as a generic name for vitamin B9.
    •Folic acid is a synthetic form of the vitamin found in supplements, fortified foods and drugs. It must be converted in the body for it to be metabolically active.
    •L-5-methyl-tetrahydrofolate (L-5-methyl THF) is the micronutrient form of folate that circulates in plasma and is involved in cellular metabolism. It is available commercially in a crystalline form of the calcium salt which has the stability to be used as a supplement, but is heat labile and cannot be used to fortify foods.

    Studies have shown that supplementing with L-5-methyl THF can raise the levels of blood folate to approximately the same level as supplementing with folic acid. However, it is important to note that only folic acid has been shown in randomized controlled trials to prevent neural tube defects (NTDs) and to be associated with lower risk for NTDs in multiple observational studies.

    So, the take home messages here are:
    •Yes, L-5-methyl THF (or folate supplement) is an alternative to folic acid.
    •Consumers should check the ingredients label to find out whether the supplement contains folic acid or L-5-methyl THF.
    •Always speak with your doctor if you have any questions about preventing NTDs.

  13. didums Says:

    Hi,

    I just started taking folic acid and want to make sure I am making the most of it. I read in several places that folic acid is best absorbed in the body when coupled with vitamin B12. Is this true? How significant is the difference between taking it with the B12 and just taking it by itself?

    Thank you!

  14. didums Says:

    (I forgot to mention, I am on a vegan diet so I used to get my B12 from my multi-vitamin. But my multi-vitamin’s label says it is not recommended for women who are pregnant planning pregnancy in the next 3 months, so I am not taking it anymore. I need to find a new source of vitamin B12 and am just trying to figure everything out…)

  15. Barbara Says:

    Hi – and thanks for your comments.

    Folic acid does not need to be paired with B 12 to be absorbed. But, both are recommended for pregnant women, especially if you are on a vegan diet. (B 12 is almost exclusively found in animal sources.) So, please work with your prenatal provider to find a multi prenatal vitamin that is right for you. (The March of Dimes does not recommend specific brands of vitamins.)

    Barbara
    March of Dimes

  16. Raina Says:

    On a side note, the question at hand still has not been answered!!!!!

    Folate or Folic acid… which is better to take? Folate is the natural form, harder to absorb and slightly more expensive… Folic acid is easier to absorb and cheaper, but synthetic… What does it mean for our body that Folate is harder to absorb ? Does it cause more stomach pain?

    Why is folic acid recommended more often over folate? Is it because of the cheaper costs and better absorption? Or do doctors use the term interchangeably and or don’t really know the difference in terms of effects on the baby…??

  17. Kat Says:

    I have recently attempted to understand the difference in the two supplements and which is better, folic acid or folate, or neither. (Obviously plant sources of folate such as “beans and greens” are healthy for sure.) It is a difficult question. It seems that folate (the “natural” form) is not as easily absorbed. However, folic acid requires conversion INTO folate in our liver once it is absorbed to be useful, but our body is not very efficient at that, leaving circulating levels of folic acid behind. Some claim that this is linked with certain disease processes. I am a doctor and I can’t make sense of it! I still haven’t made the final decision on what I will use (not pregnant or actively trying yet), however we do know that the rate of reduction of neural tube defects (such as spina bifida) pre and post mandatory fortification of cereal grain products with folic acid went from ~4100 per year to ~3000 per year. Deaths each year due to those defects dropped from ~1200 to ~800. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a3.htm)

    So, yes, many questions abound. Yes, I would agree that plant sources are the best. But, if I have the chance to prevent my future child from a debilitating and life-altering disease by taking a folic acid supplement… then I probably will. There just isn’t enough information on supplementing with folate. And I’m pretty sure I cannot choke down the high amounts of vegetables it would require to meet the daily goal, and I am a vegetable-loving vegan! (But believe me I’m going to try!)

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