Folate vs Folic Acid - The Little Known Difference | Chris Kresser

The Little Known (But Crucial) Difference Between Folate and Folic Acid

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If I asked you which of these vitamins was found naturally in food, folate or folic acid, would you know the answer? If not, you’re in good company. Medical professionals, nutrition experts, and health practitioners frequently mix up the two, simply because the terms are often used interchangeably.

Many health professionals would even argue that folate and folic acid are essentially the same nutrient. While folic acid is often considered to be a supplemental form of folate, there is an important distinction between these two different compounds. For women past childbearing age, and for men in general, excessive doses of the synthetic form of this nutrient are not necessary, and may even be harmful.

What’s the difference between folate and folic acid?

Folate is a general term for a group of water soluble b-vitamins, and is also known as B9. Folic acid refers to the oxidized synthetic compound used in dietary supplements and food fortification, whereas folate refers to the various tetrahydrofolate derivatives naturally found in food.

The form of folate that can enter the main folate metabolic cycle is tetrahydrofolate (THF). (2) Unlike natural folates, which are metabolized to THF in the mucosa of the small intestine, folic acid undergoes initial reduction and methylation in the liver, where conversion to the THF form requires dihydrofolate reductase.

The low activity of this enzyme in the human liver, combined with a high intake of folic acid, may result in unnatural levels of unmetabolized folic acid entering the systemic circulation.

Several studies have reported the presence of unmetabolized folic acid in the blood following the consumption of folic acid supplements or fortified foods. (3) Human exposure to folic acid was non-existent until its chemical synthesis in 1943, and was introduced as a mandatory food fortification in 1998. (4) Food fortification was deemed mandatory due to overwhelming evidence for the protective effect of folic acid supplementation before conception and during early pregnancy on the development of neural tube defects (NTD) in newborns.

Risks associated with excessive folic acid intake

While the incidence of NTDs in the United States been significantly reduced since folic acid fortification began, there has been concern about the safety of chronic intake of high levels of folic acid from fortified foods, beverages and dietary supplements. (5) One of the major risks associated with excessive intake of folic acid is the development of cancer. (6) In patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods, treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality. In the United States, Canada, and Chile, the institution of a folic acid supplementation program was associated with an increased prevalence of colon cancer. (78) A randomized control trial found that that daily supplementation with 1 mg of folic acid was associated with an increased risk of prostate cancer. (9)

Researchers have hypothesized that the excessive consumption of folic acid in fortified foods may be directly related to the increase in cancer rates. Excess folic acid may stimulate the growth of established neoplasms, which can eventually lead to cancer. The presence of unmetabolized folic acid in the blood is associated with decreased natural killer cytotoxicity. (10) Since natural killer cells play a role in tumor cell destruction, this would suggest another way in which excess folic acid might promote existing premalignant and malignant lesions.

A high intake of folic acid might mask detection of vitamin B12 deficiency and lead to a deterioration of central nervous system function in the elderly.

In one study, consumption of folic acid in excess of 400 micrograms per day among older adults resulted in significantly faster rate of cognitive decline than supplement nonusers. (11) Another study found a higher prevalence of both anemia and cognitive impairment in association with high folic acid intake in older adults with a low vitamin B12 status. (12) As vitamin B12 deficiency is a common problem for many older adults, these studies suggest that high folic acid intake could cause serious cognitive consequences in the elderly.

Folate from natural food sources is best

Despite the risks associated with high levels of folic acid intake, it is well established that adequate folate intake from the consumption of folate-rich foods is essential for health.

Folate aids the complete development of red blood cells, reduces levels of homocysteine in the blood, and supports nervous system function. It is well known for its role in preventing neural tube defects in newborns, so women of childbearing age must be sure to have an adequate intake prior to and during pregnancy.

Excellent sources of dietary folate include vegetables such as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley, collard greens, broccoli, cauliflower, beets, and lentils. (13) Not surprisingly, some of the best food sources of folate are calf’s liver and chicken liver.

You can supplement with folate if your dietary intake is inadequate. Look for products that contain the Metfolin brand, or list “5-methyltetrahydrofolate” or “5-MTHF” on the label. Avoid products that say “folic acid” on the label. Make sure to check your multivitamin, because most multis contain folic acid and not folate.

Women planning on becoming pregnant should consume between 800 and 1200 mcg of folate per day for several months before the start of pregnancy. Unless you’re consuming chicken or calf’s liver and substantial amounts of leafy greens on a regular basis, it’s difficult to obtain this amount from diet alone. If you’re pregnant or trying to get pregnant, I recommend supplementing with 600-800 mcg of folate per day, depending on your dietary intake. Solgar is a good brand, but there are several others that typically use 5-MTHF including Designs for Health, Thorne, Metabolic Maintenance and Pure Encapsulations.

All other people, such as men and older women, should be able to get plenty of folate in a diet with adequate vegetable consumption, and do not need to supplement.

628 Comments

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  1. My question is how long does it take for the unmetabolized synthetic folic acid to leave the body? I was taking folic acid for a long time before I knew the dangers. I have recently eliminated fortified foods and switched to methyl folate in my prenatal vitamin. How long is a reasonable time to wait to conceive?

    • Julie, I too have been taking 800mcg/day for a long time.
      I refuse to worry about it though.I’ll get the folate supp.I find it hard to eat some of these foods.I am a DC with a BS in Nutrition and I’m still learning at 64! Don’t fret anything.
      Hope this helps.

  2. This statement was made: “While folic acid is often considered to be a supplemental form of folate, there is an important distinction between these two different compounds. For women past childbearing age, and for men in general, excessive doses of the synthetic form of this nutrient are not necessary, and may even be harmful.”

    The research referenced in the article does not speak to this specifically. Please provide the research that supports this claim so we can have confidence in what you are sharing.

    • Its called God’s creation and man can never mimic successfully the perfection of God’s design. Science will never fully capture what is natural.

    • Its called God’s creation and man can never mimic successfully the perfection of God’s design. Science will never be able to capture the essence of a natural substance.
      2nd time posting this my freedom of speech was censored the first go round.

      • First of all, your comment appears twice, so no censorship. Plus, freedom of speech is the right to articulate one’s opinions and ideas without fear of government retaliation or censorship. THE GOVERNMENT, not the administrator of a web site. Plus, to say that your freedom of speech was censored makes no sense. At all. What gets censored is the speech itself, not the freedom. Your freedom of speech may be suppressed but it doesn’t get censored.
        Oh, and BTW, god is a fairy tale and has no place in this discussion.

        • That God is a fairy tale if YOUR OPINION only. Can you prove your statement? Nor can he prove his. He can say what he likes. If you don’t like it, take yourself someplace else. Your criticism is crass and this is not the place for such things. So there.

        • Well guess what? You don’t determine what is and is not appropriate in a discussion. If you don’t believe in God well that’s your problem. If you don’t like it, that’s your problem. God can be brought into any discussion and is relevant to any discussion.

      • Agree with God’s design, but because of the American Dust Bowl phenomenon, we have lost much of our nutrient rich topsoil and with pesticides (like glyphosate) having further depleted plants and soil of their minerals. Thus, we do not obtain enough of these ‘nutrients’ from our food. So we must supplement. The trick is to find the right one…”folate” (a complex of B9 vitamins) cannot be written as an ingredient per FDA regulation but instead “folic acid” is allowd; thus most manufacturers are confused and use the cheaper folic acid as part of their Multivitamin or other formulation. Hope that helps.

        • And, folic acid is made by guess who? Big Pharma. They are making money from it, and the FDA directed the USDA to mandate the inclusion of folic acid in all wheat products, plus rice and a few other things. You cannot even buy a loaf of bread or any flour that doesn’t have folic acid in it!! So, we can, overall, thank the government for this. But, then, isn’t cancer a big money maker for Big Pharma and the medical industry? Think about that.

        • Yes. I ate all the fortified junk growing up because there were 8 and mom had to feed us. Had thee hardest time in school. Beet juice, spinach, orange juice no fortified food. Brought me out of that fog, PRENATAL vitamins made me hurl. With my son orange juice cravings to the hilt. Quite possible Spina Bifida and they thought he would have it but he closed up . I feed my children well try to avoid processed food but there are still signs and as nobody is perfect it sure helps to know we do not have that conversion for folic acid and maybe it won’t wreck us, not going to hyper kill it but boy you sure know the difference between walking dead and being awake. No matter, my children are geniuses, where they couldn’t cope, they found a way and excel against the odds. I only tested minimum for it and had low homocysteine levels because my thyroid was raised correctly. THen we lowered it and shit storm, I am sure homocysteine is high now. So we start the diet process all over again. I use gentle iron with the vit with mthf and I felt like wonder woman. The thyroid helped but it was ultimately that I could absorb the nutrients needed and the much needed iron . I should not say diet I should say eating right but eating wrong is so good to the taste bud but remember they add that to the food so we want it more. Naughty scientist. Naughty fast food. But it sure don’t taste good in the gut afterwards. OK I will shut up. My daughter lost two babies and I am sure it was a factor , while one of the Greatest Medical Universities said it was not. She now knows the difference. My body craved natural food that saved my son’s life. Listen close to those cravings, they are not wrong. The body tries to adapt, you just have to pay attention.

  3. While folic acid is often considered to be a supplemental form of folate, there is an important distinction between these two different compounds. For women past childbearing age, and for men in general, excessive doses of the synthetic form of this nutrient are not necessary, and may even be harmful.

  4. I have had extremely high blood levels of B12 and raised B6 since last December although I don’t supplement these.

    I’m in extreme, hardly bearable, pain with severe cognitive restrictions. Could it be I’m not absorbing B12 and so have the signs of deficiency?

    Should I supplement folate?

    • Kathryn,

      If you think, despite high blood levels, you are b12, then supplement with sublingual b12 — methylcobalamin.

      • No. Not right off the bat. Kathryn should see a doctor for further testing.

        Too much B6 causes nerve damage.

        In some cases, too much B12 in the absence of supplementation can be a sign of certain cancers, liver, or kidney diseases.

        It is possible to have b12 deficiency symptoms with high serum levels, but I personally have not heard of this happening without supplementation.

        She should speak to a doctor to discuss these possibilities.

        • It all depends on the doctor. They all “interpret” the numbers differently. I believe current FDA guidelines state that if a patient shows symptoms of low B12, then the patient should be supplemented..

          The whole thing was this person was showing signs of B12 deficiency, but wanting to supplement with folate. Why? When I cut my finger, I don’t put a bandaid on my nose. That person did not tell us what the numbers were either. You’re assuming that they are super high, while I am assuming, not that high. I’m no professional, but I’ve been researching this for about 4 years now, and all I’ve heard and seen is that there is no harm at all in taking B12.

          • I’m not assuming anything.

            She said, “I have had extremely high blood levels of B12 and raised B6 since last December although I don’t supplement these.”

            It doesn’t matter what either of us imagines “extremely high” means. We don’t know. The bottom line is she should see a doctor.

            Is b12 deficiency a possibility, despite the imperfect blood tests? Maybe. Maybe it’s folate deficiency. Maybe it’s a disease process that causes b12 to become elevated (they do exist).

            My point is, see a doctor first before throwing yourself on the mercy of the internet.

            • I really don’t want to belabor the point, but unless she knows what the number was, we are assuming. Some doctors call numbers that are below the range high.

              As I said, I am no professional, but my doctor did not think much of b12 supplementation, even though I had absolutely classic signs and I was in so much pain I could barely walk. I supplemented and never went back to that doctor.

              I never said this person should not see any number of doctors. I was questioning why she would ask us, here on the internet, if she should suplement folate when she believes she might have symptoms of low b12, despite the bloodwork.

              • I think most informed people realize that doctors are NOT gods and the majority are completely ignorant concerning B12 deficiency. Search for the right doctor. Don’t just randomly go to any old doctor with this. And, personally, I believe we are pretty much left on our own and should educate ourselves and do what we think best individually.

    • check for an MTHFR gene mutation, impairing movement of b12 into the central nervous system, giving rises to falsely “reassuring” high levels of B12 (because brain levels are LOW). The MTHFR test is offered by spectracell labs at an excellent self pay price of forty dollars, or by numerous commercial labs that can attempt collection from your insurance company (but not all companies pay for genetic testing and the cost of the MTHFR test can run in the hundreds of dollars if denied). IF YOU test positive for the MTHFR mutation, you not only need to take folate in the methyl form, but also METHYL B12 (Jarrow, Solgar, etc)
      in order for B12 to be neurologically effective.

      • My last serum B12 test showed my level was >2000!!! My doctor (endo) said that neither high or low B12 are harmful. But, he had me tested because I was on Metformin (known to block B12 absorption) and was having tingling/burning in my feet. He said the Metformin couldn’t cause that but low B12 could. Go figure that!!!

  5. Hi Chris, I’m wondering what dose of folate I should be taking as we recently had a baby @ 21 weeks with a serious case of Spina bifida & brain damage. She was our fourth unsuccessful pregnancy (3 previous miscarriages)… it’s been a heartbreaking road and I’m only in the stages of trying to get my body and mind back into a heathy state before even considering to try again – I’m actually terrified of trying again. I’ve recently found out that I have the MTHFR mutation C677T but my homocysteine levels are normal. My naturopath has put me on a low mcg dose of folate 5MTHR but is it enough? Shouldn’t I be taking like a 5 millergram dose? Can you please help, I’m so confused.
    Thank you

  6. I recently became pregnant and was told by 2 midwives to make sure my prenatal vitamin contains FOLATE and not FOLIC ACID. Yours is one of the articles I found while researching the subject. When I went for my pregnancy confirmation appointment at my regular OBGYN she prescribed me prenatal vitamins. I requested that they contain FOLATE and not FOLIC ACID. I was told by her that I need to stay off the internet and listen to her and not Google. I’m shocked by the utter lack of education in the medical field, and my own doctors refusal to say anything other than that there is no difference between the two. Neeedless to say I forwarded her this article and have since found another OBGYN. Thank you for sharing your knowledge and keeping my little bean safe.

  7. Hi Chris – do you recommend that a woman (age 58) with a +/+ MTHFR Gene take a Multi-vitamin supplement with extra Folate and B12? If so, what types of Folate and B12? and if not, why?

    Thank you.

  8. Thank you for a straight forward explanation of folate versus folic acid. Does consuming folic acid in fortified foods block the body’s ability to process folate for people with the MTHFR mutation?

  9. Hi Chris, I am a 30 year old female looking to get pregnant in the next year in a half. My nutritionist has me on a diet and vitamin plan and I am supposed to avoid folate foods and supplements (I am an undermethylator with high levels of histamine and copper in my blood). What are alternative (if any)food/vitamin options to ensure my body is adequately prepared for pregnancy? Thanks!

  10. I’m taking methotrexate injections 17.5 mg 1/ week and doctor prescribed folic acid supplement, 1 mg 5 times per week. I would like to take 5-mthf 1 mg instead. Is this dose equivalent to the folic acid required? My doctor said it was my choice which one I chose.

    • I’ve read (don’t know the source, but try to find it), that 5-mthf is more, than folic acid, in other words, 1 mg of 5-mthf is like 5mg of folic acid.
      So, I think 400mcg of 5-mthf is enough for most people, pregnant woman can take 600-800 mcg, and maximum should be 1mg of 5-mthf daily.
      There is a risk of overmethylation, particulary, when you are taking also methyl-B12.
      I’ve heard, that 50mg of time-released niacin, can lower the risk of overmethylation, for people, that have problems with methyl-folate.
      Then, other option is to use natural folate, it is exctrated from food. It needs to be converted in body too, so people with gene mutation, will have problem also with this.

  11. Because my third child had spina bifida (in addition to multiple other birth defects which led to her death), doctors have told me to take 4,000 mcg of folic acid daily to prevent this from happening in my next pregnancy. It seems excessive, but her loss was devastating and we want to do whatever we can to try to help our next child be healthy (not pregnant yet). Now I don’t know what to do!! Any advice???

    • What about taking a comparable dose of methylfolate and/or folinic acid? I would also get genetic testing done.

    • My doctor recommended 4mg of l-methylfolate – currently 8 weeks pregnant. He mentioned that prenatal themselves do not have enough. I found 1mg on Amazon.

  12. Testing for folate- should we get our levels tested? Is it a blood serum or rbc test? Do we test for folate or folic acid?

    • I agree that one shouldn’t worry about it, but I would like to know if there really is any way to rid the body of excess folic acid floating in our bloodstreams or residing elsewhere in the body. I think that is very important. Thanks for the information if anyone here knows the answer.

  13. I was wondering why people with type 1 diabetes are told to take 5mg of Folic Acid per day in the run up to pregnancy? I understand Folate is the one to take not Folic Acid, however why the high dosage and is this amount safe?

  14. I wanted to add that Bill Walsh says, for reasons too complicated to explain in this space, that undermethylators who are also high in histamine, supplementation with a methylated folate can have some serious backlash symptoms, including depression. I know I experience the effects every time I try to take methylated folate supplements. See his youtube channel for more info.

  15. Hi,

    I saw a naturopath who recomended I take l-5-MTHF. I’m not sure if she had any genetic tests done on me. The stuff I take cost $27 a bottle which is a bit outside my price range. Would it be possible to get the same benefits from whole foods like leafy greens and whatnot and save the money I spend on the medicine?

    • Hello. Yes, you should be able to get adequate amounts from naturally occurring folate in foods, but you can also get methylfolate much cheaper than that. See, for example, Swanson, where you can get two bottles for $4.99

    • Sorry Sam, but you cannot eat good nutrition (no matter how hard you try) based on: 1. Top soil erosion. 2. Industrial farming. In order to perform at your net potential, you must SUPPLEMENT a diet with natural minerals and vitamins. Plants and animals provide vitamins. However, minerals come from the soil.

      “Dead Doctors Don’t Lie” by Dr. Wallach is worth the investment of time. Listen for free: https://www.youtube.com/watch?v=oAw17H9wlnA

        • The “critical look at Wallach” is so full of mistakes it’s embarrassing…

          One of many glaring examples discredits Dr. Wallach for his idea that certain nutrient deficiencies cause Cystic Fibrosis, and the “proof” is that a gene for cystic fibrosis was subsequently found. Of course there is a gene for CF…. there’s a gene for numerous diseases, but science has clearly proven that genes do not act alone and are expressed based on the environment (nutrient insufficiencies, toxins, stress, hidden food sensitivities, unbalanced microbiome, and so on).

          Scientists have known since the Human Genome Project that humans, for all our complexities, don’t have that many more genes than an earthworm. Why did it take years for this remarkable discovery to reach the public? Because the scientific community and mainstream media kept it under wraps to protect the massive profits generated by people believing we are victims of our genes, with only lip service to prevention and natural treatments.

          • Susan’s comments were helpful to me. It’s not conspirary theory to note that the medical industry is now blaming everything on genes. Before that, they were fixated on viruses, and before that, on bacteria, and before that, for all I know, on evil spirits and “humors”.

            A gene for every ill! Everybody, send your $100 to 23andme or ancestry.com and find out your fate!

            • It’s just not as simple as saying the medical community is blaming everything on genes. That sort of suspicious assumption is not productive. It gives room for quacks like Wallach to take advantage of sick and desperate people.

              • Other than selling vitamins – which a desperate person can get anywhere – I don’t see how Wallach is quackier than anybody else. Anyway, once you’ve been diagnosed as incurable, as far as I am concerned, anything goes. Try anything.

      • It is true that Wallach seems to be a slimy character. However, that does not undo his work on minerals. I have his book and I am glad that I read it. I just don’t buy his supps, that’s all!

      • Samuel,

        Though I still believe in eating right, I have no faith that the nutrients that are claimed to be in certain foods actually is. I have also noticed that when people say such and such food is an excellent source of a certain vitamin, it is still pretty low.

        • 20 years ago I read an article in a health magazine, “Solstice”, where a scientist decided to test various meats for their Vitamin B12 content. She found that her samples contained exactly none. As I understand it, Vitamin B12 is synthesized in the animal’s body in the presence of cobalt. No cobalt would = no B12.

          • I think that the cow needs to eat grasses — possibly because of the chlorphyll — to make B12. Instead they feed them corn — which is no longer so natural as it is — and who knows what else.

    • “folic acid is considerably more bioavailable than naturally occurring food folates at equivalent intake levels.”

  16. Hi Chris, Just reviewing the folate information for my pregnant daughter. You mentioned Solgar has folate vs folic acid, but when I reviewed their ingredients it lists folic acid as the source. Just thought I would mention it. Love. love your information and wisdom. Much gratitude!

    • Note that Solgar carries both folic acid AND folate. Separate bottles, separate products. Make sure you are getting the right one!

  17. Does anyone have any input as to whether or not this Folic Acid fortification of foods circumstance might be contributing to escalating Cancer rates in our Pets? After reading this article last week I went on the hunt for a Folic acid free Dog Kibble….and there are NONE out there. So, our Pets are being fed this in high amounts also. I was researching originally for myself, but my Pets are as important as me..LOL- maybe more so!

    • Try Nature’s Logic brand. It’s mostly made with whole foods and I’m pretty sure there’s no added folic acid. I order from chewy.com, its not cheap but I think it’s more affordable from that site.

      • Pure synergy whole food multivitamins have naturally occurring folate from organic wildcrafter ingredients, as well as vitamin c, d, e etc in a real absorbable form your body is used to getting!

      • If you spend the money on quality dog food vs purina, etc you will notice fewer/smaller poops and less or possibly no shedding.

    • Check out Acana pet foods, also. In the two versions I have, I only see zinc proteinate added as a supplement. Nice to see some pet foods moving this direction.

  18. My entire family has various combinations of the MTHFR. L- Methelfolate (deplin 15 or the generic) is what we take every 4 days and Eyefolate once a week. Depending on the combination of mutations you have the protocol could vary. We have seen drastic improvements. IF you have been tested and have this gene mutation throw your folic acid in the trash. Do NOT listen to the foilic acid is good and will cure you stories. Additionally if you are taking B-12 infections to NOT take Cyanocobalamin as it stores in our systems and is toxic for us. This is the most common cheapest b-12 shot. You should.be taking the b-12 shot made with Methylcobalamin once a month, a compounding pharmacy makes these for us. We are in a study being overseen by 11 physicians that have the mutation themselves. Changing our protocol changed our lives. You MUST get to a doc that will listen first. Any physician, patient, or chemist on this thread is welcome to contact Dr. Brian Buel 479-521-7774. He has the same combination I have and is treating our entire family in the study. Folic acid makes us sicker…been there, done that. I KNOW the protocol will change in another 5-10 years. Folate will emerge the victor!

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