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Folate Vs. Folic Acid | Risks of excessive folic acid intake | Folate food sources
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.
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.
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. (7, 8) 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.
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.
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Folate from natural food sources is best
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.
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The Adapt Naturals Core Plus bundle features two products that contain folate. Bio-Avail Multi, a multivitamin/multimineral and phytonutrient blend, contains 680 mcg of the most active form of folate, methyltetrahydrofolate. Bio-Avail Organ contains a blend of five organ meats (live, kidney, heart, pancreas, and spleen), which are among the highest sources of folate in the diet.
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.
Hi Joy,
Try the Optimal kids multivitamin from SeekingHealth.com. I have gone dairy-free and gluten-free for 2 months and I think it is helping, though I’m sorry I do not know the explanation behind it.
Great article. I am curious if you have much experience dealing with the MTHFR gene mutation? I am homozygous for this mutation and that has lead to my learning about folic acid and 5-MTHF. I am trying to figure out a good multivitamin for my toddler and middle schooler that has 5-MTHF instead of folic acid. I already take a 5MTHF/B6/B12 supplement. Also interested in if you put any validity towards a gluten-free diet for those with MTHFR? Is it necessary? Another site has recommended gluten-free and dairy-free, but I’m not sure of the WHY.
Is 5-methyltetrahydrofolic acid the same as folate? Just bought Methyl Folate from Jarrow and am reading the label. I want to be taking folate and not folic acid. Is this the right stuff?
Thanks,
Fiona
Hi Chris & everyone, I am a little confused. Not sure if have MTHFR but possiblity .. am in New Zealand and very tricky to get that testing done. However, we want to start TTC for #2, so I need to know what is a good prenatal to take that doesn’t have folic acid or the vits that are harder to break down .. what is a good prenatal that will give me my folate and iodine etc needed for pregnancy? Cheers
23andme ships to New Zealand, you will want to know your other mutations such as COMT and CBS to make sure there are fewer side effects when addressing MTHFR. You can check them out at http://bit.ly/Yfkfph.
Thorne, listed by Chris makes a prenatal with the active form, Methyl Folate, you can check out reviews at http://amzn.to/XOFMbK.
Hi Kelly – I’m from NZ too and have just ordered the genome testing kit from 23andme for the MTHFR mutations (and APOE genotyping to see if it’s OK for me to carry on eating saturated fat). It cost US $71 for the postage as well as the US$99 for the cost of both genotyping profiles. It came here really quickly. I’m going to try to have it shipped via DHL Express from the lab where I work as you have to sign it in the presence of the courier guy when they come to pick it up here in Chch before it is sealed. So our dispatcher can do that for me as I’m all over the place.
Since reading the article on Folic Acid I have stopped taking this vitamin supplement. I am going to start the Solgar Folate 800 mcg. I was wondering if it needs to be taken with a B-complex 100 or any one particular B vitamin to help with the metabolism of the Folate? If so can you recommend a good supplement to take with the Folate? I am 56 years old non childbearing age!!
Thorne has an active B complex at http://amzn.to/16YMWQC, I think the only thing this complex is missing is Benfotiamine. I would find a sublingual or topical source of B12 since some say the amount found in a pill is only 1% absorbed. The 5-MTHF in this is at the RDA for the non-pregnant/lactating adult.
Freedom of choice is paramount, Government often gets it wrong. In Australia we have just started compulsory addition of folic acid to bread.
What’s being added to bread is not folate but folic acid. Folate is an essential B group vitamin richly found In organ meats and green leafy vegetables but less so in other plant sources. Folic acid is a completely artificial substance unknown in nature first synthesised in 1947 in lederl labs and not ever consumed by man or woman prior to then. It must be synthesised to folate by the liver but this is an inefficient process that leads to an excess buildup of both folic acid and folate in the body. In the US the reduction of neural tube defects that resulted from the 1998 mandated supplementation of bread flour by folic acid (not folate) was at best from 1582 to 1337 for the entire US population; a dubious 245 reduction. Folic acid however continues to show up as a risk factor in studies for prostrate, breast and colorectal cancer. Worse it is now suspected of being responsible for an increase in Aspergers and Autism. Can you imagine all those scientists and politicians now recanting? A much better strategy would be selective folate supplementation of folate but not folic acid. My wife and I eat leafy greens, I eat organ meats. We must now eat organic bread to avoid this substance.
I met someone who had just been prescribed methotrexate for an autoimmune condition. I was pleased to hear the public health specialist prescribes folate not folic acid for these patients. So the message is getting through. Apparently it takes about 18 years for these things to filter through to the mainstream medicos.
Merle,
Do you know how I can send you a private message? I would be happy to give you my phone # so we can talk. I am not a doctor, but I have spent most of 2013 learning about and dealing with MTHFR and TTC.
Jen
That’d be great! Do you mind email? michlny hotmail
Love to hear from you!
I reached out to my RE and asked him to prescribe Metanx – we’ll see what he says….
Hi Jen, am I able to email you too? I have a few questions re pre natals and MTHFR before trying for #2. cheers, Kelly ([email protected])
Merle- have you looked at MTHFR.net? There is also babycenter.com’s group for MTHFR. I avoid all synthetic b vitamins, including those in bread and cereal and crackers. I take all active forms. Swanson vitamins and Thorne have some. I take Metanx too. That is in addition to Thorne. I asked my OB for the Metanx RX, and she gave it to me.
Jen –
Thanks so much for your reply. I’m worried to go off the Folgard because my RE has used it for so long as he insists it works. But I’ve also started taking the Thorne PreNatals and Thorne B-Complex.
I’m wondering if I can take both?
But I will see if he can prescribe Metanx as per your suggestion….
PLEASE HELP with an answer::
I am TTC (two miscarriages) and have the MTHFR mutation. My RE prescribed Folgard – with synthetic Folic acid (which he insists studies have proven it works). I have decided to take Thorne Prenatal (with active folate) and Thorne B-Complex to make sure I’m getting enough of the active form.
Can I take the Folgard and the Thorne supplements? I’m afraid to go off Folgard bc he insists it works and he always uses it….
PLEASE reply…..
How long does it take to get rid of unmetabolized folic acid in the body?
My folic acid level always tests very high way out of range. I have very diffusive hair loss since 28 and now I am 47. Is there any correlation between hair loss and high folic acid in the body. How can I lower my folic acid level?
I just started taking the Pure Encapsulations 950 + K for pre natal vitamins while trying to conceive. Is anyone else not freaked out by the %RDA? Is it okay to have 1000%-16000% of RDAs?
It is difficult/impossible to find a prenatal vitamin in Sweden not containing folic acid. Is it ok to supplement this with 400mcg metafolin (5-MTHF) which I found in England… or will they “cancel each other out”? is it dangerous?
(The prenatal I take has 800mcg folic acid.) I need a bit more then the average person as I am heterozygous for MTHFR variant C677T.
Hi Pernilla,
You can find Innate Response whole food raw food supplements in Sweden. Never found a better brand so far among the whole food ones. They do not use soy which some whole food supplements use. Also they use refractance window drying = true raw food (not freeze drying that many use). They have two supplements for pregnancy:
Pre pregnancy + Trimester 1&2: http://www.greatlife.se/halsoprodukter/baby-and-me-trimester/
Trimester 3 and breastfeeding: http://www.greatlife.se/halsoprodukter/baby-and-me-trimester-post/
Naturally with Folate and not folic acid.
Good luck!
Wow! Cheers to that!
Thank you Patrick for the great info:)
🙂 Good luck and all the best with your pregnancy, Pernilla!
Would you be able to post or email the references for this article please. Great info
I’ve started taking Solgar folic acid 800 mcg 5 days ago and all my symptoms are just increasing for now especially muscle twitching all over body. Is it normal at the beginning of taking folic acid and shall go with time? Or I shall not get stronger symptoms and it means it is not folic acid deficiency what is causing them? Thanks.
I just found out that I have low folate – 4.8 nmol/L . My B12 level is 359 ng/ml. I experience dizziness, feeling unsteady, and terrible leg muscle twitching, which won’t let me fall asleep. How much of 5-MTHF shall I take for these symptoms to dissapear (as dosages do vary a lot) and how soon shall they dissapear or start reducing after starting some extra folate? Should I add some methylcobalamin along with 5-MTHF for better benefit? Thanks in advance for answers.
My sympathies about your loss. Some people when starting out on methyl folate can tolerate higher doses, but then they end up reducing the amount because of side effects. Deplin, is a pescription of methyl folate at 7.5mg and 15ngs of Methyl Folate. Another prescription is 3mg (Deplin). If you take high amounts (which are over the RDA) like the prescriptions will you have a knowledgeable physician to monitor?
Thanks for replying mthrease. I am in Australia and there is very little knowledge of mthfr and methylfolate here. I see a naturopath, but mostly am researching on my own. My doctor said (and I have found online) that the recommended supplement dosage following a neural tube affected pregnancy is 4 or 5mg ‘folic acid’. As I prefer to take methylfolate, I am wondering if 4mg methylfolate is equal to 4mg of folic acid, or if I should take a lower dosage of methylfolate because it is better absorbed?
I have begun taking 4.8mg methylfolate and will monitor for side affects. Thanks for again for your reply.
Actually Lies!, there are quiet a few Australian practitioners who are MTHFR aware. Check out the bottom of this page:
I have just experienced pregnancy loss with a nural tube defect. (I was taking folinic acid pre-conception) I see that the recommended supplement dosage for a future pregnancy is 4000mcg ‘folic acid’. I would rather take methyl folate, should I take 4000mcg of methylfolate or should I take less due to it being better absorbed? Is there any danger to taking high doses of methylfolate?
My partner is homogynous C667T MTHFR mutation (and taking Dr.Ben’s supplements), I have no mutations. Any advice is appreciated. Thanks
I was moved by your story, I had a baby born sleeping 11-6-12 she had spina bifida and hydrocephalus. I am pregnant again, 16 weeks and have been taking perfect prenatal and solgar folate 800mcg. Not had any support from the medical profession regarding not wanting synthetic folic acid. So had to go it alone.
Hi I am Wendy too! Sorry for your loss and good luck. From what i know the methylfolate is also synthetic but just in the same form as what the body would convert to and further along in the conversion process.
It’s really late at night, but it seems even food sources of folate will not convert to the form you need efficiently if you have mutations in MTHFR. Whether it’s a whole vitamin, or leafy greens, you still need to go through the final conversion step.
I am looking for a whole foods multivitamin for my 8 yr old son and doing tons of research and label reading on line. I thought I found a good one but am VERY confused by the labeling and cannot find info anywhere to explain it. Maybe you can help.
The list looks great until I get to the Folate ingredient. It states:
Folate (as folic acid)….. 200mcg
WTH does this mean? Is it natural or synthetic? After reading your article I am very confused because I thought folate was different from folic acid. So how can it be both on this label? So confusing. It seems like I will never find the “perfect” supplement for my child. It is either they contain folic acid or the cyanocobalamin form of B12….Grrrrrrr!
Thanks in advance if you can clear this up for me. 🙂
The discrepancy in terminology is a common imprecision in the supplement industry. But if it says “as folic acid” then it is not what you want.
For children, you might consider Pure Encapsulations’ “Junior Nutrients” (which contains 5-MTHF instead of folic acid): http://www.pureencapsulations.com/products/shop-by-product-category/multivitamins/junior-nutrients.html
Or if you’re really wanting a “whole food” multi, check out Innate Response Formulas’ “Kid’s Multi,” which has natural folate from broccoli: http://www.innateresponse.com/product-p/40026.htm
Thank you David for the wonderful info. Now, if I could only figure out if “vegetable lubricant” is the same as Magnesium stearate. 🙂 These companies are some tricky bastards when it comes to renaming things to get people to buy their product. I am finding that some people say that vegetable lubricant is the same as magnesium stearate and that is something I DO NOT want in a vitamin supplement. Thanks again for your help.
Pure Encapsulations definitely does not use magnesium stearate. Not sure about Innate Response. I don’t think they use it, as they specify elsewhere that they avoid it.
That being said, I have my doubts about the dangers of magnesium stearate. I know it’s catching a lot of flak right now, but I do wonder if the concerns are unfounded. Magnesium strearate is simply a magnesium salt of streaic acid. It is actually 96% stearic acid (the rest is magnesium). A typical supplement capsule with magnesium stearate contains less than 5 mg of stearic acid. By comparison, a 3 oz beef patty contains about 1,600 mg. I’m just not sure how this could be a problem. I know folks like Mercola claim that it contributes to biofilm formation in the gut, but again, no real evidence for this other than the general fact that magnesium is a divalent cation that could find its way into a biofilm no matter what the source. But you’d probably get more magnesium from a single almond than you would in a capsule containing Mg stearate.
Anyway, those are just my thoughts. I’ll be interested to see what more research shows.
It has been a nightmare for me trying to figure out a good multivitamin so I don’t find myself buying everything separately. My diet was poor for a very long time and my body devastated as a result. I’m still functional, but I don’t think I’ve ever been at my best, even less so since I started having children (quickest way to give yourself deficiencies, especially with the sub-par nutritional information they give you at prenatal appointments, and even worse if you’re poor). I’m slowly figuring out the diet thing but my body can’t wait anymore. It needs help NOW.
One of my big obstacles was finding something with the methyl form of B12. I finally just plugged “methylcobalamin multivitamin” in Google. If you click on my name above my comment you will go to the sale page for the multi I found by that method.
I was pleasantly surprised to see that not only did it contain methyl B12, it also contains the form of folate that Chris recommends here. And that’s not even the reason I bought it.
I’m not pleased that there is no real vitamin A in it, but I figure it’s a tradeoff because A works best in an oil softgel (and yes, I found one without soybean oil in it), and this multi comes as a powder-containing capsule. So I just take my A separately, as I have yet to convince myself to eat liver. 🙁
I think you’ll be happy with the other ingredients in the multi as well. I think they went all out compared to most supplement companies including, I’m sorry to say, some supplement dealers in the Paleo/Primal/ancestral health community.