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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.
what if the bottle says folate (as folic acid)? Is it folate or folic acid?
Nope – that would be folic acid – try Megafood Balanced B-50
Why do you believe that Megafood folate is natural folate? There label makes no such claim. Do they provide information elsewhere that addresses this question?
Folate is what you want. Only take the vitamins that say folate. Folic acid is synthetic and if you have MTHFR, you can’t process folic acid.
So glad there are so many comments from people suffering with mthfr. That means word is getting out. Good to see the suggestions for a b complex vitamin with methylated folate and methylated b 12. I’m buying them.
I do not process folic acid. Is folate (as calcium folinate) or folate as 5-methyletrahydrofolic acid what I need?
I’m trying the MegaFood Balanced B-Complex now.. has the right stuff – Folate.
I have spina befida occulta & have been prescribed a high dosage of 5 mg (not mcg) of folic acid by my doctor for trying to conceive. Is that equivalent to 5000 mcg folate per day?? That seems a bit much? Thanks!
So I need to take a B-50 Complex 2x per day (better than the B-100 1x for me) – what is one where folic acid is not used that is good?
Hi Christine,
My opinion is – listen to your ND and ask him/ her any follow-up questions. 99% of MD’s are clueless about MTHFR. When you said that your “doctor” said you don’t need the B vitamins, did you mean your MD?
My MD (OBGYN) couldn’t figure out why I kept miscarrying, even when the blood work she ran said I have 2 MTHFR mutations. I had to go to other sources & do my own research to figure it out. Your ND is a great resource, as well as MTHFR.net so that you can educate yourself.
I found out recently that I am Homozygous for A1298C so my ND put me on a 5-MTHF, 1mg supplement made by Thorne Research. I am supposed to take 4 capsules per day. I have been reading a lot online about people taking B-Vitamin supplements in addition to the MTHF supplement. I asked my doctor about this and she said that I did not need the B vitamins because my bloodwork showed that I am not deficient. Do you only need to take the B Vitamins with the MTHF if you are deficient???
I think what I’m hearing in some of the comments is that this isn’t a one-size-fits-all answer for everyone. Just because you have a MTHFR gene mutation doesn’t mean it’s expressing and it doesn’t mean this is the right treatment for everyone.
However, I can say for me, it has been life changing/ life saving. After having multiple unexplained miscarriages, I am now taking methylfolate and I have a very healthy pregnancy.
I’m very happy for you. I was just diagnosed with heterozygous for C677t. Trying methylated folate and methylated b12. haven’t ever in my life felt this good. I still have some issues here and there…but I’m feeling much better.
I do not agree with this article at all. If your into methylation at all, you will understand what I’m saying. If not, I will try to make it easier to understand.
Folate, 5-MTHF, & Folinic Acid all have free floating METHYL DONORS, hence word Methyl in all their actual names (look them up). Folinic Acid has 1 Methyl Donor, 5-MTHF had 5, and Folate usually has 1. The more Methyl Donors it has, the higher the number will be (hence 5-MTHF). These are good to have if you UNDER-METHYLATE. However, if you are the 1% that Over-methylates and you take something with and extra methyl donor, get ready for the worst ride of your life neurologically. Too many free floating methyls can make your symptoms worse, for example: Anxiety. People that OVER-METHYLATE need FOLIC ACID because it absorbs and pulls out the extra methyl donors. My ND has seen this first hand with me. Please properly educate yourself about your body before believing poorly written vitamin scares like this.
Thank you, Ophelia, for a moment of clarity.
This scary article is way overblown and inaccurate.
I’ve heard this more than once. Someone tests positive for the MTHFR defect, tries 5-methyl-folate and has side-effects, like several fatigue or acne-like skin problems.
After testing positive I bought 5-methyl-folate and over a period of six months and two blood tests my homocysteine hasn’t changed from when I was just taking folic acid. It’s mid-normal just like it was before taking methyl-folate.
I read somewhere that we do convert folic acid, but at about 40 – 70% as well as people who don’t have the genetic defect. (I wish I could find that reference.)
It also turns out that according to the big NHANES study 92% of Americans get enough folate from their diets, so it’s only a small minority that even really need supplementation.
And if we convert at 40 – 70% we create enough folate from folic acid PLUS dietary folate to maintain health.
But folic acid doesn’t cause the side-effects that some people get from methyl-folate.
Your very welcome Nutranut. I get very upset seeing articles like this because there are people out there who don’t have either main methylation gene mutation (Like myself). Most of this methylation mumbo is targeted for people who have the 1298/677 mutations. There’s nothing for the ones who don’t, but do have other mutations.
I only take 800 mcg of folic acid a daily. I personally believe that to be plenty plus food intake. It has helped me quite a bit over the last few years.
Ophelia, there are a number of inaccuracies in your post.
5-methlytetrahydrofolate does not have “methly donors”, it has a ‘methyl group’ and is therefore a methly donor, and 5-methlytetrahydrofolate has only ONE methyl group, not five. The number 5 refers to where this methyl group is located in its structure.
Hi Sarah,
I’m not an expert but here’s my understanding. People with MTHFR mutations cannot process folic acid (which is synthetic), so it can build up in the system and also cause high homocysteine levels. That is why I avoid folic acid and take methylcobalbamin, which is the active form that my body knows how to process. The website MTHFR.net is a great resource for understanding this.
Jen,
Since this is a discussion of folate and folic acid, perhaps instead of saying you take methylcobalamin, which is the active form, you really meant to say you take methylfolate, which is the active form of Vitamin B9. Methylcobalamin is the active form of Vitamin B12.
Hello- does anyone know why people have to high beyond the norm levels of folate? I just had a blood test that showed high levels of b12 and folate….. Doesn’t the B vitamins flush out of your system if it’s not used?
Hi Sarah. I stumbled across your question & I am interested if you found any help and/or answers? I too, have recently been testing really high B12 & Folate levels. I also had a high ANA result of 3.2 & they keep saying it could be a false positive?! My Vitamin D was pretty high, but has come down a bit since I stopped the supplement. But my doctors aren’t helpful at all, only to say to stay away from D & B12 Supplements. From research I’ve done it points to issues with bone marrow or leukemia. They keep saying it’s OK & it’s making me crazy because I’m feeling worse…more fatigued, “foggy” & flushing frequently. I can’t get anyone to take me seriously. If you have any info. that might be helpful, I’d greatly appreciate it.
Thanks,
Laura
Check out this link on MTHFR defect and why can still have high levels of Folate / B12
http://www.stopthethyroidmadness.com/mthfr/
I have high levels of unmetabolized folic acid in my blood, can anyone please recommend what I can do to bring these levels down.
thank you
Hi Julie,
I’m no expert, but here are my thoughts:
1) remove all sources of synthetic folic acid. Avoid foods that are enriched with synthetic folic acid (usually wheat-based cereals, breads, crackers) – read the labels to see if they’ve added B vitamins,
2) add active forms of folate to your diet. This means changing your vitamins to the active forms including methylcobalbamin – I like Thorne and Seeking Health brands – (unless you have a sensitivity to methylcobalbamin, which a few people do but it seems most do not). Also eat folate-rich foods.
Hi Jen
Yes, I’ve done all those things, in fact I never eat fortified or processed foods anyway. It has been over 2 years and my levels are still high. I supplement with the Pure Encapsulations brand of active B with. I just don’t know how to get my levels down. Maybe I should stop using the supplement all together, but worry about not getting a B complex in.
thanks for responding.
For anyone asking about folinic acid, here’s my experience.
(and in case you haven’t been following, we have: folic acid- the synthetic supplement that the body has to do extra work to get folate from. Folate- the natural form, methylfolate- what the body converts folate into , it’s an active form of folate. and.. Folinic acid- another supplement version of folate that is one step better than Folic Acid if I’m understanding correctly.
Anyway.
Everyone is praising Methylfolate as the best supplement. Honestly, I’ve had the worst experience with methylfolate. It makes me feel like my brain is poisoned and I have serious mood swings which are hard to describe.. I dont normally have these types of mood swings, though I used to have them when I was a teenager, now I never do. Methylfolate also makes me extremely tired. I’m guessing this would indicate that I could be an overmethylator, but I’m not sure.
Folic acid on the other hand doesn’t have much apparent side effect , it helps to stabilize my mood and I think that it POSSIBLY may cause some fatigue- though Im not sure because I already have some fatigue. I’ve tried folinic acid as well and I think I prefer this, for many reasons stated above by other people (I agree with some of it) and again I don’t notice any side effects, except perhaps some fatigue, but I’m not sure if it does cause fatigue or if that’s just my regular fatigue (and if I can’t tell , then perhaps it’s not causing that effect, as I think it’d be more pronounced otherwise).. i might drop into thread to update
sorry I forgot to add that the Methylfolate side effects happened at every dose, even 50 mcg (I dissolved 1 mg into water so that each mL = 1 mcg and used measuring spoons to dose)
It’s because you over-methylate (have too many free floating methyl donors hence the name Methylfolate). I can’t take it either without going into full blown anxiety attacks until it clears my system. Stick with a clean form of Folic Acid to clear out the extra methyls and ignore poorly written farces like this article.
Amen. Methylfolate made me so anxious I was suicidal. It was bizarre.
you have reference numbers in this article-where are the actual references?
Just click on the numbers- they’re links.
The flaw (however well-intentioned) in this article is that no medical study (that I’m aware of) has tracked folate intake (that is to say, intake from vegetables). It’s possible that downstream activity of _any_ form of B7 is associated with the negative outcomes. The article shows risk of harm from folic acid intake but does not show that folate intake is harmless. As a primary facilitator of BH4, and thus nitric oxide (a highly reactive free radical molecule), vitamin B7 in any form could have deleterious effects.
Folate is B9.
Some of us that test positive for the MTHFR gene find that when we take methyl-folate have bad reactions, like acne. What people don’t understand is that we do convert folic acid, but at 40 – 70% as well as those who don’t have the defective MTHFR gene. Since folic acid doesn’t cause the adverse effects it’s just a matter of getting a high enough potency so that we get enough. It’s called an “inborn error of metabolism” and the answer I learned from an alternative doctor is to take high potencies, so that the amount we convert is enough. So I take 1,000 mcg of folic acid, knowing that I’m getting the equivalent of 400 – 700 mcg converted, but without the side-effects that methyl-folate causes.
Hi Noel – It’s just my opinion, but I like the Thorne Basic Prenatals (I buy them on Amazon). I also take DHA.
Hi Noel – my only issue with the Baby and Me vitamins is it doesn’t state the form of the vitamins. For example, it is important that B-12 is in the form of methylcobalbamin, and never in the form of cyanocobalbamin. Personally, I won’t take a prenatal unless I know that the B vitamins are in the active forms.
Is there a brand of vitamins and combination that you would recommend. My thinking for taking a prenatal is that it’s an all-in-one, but I can certainly take a variety if necessary.
I found a generic prenatal vitamin at Wegmans that has folate and not folic acid. I also noticed that the Baby and Me prenatal does as well. I’m getting ready to start a family and this is an important issue for me. Thank you for the article and the people that have commented with valuable information.
As someone who is B12 deficient and now supplementing with daily B12 injections I have a greater need for folate as B12 and folate cannot go through the methylation cycle without each other. I have tried active forms of folate and they just don’t work for me, I get neurological symptoms back.
I seem to do best with cyanocobalamin (I tried hydroxocobalamin and methylcobalamin injections) and folic acid. There is no one size fits all, what should be best is not for some of us!
Keep in mind that folate deficiency still exists in the age of folic acid fortification and high daily doses are required, absorption from food just won’t do the trick due to genetics.