Is Folate Superior to Folic Acid? A Review of the Research

Folate is a hot topic nutrient when talking about preconception and pregnancy due to its role in decreasing neural tube defects (NTD). Early in pregnancy, there is what we know as a neural tube that should close to support appropriate development of the baby’s brain and spine. 

A few less talked about risk factors of low folate include congenital heart defects, premature birth and low birth weight. I think we can all agree that folate is a very important nutrient! 

Like all nutrients, folate works synergistically with other nutrients. Choline, vitamin B12, vitamin B6, glycine, riboflavin, and magnesium are a few important nutrient-buddies to folate. This article will focus on folate, just remember that it doesn’t work alone. 

The type of folate that is consumed matters. The names folic acid and folate are often used interchangeably, but they are very different! 

Folate versus folic acid: What’s the difference?

Folates are naturally occurring in foods like beans, avocado, brussel sprouts, cabbage, and broccoli. There are many types of naturally occurring folates in food, not just one. 

However, the main folate found in the blood from food is 5-methyltetrahydrofolate (5-MTHF). The 5-MTHF form is “active” or ready for the body to use in the many metabolic reactions it is needed for. 

Folic acid, on the other hand, is a man-made version of folate that doesn’t have any biological function unless it is reduced to the active form, 5-MTHF. Folic acid is only found in fortified foods, such as fortified grains and supplements. Folic acid has to be “activated” (aka reduced) in order to be used in the body.

Once the connection was made that adequate folate levels decrease NTD (1965), food fortification of folic acid followed (1996-1998 in USA) along with recommendations for high dose supplementation of folic acid. This public health effort was successful in reducing the cases of NTD by 19-32%. 

Remember, folic acid is man made and has to be “activated” or reduced in order to be used in the body. An estimated 40-60% of the population CAN metabolize (“activate”) folic acid for the body to use. This means the other 40-60% CANNOT efficiently metabolize folic acid! 

Those that can’t efficiently reduce folic acid into 5-MTHF have genetic variants in the gene that regulate an enzyme called MTHFR. MTHFR stands for methylenetetrahydrofolate reductase, which is an enzyme that reduces folate into the active form of 5-MTHF. This process is necessary for the body to use folate to prevent NTD. 

When folic acid can’t be reduced, it hangs out in the body as unmetabolized folic acid (UMFA). Research is showing when consuming folic acid over 200mcg per day, the body has trouble converting it into the active form 5-MTHF, even if genetic variants aren’t present.