folate vs folic acid

Is Folate the Same As Folic Acid? Which is Better?

Dr. Jolene BrightenPublished: Last Reviewed: Fertility Leave a Comment

Chances are, if you’re pregnant (or thinking about becoming pregnant one day) you’ve heard about the importance of folate for healthy pregnancies. Maybe, you’ve heard that folate is just plain good for your health. If so, you've probably found yourself staring at bottles of supplements wondering, “is folate the same as folic acid?”

It's true—folate is essential for a healthy pregnancy and has many hormone benefits.

But what becomes confusing is that folate is often incorrectly and interchangeably referred to as folic acid.

Even scientists and researchers have incorrectly referred to these two compounds as the same exact thing for years, when in reality, they are two distinct compounds with different functions in the body

That creates a lot of confusion when deciding which form of this crucial vitamin to consume. I mean, when the experts are getting it wrong, where is a layperson supposed to find the right information?

So, in the following article, I’m breaking down the ins and outs of folic acid and folate. Hopefully, you’ll gain a clearer understanding of the differences between the two and which one you need to be focusing on (hint: it’s folate).

Keep reading for all the details you’ll ever need to know about folate vs. folic acid.

Folate vs Folic Acid

Folate and folic acid are two distinct compounds with two key differences in function: 

  • Folic acid is the synthetic form of folate, which is also called vitamin B9. The Food and Drug Administration (FDA) requires that manufacturers in the United States add folic acid to many foods, and 42 other countries around the world have similar requirements.
  • Folate is not synthetic and found naturally in many foods. 

Folate is the form of vitamin B9 that you find in foods like leafy green veggies, asparagus, and broccoli. It is an essential nutrient, critical for the growth of healthy cells and DNA creation. For this reason, it’s extremely important to get plenty of folate during pregnancy, and it’s a key component of many prenatal vitamins.

The biologically active form of folate (the form your body uses) is 5-methyltetrahydrofolate (5-MTHF). Your body takes the folate you eat and converts it into 5-MTHF within the digestive tract with the help of an enzyme called methylenetetrahydrofolate reductase (MTHFR).

When it comes to folic acid, the body is unable to convert it all to the active form in the gut and relies on other organs, like the liver to create a form the body can use. This is an inefficient and slow process, which is why some people end up with elevated levels of folic acid in their blood, which as you'll read later, can lead to a number of health issues.

This is why you'll sometimes hear it said that people with an MTHFR genetic abnormality should be advised to eat whole food forms of folate and avoid supplements with folic acid. The idea is to provide a form of folate, like 5-MTHF, that is more readily absorbed and utilized by the body.

Is Folic Acid Safe?

A mountain of evidence suggests that folic acid supplementation protects against neural tube defects (NTD) in newborn babies. This is why so many regarded it as a mandatory ingredient to be added to processed foods. And folic acid fortification has correlated with (not necessarily caused) a lowered incidence of NTD. However, in more recent years, information has come to light suggesting that naturally occurring folate is the healthier of the two options. Some research even suggests that folic acid supplementation may be associated with increased cancer risk.

Is Too Much Folic Acid Bad For You?

While it seems the government had good intentions when mandating fortification of foods with folic acid, the problem with the strategy lies in the fact that the body can only process so much of it. It is difficult to metabolize. The natural form of B9, folate, is much more easily processed and utilized.

When too much folic acid is consumed, you can’t use it all. So the excess circulates in the body, and this can cause issues. Even small amounts of folic acid have been deemed to be excessive. In one study, unmetabolized folic acid was found in the blood of nearly all of the participants. And in another, a modest dose of 400 mcg caused excess folic acid to appear in the bloodstream. 

Some of the potential problems that can arise from excess folic acid include:

Cancer

As I mentioned earlier, there’s some association between folic acid intake and cancer risk, especially prostate and possibly colorectal cancer. Some researchers have found that increased folic acid decreases the prevalence of natural killer cells, which help to destroy tumors. This could contribute to the increase in cancer rates. 

Cognitive Impairment

Some studies suggest that folic acid may play a role in cognitive decline. In one study of seniors, high levels of folic acid in the bloodstream corresponded with both anemia and cognitive impairment, especially in those with low levels of vitamin B12.

Mood

Too much folic acid can have an excitatory effect on those who consume it. In one study of healthy volunteers, they had to abandon the research after just 1 month. The participants had increased gastrointestinal issues, issues sleeping, and mental changes. 

B12 Deficiency

Vitamin B9 and vitamin B12 are intimately related. They both work together to make red blood cells and they team up with vitamin B6 to control homocysteine levels in the blood. Homocysteine, an indicator of inflammation, is an amino acid that can be associated with an increased risk of heart disease. 

When individuals are deficient in B12, and they supplement with folic acid, problems crop up. Folic acid seems to mask B12 deficiency, which is of special concern to elderly adults. B12 deficiency is associated with a greater risk of Alzheimer’s disease, cognitive decline, and even paralysis.

What Are The Health Benefits Of Folate?

In contrast to the synthetic folic acid, folate has many wide-ranging health benefits. Because it’s such an essential nutrient, it’s critical to consume adequate levels throughout all stages of life. The most notable benefits of folate include:

  • Healthy fetal development during pregnancy
  • Potentially protective against cardiovascular disease
  • May reduce the risk of cancer
  • Could help protect against Altzheimer’s disease
  • Possibly Effective as Part of a Depression Treatment Plan

Supplementing with folate is most crucial during pregnancy — sufficient levels help to reduce the risk of birth defects, and help to ensure healthy growth and development of the baby. 

Importance of Folate For Pregnant Women

Adequate ingestion of folate is of primary importance for pregnant women. Especially very early in pregnancy. It’s been associated with decreased risk of NTD, congenital heart defects, and oral clefts, i.e. cleft palate. Some research has also suggested that pregnancy outcomes may be affected by folate intake, likely due to the role folate plays in the very early stages of the development of the placenta. 

Also, because folate is used so liberally by the developing baby, it’s important for the mother to increase folate consumption, ideally even before she is pregnant. 

For this reason, many doctors suggest taking a high-quality prenatal vitamin when you first start thinking about conceiving. As I explain in my book, Beyond the Pill, I’d love for my patients to start preparing their bodies for pregnancy well before they’re ready to conceive. Aim for a minimum of six months’ preparation to ensure the best outcomes for mother and baby. Beyond just folate supplementation, it’s also critical to get your microbiome in top form (since it becomes your baby’s foundation for his or her immune system). 

If you’re considering pregnancy, even in the distant future, I’d recommend checking out my book, Beyond the Pill for a complete fertility protocol. This is especially important if you’ve been on the birth control pill which can deplete crucial nutrients that you’ll want to build back up.

Potentially Protective Against Cardiovascular Disease

Folate has been shown to be protective against heart disease. And in a review of the data, researchers found a 10% lowered risk of stroke in individuals who supplemented with folate. While we’ve known for a while that a diet high in vegetable and fruit consumption is good for heart health, it’s possible that the high levels of folate in these foods is what’s so great for the heart. While researchers used to credit antioxidants with this protective effect, folate reduces homocysteine levels in the blood, and in turn, this could be why those veggies are so dang good for you! I recommend eating 6-9 cups daily if you possibly can.  

May Reduce The Risk of Cancer

Since folic acid may increase the risk of cancer, it comes as a bit of a surprise that folate does the opposite for us. The relationship between cancer and folate consumption has been well documented. Risk of breast, ovarian, cervical, bladder, stomach, esophageal, colorectal, pancreatic, and lung cancers have all shown an inverse relationship with levels of folate intake. Or in other words, folate consumption is associated with a lower risk. Again, it’s another great reason to eat folate-rich vegetables and fruits. 

Could Help Protect Against Alzheimer’s Disease

As with heart disease, cognitive degeneration, dementia, and Alzheimer’s disease have all been linked to elevated levels of homocysteine. Lower blood levels of folate have been associated with higher levels of homocysteine, and increased incidence of Alzheimer’s and mild cognitive impairment. While further research is needed, especially exploring the role of folate rather than folic acid is needed, it offers hope that maintaining healthy levels of B vitamins can help ward off cognitive decline.

Folate as Part of a Depression Treatment Plan

Reviews of the literature show that folate levels in those with depression are lower than in individuals without depression. In addition, folate supplementation has been shown to increase the efficacy of depression medication. In general, it is well-tolerated and few side effects have been reported by study participants, making it a prime candidate for further research in treating depression.

What Are The Symptoms Of Folate Deficiency?

Sometimes, people are unable to absorb adequate folate, even if they’re consuming enough. This is particularly true for people with digestive disorders like Crohn’s, ulcerative colitis, or celiac disease.

Other people struggle to process B vitamins efficiently due to a common genetic mutation that’s referred to as Methylenetetrahydrofolate reductase (MTHFR) gene variant. 

When this happens, low levels of folate can produce some serious side effects, including:

  • Irritability
  • Fatigue
  • Anemia

For these people, supplementation with a highly bioavailable B Complex can restore their levels of folate to optimal.

Do You Need Folate Even If You’re Not Pregnant?

While pregnancy is the most crucial time to focus on folate, it’s certainly not the only time.

As I explained earlier, if you’re even thinking about conceiving, folate intake should be at top of mind.

But because of the many other health benefits we’ve explored, it really is a good idea to make sure you’re getting adequate amounts of folate either from diet or from proper supplementation

How Much B9 Do You Need?

The recommended daily allowance (RDA) for folate is 400 micrograms (mcg). For pregnant women, the recommendation rises to 800 mcg. 

Again, this is a recommendation for folate, not folic acid.

Ideally, you can get a ton of folate from whole food sources. Luckily, some of the tastiest foods on the planet contain healthy amounts of the good stuff.

What Are The Best Whole Food Sources of B9?

Some of my favorite ways to get in enough folate every day are:

  • Nuts and Seeds 
  • Legumes
  • Liver
  • Leafy greens (spinach, R=romaine, butter lettuce, greens)
  • Broccoli
  • Cauliflower
  • Brussels sprouts
  • Asparagus
  • Bananas
  • Papaya
  • Mango
  • Avocados
  • Liver
  • Citrus
  • Eggs
  • Beets
  • Edamame
  • Corn

Try incorporating more folate as part of seed cycling!

What Are The Best Prenatal Vitamins?

I have an entire, detailed article devoted to the best prenatal vitamins. In a nutshell, yes, you need to make sure you’re getting enough folate if you’re pregnant or trying to conceive. 

But you also need to make sure you’re getting plenty of the following other nutrients:

  • B12
  • B6
  • Calcium
  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Copper
  • Zinc
  • Magnesium
  • Selenium
  • Iodine
  • Iron
  • Choline

Keep in mind, your body can only absorb so much of most of these nutrients at one time, so you need to make sure you’re taking multiple doses throughout the day, rather than taking large doses all at once.

And, if you want to be sure you’re getting all of these nutrients in optimal doses, I’d encourage you to check out my Prenatal Plus which combines everything you need in one place. It’s a collection of the absolute highest quality nutrients to make sure you and baby get everything you should.  

Your Diet Really Does Matter

I’m hoping that this article will help you understand the crucial role diet and folate supplementation play in health. 

And I know it can be confusing to start from scratch to change your diet and focus on getting all the nutrients you need.

Which is exactly where my starter kit comes in. 

I’ve developed a free resource that includes a ton of amazing content and helpful resources for balancing hormones.

And it also includes a fantastic 7-day meal plan that takes the guesswork out of healthy eating and practically does it for you. You do have to buy the food. But it’s a great guideline that can help you build incredibly healthy and delicious meals that will keep you satisfied, full, and super healthy…since it’s designed to keep blood sugar stable, hormones happy, and includes all those critical nutrients we’ve been discussing. It shows you exactly what foods to eat and when, along with offers tips for making those vegetables delicious. 

It’s completely free and you can download it here

After you do, be sure to let me know how it’s working for you in the comments below. 

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is one of the leading experts in women’s medicine and is a pioneer in her exploration of the far-reaching impact of hormonal birth control and the little known side effects that impact health in a large way. In her best selling book, Beyond the Pill, she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. A trained nutritional biochemist and Naturopathic Physician, Dr. Brighten is the founder and Clinic Director at Rubus Health, an integrative women’s medicine clinic. She is a member of the MindBodyGreen Collective and has been featured in prominent media outlets such as Forbes, Cosmopolitan, ABC news, and the New York Post. Read more about me here.