Folic Acid Vs. Folate - What's the go?
It’s no secret that when you are wanting to fall pregnant, Vitamin B9 also known as folate is essential for the normal development of a baby in utero. In fact, it’s probably one of the first pieces of advice you’ll be given. Although, usually folic acid is prescribed which is the synthetic form of folate. But more recent research has uncovered a genetic defect that makes it extremely difficult for up to 2 in 4 women to effectively convert folic acid, into the active form of folate.
What is folate?
Folate, also know as vitamin B9, is a key nutrient involved in a number of vital functions. In pregnancy, it is most commonly known for preventing neural tube defects but is also involved in DNA synthesis and repair, blood cell production, and rapid cell division during pregnancy through to infancy. Less commonly known is the role folate plays in reducing miscarriage risk and supporting healthy cognitive function. Folate deficiencies are associated with a higher risk of congenital heart defects, low birth weight infants, and preterm birth.
What foods contain folate?
Folate is available in food sources such as legumes, beans, seeds, eggs, organ meats such as liver, and left green vegetables but it is also commonly supplemented during preconception and throughout pregnancy via your prenatal vitamin.
What’s the issue with folic acid?
As mentioned above, folic acid is the synthetic form of folate and in order for it to be converted into something the body can actually use (activated folate or methyl folate. The enzyme in the body that is responsible for converting folic acid into this usable form is the MTHFR (methylene tetrahydrofolate reductase). Unfortunately, not all people are capable of this conversion - in fact, around 40% of the population carries a genetic mutation on the methylation gene – MTHFR, or methylenetetrahydrofolate reductase.
So why does it matter if someone has an MTHFR defect? It matters because if you don’t have the ability to methylate, or your methylation is impaired, your ability to turn folic acid into its active form is reduced. If you don’t have the converted form of folic acid – 5MTHF then the genetic coding of your DNA may not replicate properly which creates a risk of DNA defects in the embryo. DNA defects lead to infertility and miscarriages.
It’s important to also be aware that unmetabolized folic acid is not without harm in the body. If by chance you cannot convert folic acid into folate, and folic acid is building up in your system, you are at risk of increased oxidative stress, inflammation, and vitamin B12 deficiency.
So why is folic acid prescribed, not folate?
Well, to put it simply, most studies that have been conducted on preventing neural tube defects have been done using folic acid, not folate. While we want to be using evidence-based medicine when seeking healthcare options, emerging research dictates that the biologically active form of the vitamin is at least as effective in improving folate biomarkers.
Folic acid is also favoured by supplement and drug companies because it costs less and is more heat stable. This is why you’ll often find prenatal vitamins containing folic acid at a much lower price point than those containing the active form - folate. You’ll note I said often because a lot of supplements contain the exact same folic acid which is government-funded but still over-charge for the form it contains.
Choosing the right type of supplemental folate
The different forms:
Folate: found in natural (unfortified foods), with raw leafy greens being one of the best sources. Folate is also found in grass-fed meats and eggs in smaller amounts.
Folic acid: this is the synthetic form of Folate, manufactured in the lab and used in B vitamin supplements, which will not be converted effectively with people with an MTHFR defect.
Folinic acid: This is an intermediary step in the conversion of folic acid to the active form of the vitamin.
L-Methyl folate. This is a supplemental form of folate that is well-utilized by those with the copying defect, as it bypasses the initial stages of metabolism.
As everyone is individual and has individual needs, it is important to seek individual health care advice. If you have any fertility issues, or in fact any autoimmune or chronic health issues I strongly recommend getting tested for The MTFHR mutation, (which is performed by a blood test, or saliva swab ) as part of your preconception care plan. If you do carry a genetic defect for methylation, supplementing with 5 MTHF – the active form of folic acid can correct the underlying deficiency
References:
Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014;44(5):480–488.
Servy EJ, Jacquesson-Fournols L, Cohen M, Menezo YJR. MTHFR isoform carriers. 5-MTHF (5-methyl tetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genet. 2018;35(8):1431–1435.
Obeid, Rima, Wolfgang Holzgreve, and Klaus Pietrzik. “Is 5-methyltetrahydrofolate an alternative to folic acid for the prevention of neural tube defects?.” Journal of perinatal medicine 41.5 (2013): 469-483.
Ferrazzi, Enrico, Giulia Tiso, and Daniela Di Martino. “Folic acid versus 5-methyl tetrahydrofolate supplementation in pregnancy.” European Journal of Obstetrics & Gynecology and Reproductive Biology (2020).
Serapinas, Danielius, et al. “The importance of folate, vitamins B6 and B12 for the lowering of homocysteine concentrations for patients with recurrent pregnancy loss and MTHFR mutations.” Reproductive Toxicology 72 (2017): 159-163.
