Folic Acid Vs Folate

If you were asked to explain the difference between the supplement “folic acid”, and the nutrient “folate”, what would you say? If you’re drawing a blank, don’t feel too bad. Most people in the general population, and in fact many healthcare professionals, don’t know the answer. We hear a lot about folic acid, because our food supply is enriched with it, but what exactly is folate?

Focusing my practice on fertility means that I eventually end up treating a lot of pregnant women. One question that comes up often is “How much Folic Acid should I take?”. It’s a really good question and one that ( like so many good questions) begs another question:  Should you be taking ‘folic acid’ at all?

Folate, which refers to the water-soluble vitamin B9, is necessary and important for general health, as it plays an important role in the production of red blood cells, which carry nutrients and oxygen throughout the body. Plentiful in many of the healthy foods you eat every day, Folate is named after “folium”, the ancient Greek word for leaf. So when looking for folate-rich foods think “foliage”. 

The importance of healthy folate status cannot be overstated. In the past 70 years, since its discovery as a major factor is fetal neural tube development, the world has seen a dramatic decrease in neural tube defects such as spina bifida.  

However, the distinction I’m making is between Folate and Folic Acid, which is the synthetic form of this nutrient. The difference lies in the way the nutrient is absorbed.  While Folate is broken down and absorbed in the mucosal lining of the small intestine, folic acid is synthesized in the liver and requires an enzyme called dihydrofolate reductase to convert the folic acid to a bioavailable form.  Low activity of this enzyme could mean increased levels of folic acid introduced into the general circulation.  

There is a question of the safety of having high quantities of unmetabolized folic acid in the blood stream. However, my primary concern is ensuring that women trying to conceive are getting the correct form of this nutrient. You can make sure simply by checking the label on your prenatal vitamin if you’re taking one. Ideally, it should say L-5-MTHF or Methylated folate. If it has folic acid, don’t worry. While it’s non-ideal in terms of bioavailability, a lot of it will still convert to the appropriate chemical form in your liver. But next time you go to the supplement store, check the back of the bottle to ensure you’re taking folate.

And while you’re at it, eat lots of greens and whole grains.