Folic acid supplements are especially important in pregnancy. But what about folate — and are folate and folic acid the same thing? In this article we’ll take you through everything you need to know about both nutrients. Plus, we’ll discuss why they’re so important in pregnancy and what other health benefits they have.
What is folate?
Folate is the naturally-occurring version of vitamin B9. It’s a water-soluble vitamin which we need for various processes in our bodies. For example, folate helps us metabolise proteins, make DNA and RNA, and produce healthy red blood cells.
It also allows us to break down an amino acid called homocysteine, which can cause damage if levels in the body get too high.(1)
During pregnancy, it’s especially important to get enough folate as it is vital for the healthy development of the foetus.
Folate is considered an essential vitamin, as we can’t produce it ourselves.
You may also hear folate referred to in the plural as ‘folates’. This is because there are a few different types of vitamin B9 with different chemical structures.(2) These include:
- Dihydrofolate (DHF)
- Tetrahydrofolate (THF)
- 5, 10-methylenetetrahydrofolate (5, 10-Methylene-THF)
- 5-methyltetrahydrofolate (5-Methyl-THF or 5-MTHF)
Where can you find folate?
The name folate comes from the Latin word folium, which means ‘leafy’. This is because dark green leafy vegetables like spinach, Brussels sprouts and broccoli are an excellent natural source of folate.
However, you can find folate in other natural foods as well.
If you eat meat and dairy, you can source folate from liver, seafood and eggs. Meanwhile if you follow a plant-based diet, stock up on beans, peanuts, fresh fruit and sunflower seeds.(1)
What is folic acid?
On the other hand, folic acid is the synthetic version of vitamin B9. Unlike folate, folic acid has to be manufactured.
It is available as a supplement (such as tablets, gummies or capsules). Additionally, many producers of basic foods such as cereals, flours, pasta and rice fortify their products with folic acid.
Folic acid in fortified foods
It is very common for nations to fortify food products with vitamins and minerals as part of an effort to improve public health.
For example, since the Second World War, British flour has been fortified with calcium, iron and vitamins B1 and B3 (thiamin and niacin).(4)
In the USA it has been mandatory to enrich wheat flour with folic acid since 1998.(3) Canada, South Africa, Costa Rica, Chile, Argentina and Brazil have similar policies around folic acid fortification.
The UK has been slightly late to the party. The government only announced that it would be mandatory to fortify non-wholemeal wheat flour with folic acid in September 2021.(4)
Are folate and folic acid the same?
Folic acid performs the same function in the body as folate. However there are differences firstly in how it is made and secondly in how the body absorbs it.
Folates from food are naturally quite unstable. That means that the ways we process food sources (like cooking our vegetables) can decrease the amount we’re able to absorb.
Scientists estimate that cooking our veg can destroy around 40% of the folates present in the raw plant. Meanwhile, milling and baking our grains removes up to 70% of the original folate content.(5)
Meanwhile, folic acid is absorbed twice as well as folate from food.(5)
So, while you can get your vitamin B9 from natural or synthetic sources, the amount you need to consume to meet your daily requirement is different.
Related reading
“Folic acid is the synthetic version of vitamin B9. Unlike folate, folic acid has to be manufactured.”
Why is folate or folic acid so important in pregnancy?
Most of us will be aware of folate and folic acid due to their importance during pregnancy.
This is because when a woman is pregnant, both she and the growing foetus need plenty of vitamin B9, thereby increasing the amount needed overall.
Vitamin B9 is important for normal growth and development of the foetus. Deficiency can result in problems for the mother such as anemia and the risk of congenital abnormalities for the baby.(6)
A lack of sufficient folate is particularly linked with a higher risk of neural tube defects in the developing foetus.(3)
This occurs when the baby’s spinal column does not develop properly and it can lead to very serious health problems. These include spina bifida, which can cause partial paralysis, and anencephaly, which results in stillbirth or death shortly after birth.(7)
However, research has revealed that supplemental folic acid can drastically reduce the risk of neural tube defects.
One study found that the risk of neural tube defects was reduced by 70% when the mother had a previous history of pregnancy with the same issue.
Meanwhile a Hungarian study showed a 100% decrease in risk in first time pregnancies.(3)
How much folic acid do pregnant women need to take?
In the USA, the Centers for Disease Control and Prevention (CDC) recommends that all women of reproductive age take 400mcg of folic acid every day. This is in addition to folate from natural food sources.(2)
Meanwhile, in the UK, the NHS recommends that women who are pregnant, trying to conceive or could get pregnant take a 400mcg supplement every day. They can stop taking the supplement once they are 12 weeks pregnant.(8)
Some women who are at a higher risk of pregnancy affected by neural tube defects may need to take a higher dose. Your doctor can advise you on the right amount for you.
Consider folic acid supplements early
If you’re trying to get pregnant, it’s very important to start thinking about folic acid supplementation early on.
This is because neural tube development occurs very early in pregnancy (within the first 3–4 weeks). Many women won’t even realise that they are pregnant during this time, so waiting for a positive pregnancy test may be leaving things too late.
Rather, you should consider taking folic acid as a matter of course if you are trying to become pregnant. This way, if you do fall pregnant during this time you will be covered.
What are the other health effects of folic acid?
Folic acid or folate may also be helpful in other areas of our health.(8)
One area of interest is our cardiovascular health. Remember the special amino acid, homocysteine, which we mentioned right at the top of this article? Folate or folic acid plays a role in breaking it down.
If too much homocysteine is circulating in your system, there appears to be a higher risk of cardiovascular disease.
Hence, if folic acid helps to reduce homocysteine levels, it seems reasonable that there may be cardiovascular health benefits. However, at this stage the research is not conclusive.
There is also some evidence that folate or folic acid plays a role in other diseases, including depression, Alzheimer’s disease and some types of cancer. Again, the research is very limited at this point and we need to know more before drawing firm conclusions.
What happens if you become deficient in vitamin B9?
As well as potentially putting you at a higher risk of cardiovascular disease, a lack of vitamin B9 can disrupt other processes in your body.
As we know, it’s essential for making DNA and RNA.
Severe deficiency in vitamin B9 can cause a condition called megoblastic anemia. Because your ability to make DNA is impaired, your body changes the way it produces red blood cells. Instead of making lots of very tiny cells, you end up making a smaller number of larger cells.
This also affects the way you make white blood cells and platelets.
Unfortunately your larger red blood cells are less efficient at carrying oxygen. As a result, you might experience symptoms such as fatigue, weakness, headaches and shortness of breath.(8)
If you suspect you might have a folate deficiency, speak to your doctor to get a professional diagnosis.
Can you take too much folic acid?
It is extremely difficult to consume too much folate from food sources. However, it is possible to take too much folic acid in the form of supplements.
If you take too much folic acid this way, there are some negative health effects to be aware off.
Firstly, it can mask vitamin B12 deficiency.
There is also a debate in the scientific community about whether high doses of folic acid can contribute to your risk of cancer.
The results of research into the link between high doses of folic acid and cancer have been mixed, with some studies showing an increased risk and others a decreased risk.(9)
There is also uncertainty around potential links between folic acid supplementation and respiratory health in young children. Higher folate concentrations in a mother’s bloodstream might be linked to atopic dermatitis in their children.(9)
Do I need to take a folic acid supplement?
Many people can get enough folate from their diet by eating foods such as leafy vegetables, fruit juice and whole grains.
However, if you are pregnant, the amount of folate or folic acid you need increases. As such, many health bodies around the world recommend taking a supplement.
There is a lot of evidence to support the protective benefits of getting enough folate or folic acid against the risk of your baby developing neural tube defects. These are extremely serious health issues which can result in severe illness or death.
If you choose to take a supplement, be mindful that it is possible to take too much. Speak to your doctor to find the right dose for you, and don’t take more than you are advised.
