Folic Acid vs Folate: Why does it matter?

Some of you may have heard that a number of companies have switched from using folic acid to methylated folate in their prenatal supplements. We thought we would explain what the difference is and why it matters which form you take it in.

What’s the difference?

Folate is a water soluble group of B vitamins (also known as vitamin B9) these are naturally occurring and most commonly found in green leafy vegetables, eggs and liver. Folic Acid is the synthetic oxidised version of this and is commonly found in supplements and used to fortify foods. 

Why do we need it?

Folate is necessary during rapid cell division and growth which unsurprisingly means that we double our requirement for it during pregnancy. Inadequate folate levels are also associated with the following:

• Anaemia
• Incidence and recurrence of Neural Tube Defects (serious birth defects of the spinal cord and the brain which arise during the early development of the embryo, most common being spina bifida)
• Increased risk of certain cancers
• Elevated Homocysteine which is a risk factor for cardiovascular disease and stroke.
• Raised homocysteine has also been linked to infertility and risk of repeated early miscarriage as well as risk of pre-eclampsia during pregnancy. A large Norwegian study found links with more pregnancy complications e.g. placental abruption (detachment from the uterus) and also low birth weight babies.
• certain drug medications also result in low folate e.g. anticonvulsants, methotrexate, also non steroidal anti-inflammatories such as ibuprofen and diclofenac, aspirin, the anti-diabetic drug metformin, corticosteroids such as prednisone and cholesterol lowering medications. For a detailed list go to http://umm.edu/health/medical/altmed/supplement-depletion-links/drugs-that-deplete-vitamin-b9-folic-acid (However, do not supplement without requesting advice from your doctor, pharmacist or registered Nutritional Therapist as many nutrients can interact with particular drugs and lead to either increased or decreased potency. ) 

So why does it matter which form I take it in?

In order to convert folic acid into the folate that we need, it has to undergo reduction and methylation in the liver. Unfortunately, around 40% of the population have methylation issues particularly those with an MTHFR SNP (Methyltetrahydrofolate Reductase Single Nucleotide Polymorphism). Therefore, to ensure you are getting enough folate it would be preferable to supplement with bio-available folate rather than folic acid to ensure you are getting what your body needs. 

Are there any other benefits? 

A study by Bentley et al, found that mothers who supplemented with folate, compared with those taking folic acid, had increased haemoglobin levels at the end of the 2nd trimester and at delivery and that cases of anaemia were lower. 
Other defects such as cleft palate and tounge tie are also being linked to MTHFR and poor methylation. Therefore, supplementing with folate may help reduce the occurrence of these conditions (although genetics has its role to play).

Is it only pregnant women who need to be aware of this?

Folate deficiency has been found to be high in a range of psychiatric disorders including depression, dementia and schizophrenia. Epileptics taking anticonvulsants are very often low in folate as these drugs inhibit folate absorption. As mentioned above elevated homocysteine levels are a risk factor for cardiovascular disease and stroke. Therefore people at risk of these conditions due to symptoms such as hypertension or those with a family history of cardiovascular disease may wish to consider supplementing with methylated B vitamins. You may also want to consider asking your GP for a homocysteine blood test to assess your risk. 

​Which foods should I increase to provide folate?

​Dark leafy greens are tops such as spinach and romaine lettuce. In fact the word folate actually comes from the latin word 'folium' meaning foliage, so it's no surprise that the leafy stuff is going to be an excellent source.  Also broccoli, cauliflower, sprouts, beans, peas, lentils, nuts and seeds, avocado and asparagus give good amounts. Citrus fruits are also high in folate along with papaya. In short, as long as you eat a goodly array of vegetable and fruits and really emphasise the green varieties you will boost your folate levels well. What you may be less aware of is that liver also gives us an excellent source of this valuable nutrient.  


(Testing for MTHFR SNPs and other genomics testing is available through our clinic. Homocysteine testing is also available and allows us to optimise your B6, B12 and  folate to maintain health promoting levels, reducing risk factors for disease and also to optimise fertility and healthy pregnancy for mum and baby.     Enquiries through [email protected])

M​ore on our support for Fertility here

References:
http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.2007.tb00275.x/abstract
https://www.ncbi.nlm.nih.gov/pubmed/21440300
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250974/#B2
https://academic.oup.com/aje/article/157/7/583/69692/Does-the-Interaction-between-Maternal-Folate
https://www.ncbi.nlm.nih.gov/pubmed/2682787
 http://ajcn.nutrition.org/content/77/2/467.abstract