Folate vs folic acid during preconception and pregnancy

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By Sara Russell, Ph.D., NTP, CGP
Founder, Feed Your Fertile Body!™ Program

Wondering what’s up with the controversy about folic acid and folate?

As you prepare for conception and move through pregnancy, the health of your baby and the prevention of neural tube defects are likely issues of concern and confusion. There are a number of online sources on folate and folic acid. As a group, these articles can be confusing and contradictory. Typically, they use the terms “folate” and “folic acid” interchangeably. I’ve put together this post to demystify the issue and and offer sensible information you can apply to your situation.

A huge thank-you to my wonderful colleague, Michelle Casey, for reading an early version of this piece and providing feedback!

What’s the difference between folic acid and folate?

So first let’s take a look at the differences between folate and folic acid. Folate is the active form of vitamin B-9 and the form found in foods as well as some select prenatal and other multivitamin formulas. Folic acid is the synthetic, inactive version of the vitamin. It does not occur naturally in foods. Instead, it is typically an ingredient in refined and packaged foods. Folic acid is the form present in most multivitamins, including prenatals.

Unfortunately, not everyone can convert synthetic (inactive) folic acid into active folate. In fact, about 50% of us today have difficulty metabolizing the synthetic forms of this vitamin into usable forms.

Folic acid, folate and MTHFR

You’ve probably heard people talking about MTHFR or MTHFR mutations. This refers to a genetic polymorphism (or SNP) that is strongly associated with autism and chronic disease of many types. MTHFR issues are also associated with an increased risk of miscarriage. Please note that association is not cause. In fact, an MTHFR polymorphism is not in itself a disease and does not directly cause disease.

To make matters more complicated, a highly controversial study argued that whereas low intake of folate was a risk for spina bifida, high levels increased the risk of autism. In response, a number of sources criticized the study for causing undue alarm and for lack of scientifc rigor. You can read one critical perspective here.

Now, let’s break down some reasons for the confusion, beyond the obvious issue of using the terms for the active and inactive forms of vitamin B-9 interchangeably. One way the study caused panic is through hasty conclusions. Surprisingly, it didn’t distinguish between high serum levels of folate and the cause of this phenomenon (inability to activate and use inactive folate). In other words, it attributed autism in children to high levels of folate in the mother, but failed to investigate what caused those high levels in the first place.

Sadly, many pregnant women take folate in a form that their bodies, and those of their babies, cannot properly use. This form, unfortunately, is in most big-brand prenatal supplements.

So what can you do?

Take a prenatal with active folate & avoid folic acid

To begin with, choose quality over quantity. Unless a health condition requires more, 800 micrograms of supplemental folate per day are sufficient during pregnancy.

Moreover, pay attention to how your body responds to your prenatal. When you take active folate in methylated (for example, L-5-MTHF) form, you could have unpleasant side effects due to over-methylation. When you over-methylate, you may feel ramped up, irritable, wired, edgy or inexplicably angry. Look out for these and don’t dismiss them as normal pregnancy related mood swings. Folinic acid is a non-methylated form of bio-available folate. Some high-quality prenatal supplements have one or both forms of active folate, so you have various options to choose from.

Limit your exposure to toxic substances throughout your pregnancy

If you have weaknesses in your methylation pathways, it is harder for your body to detoxify. In fact, it’s plausible that the real reason why pregnant women with high blood folate are more likely to have an autistic child is because of impaired detoxification and nutritional deficiencies in the presence of more toxic substances than the human body was designed to handle.

Third, remember that MTHFR/methylation issues are not in themselves an illness or a cause of any illness. They are instead an increased risk factor. In fact, Dr. Ben Lynch notes that the population with the highest incidence of MTHFR defects is the Southern Italian population. However, their rate of children with spina bifida and autism is considerably lower than that of their American counterparts. This, he has noted, is likely due to the fact that Italians consume more whole foods, including those rich in folate, than Americans. So they are less likely to have a deficiency in active folate, which would in turn impair their ability to detoxify properly.

Getting folate from food sourcesfolate sources

Folate aids in the production of red blood cells and has an important role in cell growth and division and in the function of the brain and nervous system. It is crucial, as such, for your baby’s proper development and growth. Just as you avoid synthetic, bio-unavailable folate in supplements, avoid fortified foods, such as flour and cereal products. These contain synthetic, bio-unavailable, folic acid. Choose whole-food sources instead.

Foods rich in folate include: leafy greens, liver, lamb, asparagus, broccoli, cauliflower, avocado, okra, Brussels sprouts, legumes, sweet potatoes, beets, oranges, cantaloupe, pineapple and berries

The bottom line

There is a huge and not fully understood bio-individual component that makes certain people respond better to certain forms and amounts of folate than others. So you may need to try a few different products before you know what works best for you. There are various forms of folate out there, with the synthetic, inactive form (folic acid) working less well for a lot of people for the reasons outlined above. Some people have a hard time tolerating moderate doses of methylfolate, which is the most biologically active form, and may do better with supplements containing folinic acid (calcium folinate), which is an intermediate form of folate, or a combination of the methylfolate and folinic acid.

Which prenatal vitamins contain active folate?

Below are a few prenatal formulations with bio-available versions of these and other nutrients. You can learn precisely what to look for on the supplement ingredient label in this post by Dr. Ben Lynch. Please speak with your nutritional therapist or holistic health care provider if you need help choosing the right formulation for your situation:

Learn more about folate and folic acid

Concluding reflections

There is a lot of fear around the right kind of supplementation in pregnancy, particularly the right form and amount of folate. In fact, the purpose of this post and of the programs I’ve designed is to educate and empower you so you have the best possible chances of having a happy, healthy pregnancy and a healthy, happy baby.

Learn more about my fertility and pregnancy programs!

The Feed Your Fertile Body!™ preconception program and the Feed Your Pregnant Body!™ pregnancy program demystify nutrition, lifestyle and supplements for parents-to-be. Learn more about the fertility program here, and contact me at with any questions. Make sure you subscribe to the newsletter. You’ll access valuable content as well as additional sneak peaks of the pregnancy program, coming early in 2017!