There is a distinct difference between folic acid and folate, even though we often hear them used interchangeably.
In this post, we’ll explain the differences between folic acid and folate, why folic acid is in most multivitamins, and why a methylfolate supplement may be superior.
Folic Acid vs. Folate
Folate is the naturally occurring and metabolically active form of vitamin B9. Folate is naturally present in a wide variety of foods such as liver, dark leafy green vegetables, avocados, legumes, and asparagus.
Alternatively, folic acid is the synthetic form of vitamin B9 found in many multivitamins, fortified foods, and certain pharmaceuticals.
Your body must convert folic acid to the metabolically active form of folate, L-methylfolate, before your body can use it. Most naturally occurring food sources of folate are already in this active form.
What Does Folate Do?
Folate functions as a coenzyme, meaning it helps other enzymes in the body carry out important jobs.
For example, folate helps convert a compound called homocysteine to an essential amino acid called methionine. Without enough folate, homocysteine will become elevated. High homocysteine levels have been linked to infertility and recurrent miscarriages in some studies. In fact, high levels of homocysteine have been found in 25 percent of women with unexplained, early miscarriages (1). Women with PCOS are also more likely to have elevated homocysteine levels (2).
Among other things, folate is also essential for red and white blood cell production as well as heme production, the iron-rich molecule attached to red blood cells. This is why a folate deficiency can lead to megaloblastic anemia.
Folate is crucial for women’s health as it helps breakdown hormones, aides detoxification, affects mood, promotes a healthy pregnancy, and more.
Why is Folic Acid in Most Multivitamins?
One word: cost!
Unfortunately, many supplement companies formulate their products with the least expensive forms of vitamins in mind. Folic acid is much cheaper to put into a vitamin than the active form, thus you will often see folic acid in most conventional prenatal and multivitamins.
Methylfolate Supplement May be Superior
Taking a prenatal or multivitamin with methylfolate may be more beneficial than taking one with folic acid. Remember, methylfolate is the most active form of folate in the body. It is well absorbed and can effectively raise folate levels in your blood (3).
Best for People with an MTHFR Mutation
Methylfolate supplements are generally recommended for people with a common genetic mutation called MTHFR.
Up to 60 percent of people may have at least one genetic mutation in their MTHFR gene (4). This gene provides instructions to your body to make an enzyme that converts folic acid into the active form, L-methylfolate. If you have two genetic mutations in your MTHFR gene (as seen in 25 percent of Hispanics and 10 percent of Caucausians and Asians), your ability to convert folic acid into the active form is reduced by an estimated 70 percent (5, 6).
Women with this genetic mutation may have an increased risk of migraines, infertility, and neural tube defects during pregnancy (7, 8, 9). By taking a methylfolate supplement instead of folic acid, you are bypassing the defective enzyme and providing the body with active folate that it can use right away.
For women with MTHFR mutations and recurrent miscarriages, taking methylated folate may result in better pregnancy outcomes (X).
Less Likely to Mask a B12 Deficiency
Taking too much folic acid may mask a vitamin B12 deficiency by preventing megaloblastic anemia (often the first sign of deficiency).
However, the detrimental effects of vitamin B12 deficiency span beyond anemia and can cause other symptoms like numbness, tingling, weakness, constipation, loss of appetite, and more (10).
Fortunately, methylfolate supplements do not mask B12 deficiencies, which allows us to treat this deficiency more effectively.
Methylfolate Requires Less Conversions
Lastly, a huge benefit of a methylfolate supplement is that it is already in the active form. It does not need the MTHFR enzyme and can start working right away.
Folic acid, however, requires four conversions to get to the active form and is highly dependent on individual genetics and other nutrients for an effective conversion.
Folic Acid vs. Folate: Which is Better?
Folate is the naturally occuring and active form of vitamin B9 found in food. Folic acid is the synthetic version of this vitamin and is often found in multivitamins, fortified foods, and certain drugs.
The body does not use folic acid very efficiently, especially if you fall into the 60 percent of people that may have an MTHFR mutation. However, even if you don’t have an MTHFR issue, it’s still best to choose more metabolically active forms of folate and avoid high doses of folic acid.
In fact, one case study of a woman with infertility shows that high doses of folic acid may be harmful and actually increase homocysteine levels (11). When this woman stopped the folic acid and was given 500 mcg of methylfolate instead, her homocysteine levels dropped to a normal level within five days! The researchers of this study argue that methylfolate should be proposed instead of folic acid for periconceptional support and even for nutrition supplementation in general.
Excess folic acid has also been shown in an animal study to promote higher insulin levels (combined with insulin resistance), altered cholesterol levels, and a greater likelihood to overeat (12).
Overall, we recommend choosing a prenatal or multivitamin containing methylated folate, which is often seen on the label as:
Additionally, aim to increase your intake of dietary folate by eating more dark leafy greens, legumes, avocados, and liver from grass-fed animals (we realize this last one may take some convincing!).
Nonetheless, it’s always best to discuss methylfolate supplementation with a functional medicine practitioner, especially if you have PCOS, infertility, or other hormonal imbalances. Depending on your genetics, lab results, diet, and underlying condition, your level of methylfolate supplementation may vary greatly!
Here are a few of our favorite prenatal vitamins that include active folate:
Interested in learning more? Contact us today to learn about our personalized functional medicine programs and testing. Yes, we test for MTHFR and associated mutations, and methylation panels to see how your body is functioning.