Folate is the natural form of vitamin B9, which helps with cell development and metabolism. Folic acid is the synthetic form of vitamin B9 (i.e. made in a lab) which must be synthesized in the liver before it is able to perform its functions in the body.
In 1998, the FDA began to require certain foods to be enriched with folic acid, particularly flours, breakfast cereals and bread. The goal of this fortification was to reduce the incidence of neural tube defects in infants (which is caused in part by not getting adequate folate from the diet). The neural tube is one of the first structures to form within an embryo, usually during the first 6 weeks of pregnancy, often before many women know they are pregnant! This regulation has been incredibly successful at reducing the occurrence of NTDs in this population.
The folic acid vs folate story gets a little more complicated from here. Folic acid must undergo several conversions in the body – first to dihydrofolate- DHF and then tetrahydrofolate- THF before it’s final form of L-methylfolate, which is the active, usable form. The enzyme methylenetetrahydrofolate reductasteor MTHFR for short, is critical to this conversion process.
If you’re TTC or an expecting mother, your folate needs are higher than the average population.
However, in the US, studies estimate that up to 60% of the population do not properly convert folic acid to L-methylfolate due to a genetic abnormality with the MTHFR enzyme. This can potentially lead to a reduction in usable folate despite supplementation, or even to folate buildup in the liver due to processing issues, which may cause serious health issues such as increased risk of cancer.
Luckily, supplements that contain the “L-methylfolate” form of folate rather than folic acid are becoming more readily available and do not come with the same conversion issues of folic acid.
If you are eating a varied diet that is rich in plant foods, you are likely getting enough folate without the need for additional supplementation. Great sources include dark leafy greens, broccoli, asparagus, cauliflower, avocado, artichokes, beets and lentils – all the healthy foods you should be eating anyway! Try loading up on spinach or other dark leafy greens in a smoothie, eggs or stir fry to bump up your daily folate intake.
If you’re TTC or an expecting mother, your folate needs are higher than the average population. Women who are pregnant or TTC should aim to get 600 mcg of folate daily – usually as part of your prenatal vitamin. Make sure to look for supplements that contain the form called “L-methylfolate”, which as we mentioned previously, is the safer and more bioavailable form of folate.