Vitamin B9: Folate vs. Folic Acid… what’s the difference?

Before I begin, I want to say that not everybody will necessarily have an issue with the 'form' of vitamins found in their supplements. This article is simply meant to highlight that there ARE differences in the form of vitamins that are available on the market and we now have evidence to show how these differences may impact your health/wellbeing and your pregnancy.

If you’ve been using synthetic vitamins with no health problem, then great! At the end of the day that’s all that really matters. We are all unique beings and we all have little nuances with our health goals or concerns. This article is for people who have been struggling and want to learn a bit more on this topic. Let us begin!

Vitamin B9 is also known as folate and there are hundreds of different forms of folate naturally occurring in food. For the rest of this article, remember that folate refers to the active form of vitamin B9.

Folic acid on the other hand, is SYNTHESIZED in a laboratory setting. This synthetic form of vitamin B9 is used to fortify many processed foods like breads, cereals, crackers, granola bars, etc. Take a look at your bread and it might say “contains 100% of your daily requirement of folic acid”. You can also find synthetic folic acid in sport electrolyte drinks, pre-workout beverages, health food bars and vitamin supplements - including your prenatal vitamins or multivitamins.

I’ve circled in the diagram below how similar, yet different the biochemical structure looks like of folate, folic acid and folinic acid… notice how their molecular structure varies by one methyl group:

Source: https://lpi.oregonstate.edu/mic/vitamins/folate

Historically, here is where the controversy lies:

When folate was first discovered to be beneficial in preventing neural tube defects in pregnancy, all the research that was done on folate at the time was using the form of SYNTHETIC FOLIC ACID. This is why many doctors today will still tell their patients that there is no difference between synthetic folic acid and folate. Since then, science on this topic has evolved tremendously! So… if your healthcare provider said that folic acid is best, they likely are sharing the knowledge that they received during their training.

Here is what we now know…

Folic acid is metabolically INACTIVE and it requires our body to undergo a process called “methylation” to activate it. Methylation adds a methyl group to the synthetic folic acid so that it can become the active form of folate, before your body can actually use it.

Here is how this biochemical process happens:

Source: https://lpi.oregonstate.edu/mic/vitamins/folate

Here are two problems with assuming that folic acid and folate are the same:

👉Genetically, 30-40% of people may have a gene variant to the enzyme MTHFR that is involved in methylation. What does this mean in simple terms? It means that if you take synthetic folic acid, 30-40% of people may not be able to fully convert the synthetic folic acid into active folate for your body to use. Remember, your body UTILIZES FOLATE, not folic acid. You can get a genetic test to see if you have a genetic variant to one of the MTHFR enzymes putting you at greater risk, but this is never done on routine lab work in our OHIP medical system.

👉There are risks associated with EXCESS consumption of un-metabolized folic acid. I really don’t want to scare people here, so ask me at your next appointment if you’d like to know more about this.

Another controversial point on this topic:

Synthetic folic acid has been shown to be well-absorbed in the body. Absorption, however, is NOT THE SAME THING as utilization. Your body cannot utilize folic acid until it is methylated into active folate.

When you are pregnant the type of folate that is transferred to your baby is methyl-folate, not folic acid. When you are pregnant, the important time to have optimal folate levels is before week 6 of pregnancy!

Here’s why:

the neural tube (which forms the brain and spinal cord) fully closes by week 4-6 of pregnancy! Meaning, the neural tube is closed before you even know you are pregnant!😱 All the major organs are also nearly formed by week 8 of pregnancy. Most women don’t even get an appointment with their OB or midwife until they are at the end of their first trimester (week 12) of pregnancy. This is why I always encourage you to meet with your ND or healthcare provider with a focus on fertility who can help guide you with a health plan during this critical time of development… especially if you have a history of infertility or miscarriage.

Folate been shown to prevent neural tube defects like spina bifida and anencephaly. When taken BEFORE you get pregnant and during your first trimester, folate has been shown to decrease the risk for neural tube defects by 50-70% (CDC). 🤩

Here’s what you may not know... midline closure issues like cleft lip, cleft palate, ankyloglossia (tongue or lip tie), bicornuate (heart shaped) uterus, etc. *may* also be linked to inadequate folate metabolism! Research is evolving in this area. We don’t have the all the answers to everything and it can take decades for certain research findings to finally make it into standard care practices.

Another thing you may not know, excess folic acid intake can mask a vitamin B12 deficiency. It is far more common in pregnancy for women to over-supplement with folic acid because they heard it is good for them. This may cause a type of anemia called megaloblastic anemia (i.e. vitamin B12 deficiency anemia). Vitamin B12 is essential in brain and central nervous system development. If a certain vitamin is good, it does’t mean that taking a lot of that vitamin is better. Safety first! This is why I always encourage my patients to have certain labs tested at different points in their pregnancy to ensure everything is balanced. These labs are not always part of routine lab testing.

Why do supplement companies even use synthetic folic acid in their vitamins?

Synthetic folic acid is much less expensive to manufacture than active folate. It all comes down to cost.

Talk to your ND about what you can do BEFORE pregnancy to help mitigate any potential undesired outcomes. Not all vitamins are created equal and in Canada, there is unfortunately no standardization for the requirements of what should be in your prenatal vitamin.

Lastly, always remember that you may not have any issues converting synthetic folic acid into active folate. There are plenty of women who take the standard prenatal vitamins and have no problems. This article is meant to provide information and spark discussion points that you can have with your own healthcare team so that you can be empowered to make decisions that are best for you and your baby.

Have a great week!

References:

PMID: 23482308

PMID: 18326588

PMID: 29360980

PMID: 19193985

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PMID: 23480969

PMID: 9457954 PMID: 28689805