Folic Acid vs. Folate: What's the Difference and Why Does it Matter for Pregnancy?
If you're trying to conceive or are already pregnant, you've likely heard the terms "folic acid" and "folate" thrown around a lot. But do you really understand the difference between the two? And more importantly, does it actually matter which one you take?
The truth is, the folic acid vs. folate debate can get pretty confusing, with a lot of conflicting information out there. Some experts tout the benefits of folate, claiming it's a more natural and better-absorbed form of vitamin B9. Others insist that folic acid is just fine, and that you don't need to worry about getting the "right" type.
So, what's the real story? In this comprehensive blog post, we'll dive deep into the science, research, and expert recommendations around folic acid and folate. By the end, you'll have a clear understanding of:
The key differences between folic acid and folate
Why folate is so crucial for pregnancy and fetal development
The role of MTHFR gene variants and how they impact folate metabolism
How much folic acid/folate you really need before and during pregnancy
Tips for choosing the best prenatal vitamin for your needs
Let's get started!
Folate vs. Folic Acid: What's the Difference?
To understand the folic acid vs. folate debate, we first need to define the key terms. As Dr. Prati Sharma, a board-certified reproductive endocrinologist, explains:
"Folate is a water-soluble B vitamin that's used by our bodies to make new cells. It's the natural form of vitamin B9 that's found in foods like leafy greens, eggs, avocados, and legumes."
Folic acid, on the other hand, is the synthetic form of folate that's added to supplements and fortified foods. As Dr. Sharma notes, "Folic acid is more stable and easier for the body to absorb than the natural folate found in foods."
But the story doesn't end there. Folic acid actually needs to be converted into the active, usable form of folate in the body - a process that's facilitated by an enzyme called methylenetetrahydrofolate reductase (MTHFR).
This is where things can get a bit complicated. As Dr. Sharma explains, "About 40% of the population carries a variant of the MTHFR gene, which means they may not metabolize folic acid as efficiently into the active methylfolate form."
In other words, for those with certain MTHFR gene variants, taking folic acid supplements may not be enough to ensure they're getting adequate levels of the active, usable form of folate. This is where the debate around folic acid vs. folate supplements comes into play.
The Crucial Role of Folate in Pregnancy
Before we dive deeper into the folic acid vs. folate discussion, it's important to understand why folate is so critical, especially during pregnancy.
As Dr. Lora Shahine, a double board-certified reproductive endocrinologist and OBGYN, explains, "Folate is the building block for DNA and RNA synthesis. It's essential for the proper development of the baby's neural tube, which forms the spine and brain."
In fact, the importance of folate for preventing neural tube defects (NTDs) like spina bifida and anencephaly was discovered in the 1950s. As a result, the U.S. began fortifying certain foods with folic acid in the 1990s, leading to a dramatic 93% decrease in the incidence of NTDs.
Dr. Shahine emphasizes the gravity of this, noting, "Neural tube defects can either be spina bifida, where the neural tube doesn't close, or anencephaly, where the baby forms without a brain - which is not compatible with life."
Given the critical importance of folate for fetal development, the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists (ACOG) recommend that all women who are planning a pregnancy or could become pregnant take 400-600 micrograms of folic acid daily.
The MTHFR Gene Variant Debate
As mentioned earlier, the MTHFR gene plays a key role in the conversion of folic acid into the active, usable form of folate. And this is where the folic acid vs. folate debate really heats up.
Some experts argue that those with certain MTHFR gene variants may not be able to effectively convert folic acid into methylfolate, the active form. This, they claim, means that these individuals would be better off taking a prenatal vitamin that contains methylfolate instead of (or in addition to) folic acid.
However, as Dr. Sharma points out, "Universal screening for MTHFR is not recommended or evidence-based." She explains that while about 40% of the population does carry an MTHFR gene variant, "the data does not support testing for MTHFR in most clinical scenarios."
In fact, Dr. Shahine notes that the prevalence of MTHFR gene variants is estimated to be between 60-80% worldwide. "Whether you test positive or not, it's not going to tell us if you have a higher risk of neural tube defects or miscarriage," she says. "I'm going to recommend the same amount of folate, whether it's in the form of folic acid or methylfolate, regardless of the result."
So, while some supplement companies and wellness providers may tout the benefits of methylfolate over folic acid, the medical consensus seems to be that for the general population, the standard recommendation of 400-600 micrograms of folic acid is sufficient - with or without an MTHFR gene variant.
How Much Folic Acid/Folate Do You Really Need?
The recommended daily intake of folic acid for women who are planning a pregnancy or could become pregnant is 400-600 micrograms, according to ACOG and the U.S. Preventive Services Task Force.
However, there are some exceptions to this general guideline:
High-risk pregnancies: Women with a personal or family history of neural tube defects, or who are taking certain medications (like anti-seizure drugs), may need a higher dose of up to 4 milligrams of folic acid per day.
Vegetarians/vegans: Those who don't consume animal products may need to supplement with a higher amount of folate, as plant-based diets tend to be lower in this nutrient.
MTHFR gene variants: As discussed, some experts recommend a "hybrid" prenatal vitamin that contains both folic acid and methylfolate for those with MTHFR gene variants. However, the medical consensus is that the standard 400-600 micrograms of folic acid is still sufficient for most people.
It's important to note that while higher doses of folic acid (up to 5 milligrams) have been studied, the evidence on potential risks is mixed. Some research has suggested links to autism and other mental health disorders, but the data is still inconclusive.
As Dr. Sharma advises, "There's nothing that's shown causation. But again, what's the recommendation? What are our guidelines? 400 micrograms of folic acid should be plenty, and eat a diet rich in folate."
Choosing the Best Prenatal Vitamin
With all this information in mind, how do you choose the right prenatal vitamin for your needs? Both Dr. Shahine and Dr. Sharma offer some helpful tips:
Look for 400 micrograms of folic acid: This is the standard recommended amount, unless you have a specific high-risk condition that requires a higher dose.
Consider a "hybrid" prenatal: If you're concerned about MTHFR gene variants, a prenatal that contains both folic acid and methylfolate may provide an extra layer of reassurance.
Prioritize third-party testing and verification: In the U.S., the supplement industry is largely unregulated, so it's important to choose a brand that has been rigorously tested and approved.
Focus on overall nutrient profile: A quality prenatal should contain not just folic acid/folate, but also other key nutrients like iron, choline, and vitamin D.
Consider your individual needs and tolerability: Some women do better with gummy or chewable prenatals, especially if they struggle with nausea in early pregnancy.
Ultimately, the most important thing is to find a prenatal vitamin that you can consistently take - one that provides the recommended nutrients without causing unmanageable side effects.
As Dr. Sharma emphasizes, "As long as you know the guidelines and you are taking your prenatal vitamin rigorously, you're going to be just fine. Don't worry - nothing bad is going to happen if you forget a few days here and there."
Staying Calm and Confident
The folic acid vs. folate debate can certainly be confusing and overwhelming, especially for those trying to conceive or newly pregnant. But the key takeaways are:
Folate is crucial for fetal development and preventing neural tube defects.
The standard recommendation of 400-600 micrograms of folic acid daily is sufficient for most people, with or without MTHFR gene variants.
While methylfolate supplements may provide an extra layer of reassurance for some, the medical consensus is that folic acid is still an effective and safe option.
Focus on finding a high-quality prenatal vitamin that you can consistently take, rather than getting caught up in the hype and fear-mongering around supplements.
Remember, the goal is a healthy pregnancy and baby - and with the right information and support, you can feel confident that you're doing everything you need to support your reproductive health.
Additional Resources for Support
Dr. Shahine shares a wealth of additional resources to help those struggling with infertility and pregnancy loss. These include:
Dr. Shahine's free newsletter, which provides ongoing support and education
Her "Brave and Curious" podcast, which delves deeper into fertility-related topics
Her books on fertility and miscarriage, including the best-selling "Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss"
Her active social media presence on Instagram, TikTok, Twitter, Facebook, and LinkedIn
Stay brave, stay curious, and trust that you've got this!
