Tanya Smith Acupuncturist Chinese Medicine Practitioner

Folate vs. Folic Acid: Which one is best in pregnancy?

Pregnant BellyThere is no argument that folate (sometimes – mistakenly – referred to as folic acid) is important for the health of a developing baby.

In early pregnancy (for the first 28 days) the fetus is rapidly dividing cells that form the neural tube. The neural tube becomes the baby’s brain and spinal cord. If there is not enough folate in the mother’s system before pregnancy and in early pregnancy, it can result in problems with the way the neural tube grows or what’s called a neural tube defect.

Sources of folate

Folate gets it’s name from the word foliage or leaves and is in high concentration in leafy green veggies. Folic acid is created in a factory.

Our ancestors grew healthy and well-formed children for thousands of years without supplements. On average, they ate about 10 times more leafy greens than we do. They also got folate from sea vegetables and organ meats like liver. Legumes and chickpeas are also excellent sources, as are citrus fruits.

As our diets changed and we started eating more processed foods and less nutrient dense foods, the incidence of neural tube defects increased. In the interest of public health, the Canadian government decided, in 1998, to try to prevent neural tube defects by fortifying wheat flour with folic acid (instead of educating us to eat more leafy greens!).

Folate vs. Folic Acid

These days, women are encouraged to take folic acid supplements during pregnancy. And although it does appear to decrease the incidence of neural tube defects, folic acid is not folate. They differ in some very important ways:

  • Folate is the naturally occurring B-vitamin found in foods like broccoli, spinach, lentils and liver. When we eat foods containing folate, it is converted to the metabolically active 5-methyltetrahydrofolate (5-MTHF) and travels via the blood directly to the cells.
  • Folate is a critical in the production and maintenance of new cells. It is part of the system that synthesizes DNA and RNA when new cells are formed and prevents changes or mutations to DNA. When cells are rapidly dividing in pregnancy, folate is required in large amounts for the correct formation of each cell of the baby.
  • Folic acid does not occur in nature. It is a synthetic substance that our bodies can turn into a usable form, only after it has undergone 2 conversions in our liver. It is a very inefficient way to get what we need.
  • About 30% of the population has a genetic variation (MTHFR) that doesn’t allow for the conversion of folic acid to a usable form of folate, so these people can unknowingly become folate deficient, even when they are supplementing with folic acid.
  • Folic acid that is not converted in the liver can build up in the blood stream and studies are starting to show increase the likelihood of some types of cancer. Folic acid will not lower the risk of cancer as folate does.

Which supplement is best?

Ideally, we would be able to get all of our nutrition from our food but in pregnancy that can sometimes be difficult. This is where prenatal vitamins are helpful. Unfortunately, most prenatal vitamins contain folic acid instead of folate because it is cheaper. It will help prevent birth defects but won’t have all of the health benefits of folate.

A better option is to take the biologically active form of folate, 5-MTHF in supplement form. I would strongly recommend supplementing with this instead of folic acid. 400 mcg per day is the recommended dose to prevent disease, but I recommend 600-800 mcg per day for optimal health.

Check the side of the bottle. If you see “folate” “5-methyltetrahydrofolate” “Metafolin” or “L-methylfolate” that’s the one you want.

If you are wondering how much folate is in your diet, check out this resource!


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