Someone is not right. (Ding. Ding. Ding. Ding.)
Folate versus folic acid. What was I taught as a medical doctor and pharmacist? No difference. So alert bells chimed in my
head two years ago when I started reading alternative takes on medicine in the effort to fix my gastrointestinal tract (which led to many more benefits in myself and my family than I ever expected) and seeing the “naturalists” crying out against folic acid.
Ding. Ding. Ding. Ding. Discrepancy alert. Need real story. These alternative views felt there was a difference and started slinging around acronyms I had long buried in my medical student past, like MTHF and MTHFR, and referring to tests which could be ordered for diagnosis of disorders revolving around MTHFR deficiencies. They fear-mongered with increased risks of cancer with folic acid intake. With complete honesty and openness, my thoughts at the time were: 1) Geesh, where do they come up with this stuff and these tests? Egads they’re feeding the neuroticism. Getting vulnerable people all worked up. AND 2) My mom always said there’s a bit of truth in every rumor. I really need to look into this. Chuck it on the list to research.
Well, I have finally made it to the “Folate vs. Folic acid” boxing match. I see and relate to the good intentions behind the use of folic acid in our supplemented foods and vitamins, and yet I see and admit the potential failures of folic acid compared to folate. As I’m finding in so many areas I’m reading about now with alternative medical views, medical research is beginning to perhaps support folic acid’s shortcomings too, but it seems to take many decades before things trickle down to the doctors in trenches and the public. Frustrating but true.
Join me as I summarize what I have learned regarding folate and folic acid. My blog posts are a collection of what I have learned. A story. They are not intended for medical advice. Don’t use them that way.
1. Folic acid and folate are both types of vitamin B-9. FOLIC ACID is synthetically made and does not naturally occur in our bodies or in foods. FOLATE usually refers to naturally occuring forms of vitamin B-9, although it can be a wastebasket term to include both folic acid and naturally occuring forms of vitamin B-9.
You really need to read well and scrutinize to figure out how the term “folate” is being used when you see it. Technically, it looks like the term “folate” is used to include ALL forms of vitamin B-9, both natural and artificial. Kind of like a wastebasket, generic term. (You know. Like not all kleenexes are Kleenexes!) However, some sources specify that “folate” is natural and “folic acid” is artificial. In many places, you’ll see the terms folate and folic acid used interchangeably, without regard for any distinction.
Why the terminology looseness across sources? All folates (generic term) share a common structural core. Natural folates and folic acid are structurally and functionally similar and feed into the same pathways in the body–so some sources don’t see a need to differentiate. Don’t take it for granted that an article you’re reading or a vitamin you’re taking is referring to a naturally occurring, physiologic type of vitamin B-9 (folate). If it says “folic acid,” you can be sure it’s the artificial stuff. If it says “folate,” you need to get more details.
In the remainder of this post and the next folate/folic acid post, I’ll use folic acid to refer strictly to folic acid and try to clarify which folates I’m talking about, food-based or otherwise. Due to amount of content, folate/folic acid will take two posts.
2. Real foods contain natural folates, and processed foods (and most vitamins) contain folic acid. The folate in real foods is not as shelf-stable as the folic acid added to foods and vitamins.
Real foods which contain good amounts of natural folates:
- Leafy greens like spinach
- Beans and lentils
- Asparagus
- Broccoli
- Romaine lettuce
- Broccoli
- Mango fruit
- Oranges
- Liver
- Egg yolks
- Wheat germ
The longer fresh, real food sits exposed to air, disconnected from its living source, the more the natural folate breaks down, making the folate content much lower with time. So the closer you are from garden to mouth, the better in regard to natural folates. In addition, cooking will diminish the folate content as well, sometimes quite significantly! So the less you cook foods, the higher the natural folate amount. (Eat a little cooked…eat a little raw…)
On a science note, the forms of folate found in natural foods are primarily tetrahydrofolate (THF), 5-methyltetrahydrofolate (5-MTHF), and 5-formyltetrahydrofolate (5-FTHF). So when people use the term “folate” regarding foods with intrinsic folate content, please know that it’s not just one form. It’s not just “folate.” There are several forms of “folate,” and these three are the most common, with 5-MTHF being the most common. This tidbit of information will come into play later when I talk about why some people won’t do well with synthetic folic acid.
Processed foods with folic acid added include:
- Fortified breakfast cereals
- Enriched bread
- Enriched flours
- White, enriched rice
- Enriched pasta
- Enriched crackers
When grain products are processed, they are stripped of virtually all their naturally occurring folates. In the 1990s, the United States began mandating the addition of synthetic folic acid to processed foods to boost women’s levels of folate in the body and drive down the incidence of neural tube defects (abnormalities in the brain and spinal cord). It worked.
Folic acid is an oxidized form of vitamin B-9 and is used because it is very shelf-stable and inexpensive to make. Folic acid levels won’t diminish as much in processed foods as they sit on the shelf, and it is easily absorbed from the gastrointestinal tract. (And experts thought it was similar enough to natural folates to not cause any problems in the general population…)
3. Back up. What’s vitamin B-9 (folate/folic acid) for anyhow?
If you remember chemistry class, maybe you’ll remember the one carbon group called a “methyl” group. Well, folates carry methyl groups for transfer in cellular reactions in the body. They are involved in “methylation.” This is very important for making our DNA and RNA; for turning off and on genes; for recycling some of our enzymes that are used for “detoxifying;” for reducing our homocysteine (and therefore cutting down heart disease and stroke levels) to recycle methionine; for our red and white blood cells; for production of a fetus; and for neurotransmitter production. This just gives you a basic insight to just how valuable folate is. It’s critical, and you can’t store folates up, so you need a fairly steady supply daily.
4. What does folate/folic acid do in pregnant women?
My own pregnancy is what moved the folate versus folic acid debate up on my “to-research” list. I’m just finally getting around to putting it all together in a post.
Folate (generic term) is important for the developing fetus, and demands for it increase during pregnancy. Without it, there is an increased risk of neural tube defects like spina bifida (an opening in the spine) and anencephaly (lack of brain formation), congenital heart defects, and possibly preterm birth. For reduction of neural tube defects, enough folate/folic acid needs to be present at conception and very early in pregnancy, often before a woman knows she is pregnant! (A plug to eat good nutrition lifelong!)
Adding folic acid to the US and Canadian processed food supply in the 1990s decreased the occurrence of neural tube defects (NTD). The authorities didn’t feel it was possible or reliable to get enough folate through diet to diminish the risks of these serious birth defects. However, supplementation of folic acid may not be adequate for women with a disorder known as methyltetrahydrofolate reductase deficiency (MTHFR deficiency), which is actually pretty common! I’ll talk about this next post and also address alternative forms of folate supplementation which could be considered. Women with a personal history of NTD, prior birth history of NTD, or family history of neural tube defects may have a higher incidence of 5-MTHFR deficiency and will want to know about this.
Closing
Thanks for reading. Eat lots of folate-rich natural foods! Next post we will explore much more deeply why folic acid may not be “as good as” natural folates and may even be detrimental for people! After researching, I’m a big fan now of natural folates. I work very hard to eat leafy greens daily and liver weekly, both great sources of natural folate. Folate is now a word we use commonly in the house to teach the kids about the food they eat. The more they understand WHY we eat, the better they actually WILL eat. (This post is just a precursor to what I think is such an interesting and fascinating second post, which will describe more why folic acid is demonized.)
~~Terri
Links to Sources:
1. https://tspace.library.utoronto.ca/bitstream/1807/30137/1/Lakoff_Alanna_D_201006_MSc_thesis.pdf
The HSD 