How to Choose the Right Folate or Folic Acid Supplement
Vitamin B9 (also known as folate or folic acid) is available in various types of nutritional supplements - and each has its pros and cons. Here you will learn how these supplements are different, so you can choose the one that best fits your needs.
Folate and Folic Acid – an Introduction
Folate is a water soluble vitamin, also known as vitamin B9. This vitamin is vital for DNA and RNA production, cell division and production of different amino acids in the body.
The word folate is used as an umbrella term that includes different molecular forms of folate found in food as well as those created synthetically in laboratories.
Folic acid is the synthetic form of folate, which is most commonly included into nutritional supplements and multivitamins.
There are quite a few important differences between the various forms of folate and folic acid. They have different absorption rates and once they enter the body, they are metabolized differently.
It is important to know these differences, so you are able to choose the folate/folic acid supplement that best suits your needs. We’ll take a closer look at these supplements and explain the differences in more detail.
In this article, you will find:
Different Types of Folate and Folic Acid Supplements – an Overview
We can divide the available folate and folic acid supplements into 4 major categories.
1. Food Based Folate Supplements
Food based folate supplements contain folate derived from raw foods. The source of folate in these supplements can be any vegetable, rich in naturally occurring folate (broccoli seems to be a popular choice).
It is rare to get food based folate as a standalone formula. Typically, this type of folate is combined with other vitamins and minerals. It is an important part of whole food based multivitamins, prenatals and B complex vitamins.
Food sourced folate supplements are ideal for those people who want to avoid taking any synthetically made vitamins and are planning to take folate as part of food based multivitamin supplement.
Popular choices for food based multivitamins include:
Mary Ruth's Organic Multivitamin (Liquid multivitamin made with certified organic ingredients.)
There is one potential problem with food sourced type of folate, though. This type of folate is notoriously susceptible to oxidation and quickly looses potency during manufacturing and storage. It is generally though that other forms (such as methylfolate or folinic acid) are more reliable in raising blood levels of folate. So, if you need to take folate for a specific health condition (not just as a way of supporting general wellbeing), it is better to choose another form of folate supplement (methylfolate of folinic acid).
2. Folic Acid Supplements
Folic acid is the form of folate that is most commonly included into multivitamins, B complex vitamins or prenatals. There are 2 main reasons for this widespread use: the instability of natural folates and low costs of production of folic acid.
Folic acid seems to be the obvious choice for people who like the ease and convenience of taking multiple vitamins in 1 daily pill - since most multivitamins on the market contain folate in the from of folic acid.
However, other forms of folate have several important benefits over folic acid. If you take the time, you can also find a vitamin pack that contains methylfolate and not folic acid.
Also, there are some groups of people who should always steer clear of folic acid supplements and take another form of folate. These include people with certain medical conditions, genetic mutations, those who are taking specific medications and others.
You can find more details on issues related to folic acid below.
Problems with Folic Acid Supplements
Folic acid is a synthetic molecule that can’t be used directly by the body. Once you take your folic acid supplement, it must first be converted into the form of folate that is circulating in the body, called tetrahydrofolate.
In order to make this conversion, our body uses the enzyme called methylenetetrahydrofolate (MTHFR). It has been shown that a large part of population has impaired activity of this enzyme – there are estimates that between 40 and 60% of people have some degree of MTHFR gene mutation.
If you have this mutation, folic acid that you take doesn't convert well into the biologically active folate. As a result, you may have chronically low levels of folate in your blood – even if you constantly take folic acid supplements.
At the same time, impaired conversion process leaves you with unmetabolized folic acid circulating in your bloodstream. This may potentially lead to a range of adverse health effects.
Taking too large doses of folic acid can also cause problems – even if you don’t have the MTHFR gene mutation. Your body simply isn’t able to utilize all the folic acid that you ingest and some of it remains unmetabolized.
To minimize the risk of long term side effects of overdosing on folic acid, scientists have established the upper intake limit. For adults, this is set at 1.000 mcg of folic acid daily.
3. Methylfolate Supplements
Methylfolate is the most bioavailable form of folate, which means that your body can use it without any conversion. It is a stable, water-soluble folate with long shelf life.
Methylfolate is more expensive to make than folic acid and for that reason it is still not widely used in nutritional supplements. However, as health issues with folic acid are becoming more and more known, methylfolate is steadily gaining popularity.
Methylfolate supplement is the folate supplement that is best suited for a large majority of people.
However, there are some people who should always choose methyfolate over other folate supplements. These include:
- Those who have a diagnosed MTHFR mutation or have a close family relation with this mutation
For this group of people it is absolutely necessary that they get their folate in methylfolate form – they are simply unable to convert folic acid well. Folinic acid is also a possible choice, but not as good as methylfolate (it still needs conversion; however, it is not affected by the MTHFR enzyme)
- Pregnant Women
Many pregnant women are aware of the benefits of folate for the developing baby.
Folate is necessary for the development of new cells and needed for the normal closure of the neural fold.
The number 1 form of folate in prenatal supplements is folic acid. However, if you are pregnant or planning to get pregnant, it is always best to get your folate in the form of methylfolate and not folic acid. The main reason for this is that you may have a mild MTHFR defect that has never been diagnosed. In this case, you are able to convert folic acid to bioactive folate to a certain degree – however, your blood levels of folate may be too low to support healthy pregnancy. Unlike folic acid, methylfolate will reliably raise your blood folate levels.
There are also other benefits of taking methylfolate during pregnancy. Many women find that folic acid causes stomach pain and nausea, while methylfolate seems to be easier to digest. It has also been shown that women who take methylfolate supplement have lower risk of pregnancy anemia than women who take folic acid supplements (1, 2).
- People with B12 deficiency or with higher risk for this deficiency
Folic acid masks the blood signs of B12 deficiency (anemia), which allows the condition to progress and cause irreparable neurological damage. If you’ve been diagnosed with B12 deficiency and need to monitor your condition or you have a close family member with B12 deficiency, you need to take methylfolate supplements and not supplements containing folic acid.
- If you are planning to take folate for brain health, depression or anxiety
Methylfolate is the form of folate that crosses the blood brain barrier and directly enters the brain cells. Once it gets there, it helps with the production of important neurotransmitters (chemical messengers in the brain).
Methylfolate is commonly used for enhancing cognitive function. People with depression take it as a standalone nutritional supplement or together with their anti-depressant medication (it has been shown to enhance the effects of SSSRIs in those people who respond poorly to antidepressants).
Methylfolate is also taken for alleviating the symptoms of anxiety and for mood disorders.
- Older people
As we age, our ability to convert folic acid into the bioactive form of folate decreases (even if we don’t have MTHFR mutation). This leads to associated issues – unmetabolized folic acid in serum and low blood folate levels. That is why older people are recommended to take the bioavailable methylfolate and not folic acid supplements.
- If you take medication that interfere with folic acid metabolism
Some prescription drugs disrupt how folic acid is metabolized in the body. These include:
- Oral contraceptives
- Metformin (medication for blood sugar control, commonly used by diabetics and PCOS patients)
- Anticonvulsants ( valproate, primidone, phenytoin, etc)
- Methotrexate (anticancer medication, also used for rheumatoid arthristis, Chron’s disease, psoriasis)
- Sulfasalazine (used by people with Chron’s, ulcerative colitis and rheumatoid arthritis)
- Certain diuretics (water pills, such as triamterene)
If you take any of these medications, your body won’t be efficient at converting the folic acid that you ingest. That is why it is recommended that you take other, more bioavailable forms of folate supplement, such as methylfolate or folinic acid.
4. Folinic Acid Supplements
Folinic acid is a form of folate that can be found in natural sources. It is more bioavailable than folic acid as it needs a couple of steps less in the conversion process. A major plus of folinic acid is that its metabolism is not affected by the MTHFR gene mutation. Folinic acid is less bioavailable than methylfolate, though.
Folinic acid is the rarest form of folate supplementation. It is typically used by people with specific health conditions.
Folinic acid is taken in the following cases:
- Alongside chemotherapy medication fluoroucacil
Folinic acid enhances the action of fluoroucacil on cancer cells.
- Folinic acid for reducing methotrexate toxicity
Folinic acid is also used by people who take medication methotrexate to alleviate its toxic side effects. This medication is commonly used by people with arthritis and psoriasis.
- Autism spectrum disorder, cerebral folate deficiency and folate receptor antibodies
Folinic acid is also prescribed for some people with autism disorder and conditions related to cerebral folate deficiency and folate receptor antibodies.
- People with anxiety and mood disorders
Sometimes people use folinic acid for relieving the symptoms of anxiety and mood disorders; however, methylfolate seems to have more evidence of use for these conditions.
Folic Acid Supplements
There is a wide range of folic acid supplements that you can choose from. All of these supplements are surprisingly similar, though. They all contain the same molecular form of folate – namely folic acid – and they all have the same added ingredients that make up the tablet (such as binders and fillers).
However, there are a couple of small differences between them. Main things that are different are:
The typical supplemental dose for folic acid is 400mcg, so that explain why so many tablets come in this dosage. You can also find tablets with 800 mcg of folic acid, which are a popular choice among pregnant women.
There are also supplements that contain higher dosages of folic acid. These are created for people who have a diagnosed medical condition that requires high dosages of supplemental folic acid.
These conditions include high homocysteine levels, methotextrate therapy (for example for psoriasis or arthritis) or pregnancy with a high risk of neural defect. Women who have previously had pregnancy with neural defect take up to 5 mg of folic acid daily.
If you don’t fall into the above mentioned categories, though, be careful not to exceed the upper intake limit for folic acid. This is set at 1.000 mcg per day. It is not recommended that you take too much folic acid as this increases the risk of side effects.
Sources of Folic Acid
Most of the folic supplements contain folic acid that is 100% synthetically made. Few of them, however, contain folic acid derived from fruits. The chemical formula of both types of folic acid is the same – only the source is different. Still, for many people this difference is significant.