Vitamins
Are You Getting Enough Folate?
Folate and folic acid are not the same, and without B12 and other B vitamins your body cannot properly utilize these nutrients.
Vitamins
Folate and folic acid are not the same, and without B12 and other B vitamins your body cannot properly utilize these nutrients.
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That folic acid is important during pregnancy, you've probably heard before. But do you know the difference between folic acid and folate, and do you understand why the other B vitamins also play a major role? Let's clarify!
Folate, Folic Acid, Folate Equivalents — Are They All the Same?
No, there are some subtle differences:
Folate: This describes the naturally occurring folate found in food.
Folic Acid: This is the synthetic form found in supplements or added to foods.
Folate Equivalent: Since these two forms have different bioavailability, the amount in foods and supplements is often given as folate equivalent (FE). The conversion is: 1 µg FE = 1 µg dietary folate or 0.5 micrograms folic acid (when taken on an empty stomach)
What Role Do the Other B Vitamins Play?
After absorption, folic acid must first be converted in the liver to the active forms 5-methyltetrahydrofolate (5-MTHF) and then tetrahydrofolate (THF) in order to be used for DNA synthesis. The other B vitamins B2, B3, B6, and B12 are needed for this conversion.
Specifically, without B12, the conversion of 5-MTHF to THF cannot take place, and too much 5-MTHF accumulates. This condition is also called the «folate trap».
Here's why: Folic acid supply is actually adequate, but due to B12 deficiency, the available folic acid cannot be used, resulting in symptoms of folate deficiency.
So if you eat plenty of dark green leafy vegetables and think you're optimally supplied with folate, you could still have a deficiency if you consume no animal products and don't take a B12 supplement.
Important to Know:
About 30–50% of Europeans carry genetic variants (e.g., MTHFR C677T or A1298C) that impair the conversion of folic acid and dietary folate to the biologically active 5-MTHF. This means not everyone is able to actually utilize the folate and folic acid they consume in their body.
Furthermore, there is evidence that synthetic folic acid can accumulate at high doses and potentially have toxic effects. For these reasons, it may be worthwhile to take the harmless 5-MTHF directly.
Why Take Folic Acid?
Folate requirements almost double during pregnancy, so ideally, a folate-rich diet and a supplement containing 400 µg should be started several months before conception. If supplementation begins later than one month before conception, a higher dose of 800 µg should be taken (Koletzko et al., 2018).
Here's why: Folate is essential for normal cell growth during pregnancy.
With adequate folic acid supply, the risk of neural tube defects decreases by more than 70% (Obican et al., 2010)!
This malformation of the spine occurs when the neural tube fails to close properly during early fetal development.
The Problem: The closure of the neural tube occurs between days 29 and 30 of embryonic development. At this point, some women don't yet know they're pregnant.
Deep Dive
What Does Homocysteine Have to Do with It?
Elevated levels of homocysteine are often measured in mothers of children with neural tube defects. Homocysteine is an amino acid in our body that, when present in excess, can cause cell damage. However, in regulated amounts, it has a legitimate role and supports the formation of other amino acids.
Vitamins that help regulate homocysteine levels, in addition to folic acid, are vitamins B2, B3, B6, B12, and other substances like choline and betaine. They all contribute to the breakdown and metabolism of homocysteine.
What Else Can Folic Acid Do?
A recent study of 2,000 Canadian women showed that good folic acid supply during pregnancy can reduce the neurotoxic effects of lead exposure on a child's brain development.
The researchers found that the relationship between blood lead concentrations and autism-like behavior in children during the first years of life was stronger when mothers had taken less than 400 µg of folic acid during pregnancy (Alampi et al., 2024).
This finding highlights the importance of folic acid for children's brain development. So even if family planning is still a ways off, it makes sense to start taking folic acid now ;-)
