The Importance of Folate (and Why Supplementing With Folic Acid May Be Necessary)

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  • If you have been pregnant or planning to conceive (or if you know someone who is), chances are you’ve probably been advised to increase your intake of folic acid, or folate. This is one of the top nutrients essential for a healthy pregnancy, as it helps reduce the risk of birth defects
  • You can get a synthetic version of folate from folic acid supplements, multivitamins and fortified processed foods. However, I urge you to make healthy, whole foods your primary source of this nutrient

If you have been pregnant or planning to conceive (or if you know someone who is), chances are you’ve probably been advised to increase your intake of folic acid, or folate. This is one of the top nutrients essential for a healthy pregnancy, as it helps reduce the risk of birth defects.

But the truth is that virtually everyone can benefit from having optimal folate levels, as it has been shown to have a wide array of benefits, especially for brain and heart health. So what does folate, or folic acid, do? Here’s everything you need to know about this nutrient and why you should make sure you’re getting enough.

What Is Folate, and What Sets It Apart From Folic Acid?

Also called vitamin B9, folate is a water-soluble nutrient that is essential in the synthesis of nucleic acid. This is one of a large family of molecules that include RNA and DNA. It is vital for several functions in the body.1

There’s usually a bit of confusion when it comes to folate versus folic acid. Usually, these terms are interchangeably used; however, there are certain differences between the two. Folate refers to the naturally occurring nutrient found in foods, while folic acid is the synthetic form that is usually seen in supplements and sometimes added to “fortified” foods.2

In addition, your body actually uses folate more efficiently, as it regulates healthy levels by getting rid of excess folate through your urine.3 Nevertheless, folic acid can be beneficial as well, but only as long as the correct form is consumed (more on this later).

The Uses of Folate/Folic Acid in the Body

Folate has numerous functions in the body, as it is vital for the:4

Production of healthy red blood cells

Repair and synthesis of RNA and DNA

Rapid division and growth of cells

Protection of heart and brain health

Folate may also have a significant effect on your hearing. One study found that taking a folic acid supplement may help slow down age-related hearing loss.5

Can You Be at Risk of Folate/Folic Acid Deficiency?

If you fail to get enough folate in your body, then you could be at risk of developing folic acid deficiency. One of the hallmark signs of this condition is anemia, as folate is essential for the production and maintenance of red blood cells. Other signs of folic acid deficiency include:6

Fatigue, tiredness or weakness

Sores around the mouth

Irritability

Forgetfulness

Appetite loss

Weight loss

Ideally, you should strive to get folate naturally from your diet. Consumption of healthy, folate-rich foods will help ensure that you have optimal levels of this nutrient in your body. Remember that the human body does not store folate, so you have to get it every day from foods.7

Natural Food Sources of Folate

You can get a synthetic version of folate from folic acid supplements, multivitamins and fortified processed foods. However, I urge you to make healthy, whole foods your primary source of this nutrient.

Vegetables, without question, are your best form of folate. Some of the most ideal sources include spinach, asparagus, turnip greens and broccoli. Beans are another type of high-folate foods, and lentils and garbanzo beans are wonderful options. Other examples of foods rich in folate include:8

Peas and nuts

Citrus fruits and juice

Avocado

Cauliflower

Okra

Celery

Brussels sprouts

Squash

Nevertheless, there are instances when you need to get supplemental doses of folic acid. If you’re pregnant, for example, your folate needs are much higher than that of other people. Unfortunately, not all pregnant women are able to consume a well-balanced, wholesome, folate-rich diet at all times.

For this reason, taking a high-quality folic acid supplement may be the best course of action — but it must be the beneficial form of this supplement.

Here’s What You Should Look for When Buying a Folic Acid Supplement

The problem with many folic acid supplements in the market is that the folic acid they contain is in a form that many people cannot use. This is because for folic acid to perform its beneficial functions, it must first be activated into the biologically active form 5-methyltetrahydrofolate or 5-MTHF. But due to a genetic reduction in enzyme activity, almost half of the population find it difficult to convert folic acid into 5-MTHF.

Therefore, to maximize folate’s benefits, look for a folic acid supplement that contains the 5-MTHF form of folic acid — and not just simply state “folic acid” on the label. 5-MTHF is the form that's most usable by your body and is even able to cross the blood-brain barrier,9 allowing you to reap its brain health benefits.

Why Is Folate (or Folic Acid) Crucial for a Healthy Pregnancy?

Folate has shown a crucial role in ensuring proper neurological development during the gestation period and a child early infancy.10 For this reason, pregnant women are highly advised to optimize their folate levels in order to protect their child from major birth defects, such as anencephaly, neural tube defects and spina bifida.11

Folate is also important for the growth of an embryo’s spinal cord. Since this is one of the first body parts that are formed during reproduction, the pregnant mother’s folate should be at an optimal level during the early stages of fetal development.12 It’s said that the risk of birth defects are highest during the first three to four weeks of pregnancy,13 so this is when folate levels must be optimized. In fact, getting enough folate is advised for all women of childbearing age, even before they become pregnant.

So how much folate or folic acid containing folate as 5-methyltetrahydrofolate is needed during pregnancy? For all women of childbearing age, the recommended dose is 400 micrograms of folate per day. For pregnant women, the same amount is advised during the first three months of their pregnancy. Upon entering the second trimester, until the end of the pregnancy, the dose is increased to 600 micrograms.14 Meanwhile, breastfeeding mothers are advised to get 500 micrograms of folate per day.

Studies Show the Other Benefits of Folic Acid/Folate

Aside from its crucial role in pregnancy, folic acid is said to offer other benefits on cardiovascular, neural and psycho-emotional health. It’s actually an activator linked to various effects, and different studies support these claims:

Reduced risk of stroke — Researchers who tracked the stroke risk of over 20,000 adults with high blood pressure found that those who took a daily folic acid supplement had a 21 percent lower stroke risk than those who are only taking high blood pressure drugs.15

Lower risk of brain shrinkage — Folate helps keep blood levels of the amino acid homocysteine within a normal range, which then helps reduce the amount of brain shrinkage, therefore reducing your risk of Alzheimer's disease.16

Maintenance of normal cholesterol levels — A Polish study found that taking a 0.4 mg of folic acid supplement for 12 weeks helped reduce LDL cholesterol levels in test subjects. Again, this is mainly a result of the reduced homocysteine levels.17

Neurological support — A Korean study found that patients suffering from dementia had low levels of folate and high homocysteine levels, which means it may have a potential effect on neural health.18

Folic Acid for Men: Do They Need It, Too?

In some cases, men may also supplement with folic acid, especially those who want to conceive a child with their partner. There are studies that link optimal folate levels to fertility, particularly to sperm health and function.

One study found that men who have low folate intake produced sperm with incorrect chromosomal structure.19 Another separate study found that male patients who were infertile had significant improvement in their sperm motility after taking a nutritional supplement with folic acid, and were able to successfully impregnate their partners.20

Folic acid may also be prescribed along with methotrexate, a rheumatoid arthritis (RA) drug. This is because this drug can actually block folate, which can then trigger folate deficiency. To prevent this from occurring, patients, whether male or female, must take supplemental folic acid with this medication.21

Supplemental Folic Acid Dosing: Can You Take Too Much of It?

While there’s no risk associated with getting natural folate from food, taking excessive folic acid from supplements may result in side effects, such as:22

Stomach problems

Sleep problems

Skin reactions

Seizures

There are also concerns about the potential of excessive synthetic folic acid intake (from supplements and fortified foods) to an increased risk of certain cancers, including prostate, lung and colon cancers. According to an article in NBC News:23

“In one study conducted in Norway, which doesn't fortify foods, supplementation with 800 mcg of folic acid (plus B12 and B6) daily for more than 3 years raised the risk of developing lung cancer by 21 percent. Another, in which men took either folic acid or a placebo, showed those consuming 1,000 mcg of folic acid daily had more than twice the risk of prostate cancer.”

Researchers also found a potential link between excessive folic acid supplementation and autism. According to a recent study, excessive amounts of folate and vitamin B12 in a mother's body might increase her child’s risk of developing an autism spectrum disorder.24

But this does not mean you shouldn’t be taking folate at all; rather, always consult your physician before taking any folic acid supplement, and follow their recommendation of how much folic acid (from both foods and supplement) you should get in a day. This will help ensure that you’re getting a safe yet optimal dose. And, as mentioned above, opt for the beneficial form, which is 5-MTHF. If you are pregnant or breastfeeding, stick to the dosage prescribed by your physician — do not take more than the advised amount.

Remember: Opt for Natural Folate First

Ideally you should take a folic acid supplement only if you have a drastic need for higher levels, such as if you’re pregnant. Remember, opt for the safe form of supplement, which can be used by your body. Keep in mind that folate is one of those nutrients that you will not have any difficulties getting, as long as you consume a well-balanced, high-quality diet.

As much as possible, optimize your folate levels first and foremost by changing your eating habits. Consume healthy, wholesome foods that are ideally raw and organic — no supplement can ever take the place of this.

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