Thinking Twice About Loading Up On Folic Acid For Fertility And Pregnancy

If you’re reading this, you have probably heard by now the importance of folic acid in early pregnancy. One of the first things anyone TTC or newly pregnant does is invest in a prenatal vitamin, specifically for the folic acid. Most of us probably swallow the vitamin and forget about it, chalking it up as yet another routine TTC/pregnancy ritual, like taking your basal body temperature or going to your monthly prenatal appointments. 

But what is folic acid? And should you be giving your prenatal vitamin more consideration?

If you’ve done your own research, you’ve probably read that folic acid is actually the synthetic form of folate, also known as B9 because it is a member of the B-vitamin family. Folate is absolutely essential for the production of new DNA, and new DNA is needed for all new cells. Chris Kresser, a renowned expert, leading clinician, and top educator in the fields of Functional Medicine and ancestral health states that as a baby grows in the womb, constant cell division takes place, which requires the continual production of new cells. This, in turn, requires a large supply of folate. Folate also promotes healthy neural tube formation, adequate birth weight, and proper development of the face and heart.

Unfortunately, most people consuming the Standard American Diet (SAD) likely aren’t getting enough folate. You may be thinking, “But l’ve seen many food labels with folic acid listed as an ingredient. How could most people not be getting enough?” To which I say, it’s important to understand that the folic acid and folate are not the same thing, even though they are often used interchangeably. 

Folic Acid

Back in the 90s, the Food and Drug Administration (FDA) required that enriched grain products be fortified with folic acid because scientists linked folate deficiency with neural tube defects. The theory was that if certain families could not afford prenatals for themselves, pregnant women could still get enough folate from their fortified foods to protect her and her baby from the harmful consequences of folate deficiency. Since that time, neural tube defects have dropped by as much as 31%(1). This seemingly miraculous public health breakthrough has led to other countries considering similar programs. You might be thinking this sounds great! So, what’s the issue?

Well, folic acid, the synthetic form of folate, does not occur naturally in our body, nor is it found in nature. It’s inexpensive to source and shelf stable, which is why it’s found in so many processed foods. 

The problem with folic acid is that it must go through a conversion process to become the active form of folate that the body can actually use in other biological processes. Even for people who are able to convert folic acid, it’s a time and energy consuming process and not very efficient. On the flip side, some people, an estimated 40-60% of the population to be exact (2), aren’t able to convert folic acid efficiently or even at all, especially individuals with certain variations in certain genes, such as the MTHFR gene. 

What does that really mean though? If you aren’t able to convert and use the folic acid you are taking in, and you are supplementing with folic acid and/or eating a lot of processed, fortified foods on top of that, you can end up with too much unmetabolized folic acid circulating in your blood, which scientists are learning may not be a good thing. 

There is some evidence that too much folic acid can increase DNA methylation, and therefore spike cancer risk, especially in older people. It also may increase insulin resistance and lead to other health problems down the line for mom and for baby. Yikes, you probably want to toss your prenatal right away, right? Not so fast! Too little folate can also have adverse effects including birth defects, increased risk for cancer, and even dementia. But notice that I said folate and not folic acid. So what exactly is folate?

Folate

Folate, in contrast to folic acid, is naturally occurring in our bodies and in nature. It’s found primarily in dark leafy vegetables, beans, peas, nuts, oranges, lemons, bananas, melons, and strawberries. It’s also in eggs and the ancestral fertility powerhouse liver! Eating a whole foods diet is the best and safest way to get the right amount of folate in your diet for most people. 

However, a diet lacking in folate can lead to folate deficiency and is especially prevalent in people who have medical conditions that might impact their ability to absorb nutrients from food, such as celiac disease. Individuals who are pregnant or TTC most likely benefit from folate supplementation. 

Another instance where supplementation might be warranted is TTC or pregnancy because pregnant women need twice the amount of folate compared to non-pregnant people. The Recommended Dietary Allowance (RDA) for folate during pregnancy is 600 mcg/d, 50% higher than the non-pregnant RDA of 400 mcg/d. However, even when regularly consuming the foods listed above, it may be difficult for a pregnant woman to obtain the necessary amount of folate. Also, the pregnancy RDA is based on the amount needed to prevent birth defects—not promote robust health. It also assumes that 50% of the folate consumed is absorbed. But studies show this is just an average, and the rate of absorption from food is dependent on many factors, including zinc status. Therefore, I recommend a total amount of between 800 and 900 mcg/d from food and supplements combined.(3)

We want to ensure that we are getting folate in the right form and the right amount. However, there are some things to consider and ways that you can ensure that you are getting the natural folate that your body needs for a healthy pregnancy vs. synthetic folic acid.

 

So What Should I Do About My Prenatal? 

As we discussed above, an estimated 40-60% of the population struggle to convert folic acid into folate. That’s a staggering number of people who aren’t able to efficiently use the folic acid that’s found in fortified foods and supplements. This means folic acid probably isn’t the best bet for most moms-to-be, and maybe not for the general population either, but that’s another blog topic. And no, you don’t need to run out and get genetic testing to navigate this one. 

The answer is simple: just use a prenatal with either folate, folinic acid, or 5-methyl folate. It’s important to get a high-quality prenatal with folate that your body will actually be able to use to optimize you and your baby (or future baby’s) health. These 3 forms of folate will do just that because they are readily absorbed and used by the body, won’t mask symptoms of vitamin B12 deficiency which can happen with folic acid supplementation. Further, they can be safely used by individuals with metabolic defects caused by MTHFR mutations. Lastly, they prevent the potential negative side effects of too much unmetabolized folic acid circulating in the bloodstream. 

If you are having trouble finding a prenatal that will work best for you, here is a link of trusted prenatal supplements that we recommend.

Bottom Line

Folate should be an important part of your prenatal diet, both in whole foods and supplemental forms. Just be sure you’re not sourcing your folate from the synthetic form of folic acid found in many prenatals, or in fortified foods – so read those food labels and avoid this when possible. And as always, speak with your medical provider if you have any questions about what is best for you and the health of your pregnancy.

Citations 

1.LJ Williams et al. “Prevalence of Spina Bifida and Anencephaly During the Transition to Mandatory Folic Acid Fortification in the United States,” Teratology 66, no 1 (2002): 33-39

2.Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-8. Doi: 10.3109/00498254.2013.845705. Epub 2014 Feb 4. PMID: 24494987.

 3. https://healthybabycode.com/5-myths-about-pregnancy-nutrition-5-folic-acid-supplements-are-safe