You may have heard about the folic acid controversy and wondered what it has to do with you. At the center of this debate is the U.S. governmentâs folic acid food fortification program, which became mandatory in 1996 âdue to overwhelming evidence for the protective effect of folic acid supplementation before conception and during early pregnancy on the development of neural tube defects in newborns.â (Source)
While this effort has resulted in fewer birth defects, the long-term effects for nonpregnant adults have come into question, especially with the significant increases in cancer since the program began as well as the lack of long-term studies by the government. âThe more we learn about folic acid, the more itâs clear that giving it to everyone has very real risks,â says folic acid researcher David Smith PhD, as quoted in a Prevention magazine article titled Is Your Breakfast Giving You Cancer?
The people at most risk are those who consume too much fortified food, and the estimated one-third of the human population who has a gene mutation named MTHFR, which causes them to be unable to turn folic acid into folate due to the fact that they do not produce enough dihydrofolate reductase. This unmetabolized folic acid ends up in the blood stream, which may lead to health issues such as cognitive decline and susceptibility to certain cancers.
As Smith goes on to say, âUnlike folate, folic acid isnât found in nature, so we donât know the effect of the excess.â
Due to feedback on this revelation and concern about a related proposed rule from the government, it was just announced that the National Toxicology Program and the Office of Dietary Supplements will be conducting research into the potential adverse health effects of ingesting high levels of folic acid.
This revelation has also resulted in the availability of more natural folate and folinic acid supplements. But, whatâs the difference between all of these? Even though the terms are often used interchangeably, folate, folic acid and folinic acid are not the same.
Folate, or vitamin B9, is found naturally in food as tetrahydrofolate derivatives. Folate is metabolized to THF in the small intestine, which allows for easier accessibility to the body. It is essential to your health to get adequate folate intake from natural food sources. The following chart from The World’s Healthiest Foods lists some of the best sources.
The U.S. Recommended Daily Allowance for folate is 400mcg for those 14 years and older. Pregnant women should consult with their obstetrician about their folate dosage, but the general recommendation is 600mcg.
Folate is required by the body during rapid cell division and growth. It is also essential for human development, normal nerve functioning, proper brain functioning and reducing blood levels of the amino acid homocysteine (a cardiovascular risk factor). Folate also supports the growth of the placenta and fetus, and helps to prevent certain types of birth defects. The tetrahydrofolate that is derived from folate breaks down harmful homocysteine into beneficial methionine, which promotes cardiovascular and brain health. (Source)
Folate deficiencies are associated with anemia, neural tube defects, low birth weight, depression, memory loss and elevated homocysteine.
Folic acid is an oxidized synthetic compound that was introduced in 1943. It is used in food fortification and in dietary supplements. It is known to be more stable and bioavailable than natural folates. Folic acid goes through initial reduction and methylation in the liver, but needs dihydrofolate reductase in order to be converted to THF form. (Source) Increasing evidence is suggesting that this process may be slow or impaired in humans. (Source) Folic acid functions much like folate.
Folic acid is found in fortified products like breads, breakfast cereals, pasta, white rice and other products that contain enriched flour, and supplements.
Folinic acid is a metabolically active form of folic acid that does not require the enzymatic conversion. It is used for folic acid deficiency and as an antidote to folic acid antagonists. Folinic acid is one of the forms of folate that can be found naturally in foods. It is a folate substance that is stable when isolated. Folinic acid is often used as a replacement for folic acid.
If you canât get enough folate through your diet, I suggest you look for natural folate supplements, which are derived from whole-food, nonsynthetic sources. Itâs a good idea to look for products that list 5-methyltetrahydrofolate, or 5-MTHF, on the label or that are sourced by Metafolin (L-methylfolate), which requires no conversion because it is bioidentical to folateâs bio-active form. Folate 400mcg as Metafolin by Solgar is a popular option at Natural Healthy Concepts.
What do you think about the folic acid controversy? What do you eat to get enough folate each day? Do you take a folate, folic acid or folinic acid supplement? Iâd love to hear your thoughts on this topic!
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Fantastic article! I’m still a little confused though. I was recently diagnosed with MHTFR (one gene) and I suffer from mold anxiety. I know I need to be taking some type of supplement but I’m confused. Should I be taking folate or folinic acid? B6 and B12 as well?
My thoughts are that a Methyl-B12 (there may be a masked deficiency of B12) and/or a folinic acid or L-methylfolate would be best. Look for Quatrefolic or Metafolin L-methylfolate in the ingredients such as 5-MTHF by Metabolic Maintenance B12 should be in the form of methylcobalamin instead of cyanocobalamin. Choosing a complex with the cofactors of B2, B3, B6 and Vitamin C wouldn’t be a bad thing either – something like Ortho Molecular’s Methyl B Complex
Given the possible issues with folic acid, is there a reason supplements and foods do not use the natural form (folinic acid)? Having tested positive for at least one marker for MTHFR, I find it difficult to find multivitamin or even B supplements without folic acid.
There are some supplements that do use the folinic acid form – you can find some here but you are right, one must be careful. More and more manufacturers are avoiding folic acid. This Methyl B Complex may be worth taking a look at.
I have high B12, 2000! I’m reading that it means I’m not absorbing the vitamin. I take B12 and Folic acid (doc said to take with biotin since my hair was thinking due to AI). Can I still be deficient?
Would Folate as metafolin (L-methyfolate) be adequate for somebody who has the MTHFR gene mutation? Than you. Great article, especially because when researching Folate, I have found it confusing with statements that Folate IS folic acid, and that folinic acid is synthetic! Very confusing out there!
I have not been tested for the gene mutation and I will be trying to conceive in the very near future. I already have two healthy kids.
Is it best to take folate or folinic acid?
I only found out about folinic acid yesterday as I happened to read the ingredients part of the particular brand.
Thanks for your help.
Look forward to your reply.
Thanks a lot for being my personal instructor on this subject matter.
I enjoyed your article a lot and most of all enjoyed how you handled the issues I widely
known as controversial. You are always rather kind to readers much like me and let me in my
life. Thank you.
So… what are the dosage suggestions for folate/Dominic acid for a pregnant woman with mthfr; and what are the recommendations if the newborn has mthfr? I had my daughter tested (positive) at 4 weeks, do I need to supplement her as well? Thanks
A pregnant woman with MTHFR should not supplement with folic acid in my opinion. In consulting with your healthcare practitioner, he/she will probably suggest L-Methylfolate (Quatrefolic or Metafolin).
A child with MTHFR should not be given folic acid; if needed after a consultation with your practitioner, they would also likely suggest L-Methylfolate instead.
if you have folate deficiency will all your symptoms go if you take supplements?
You may fill nutritional gaps in your diet with folic acid supplementation and dietary intake of folate. According to the Centers for Disease Control and Prevention (CDC), folic acid is found in fortified grains and cereals or in dietary supplements such as multivitamins, prenatal vitamins, tablets, capsules, veggie caps, softgels, liquid extracts, lozenges, or chewables. Folate, on the other hand, is the natural form of vitamin B9 found in foods such as dark leafy greens and other whole foods. It is important to get enough folic acid and folate in the diet to support optimal health during all stages of life.
NHC has folic acid supplements here:
Here are some recommended folic acid dosages: http://www.umm.edu/health/medical/altmed/supplement/vitamin-b9-folic-acid
Also consider consulting with your healthcare provider. Best of luck on your health journey!
Your linking of Folic Acid to an MTHFR gene variant is incorrect. There are some five or six enzyme steps between the synthetic Folic Acid and the MTHFR enzyme. A variant MTHFR gene/enzyme does not affect our ability to process the synthetic Folic Acid. Our DHFR enzyme processes synthetic Folic Acid, not our MTHFR enzyme.
Our DHFR enzyme is inefficient at processing synthetic Folic Acid, and for some people who have a variant DHFR gene, that process is even more inefficient. That potentially leaves us with Unmetabolised Folic Acid (UMFA), and there are suggestions that UMFA may be implicated in some cancers.
Your article also uses the terms Folate and Folic Acid interchangeably in a few places, but it’s vital that an article about Folic Acid vs Folate is more careful.
I’m a vegetarian trying to get all my b vitamins. I take folinic acid and Methyl B12 supplements, along with B6, B1, B7 supplements.
To ensure that I get enough B12 since I do not eat meat, chicken, fish, I also eat fortified cereals every day. Are the fortified cereals too much?
According to the U.S. Departmenty of Health & Human Services’ National Institutes of Health:
“Strict vegetarians and vegans are at greater risk than lacto-ovo vegetarians and nonvegetarians of developing vitamin B12 deficiency because natural food sources of vitamin B12 are limited to animal foods. Fortified breakfast cereals are one of the few sources of vitamin B12 from plants and can be used as a dietary source of vitamin B12 for strict vegetarians and vegans.”
Their website lists the Recommended Dietary Allowances (RDAs) for Vitamin B12 (see Table 1): https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional
Also: The Institute of Medicine (IOM) did not establish a UL (Tolerable Upper Intake Level (UL), or maximum daily intake) for vitamin B12 because of its low potential for toxicity. In “Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline,” the IOM states that ‘no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals.’”
If you have further questions, consider consulting with your healthcare provider.
Thank you for your information. You mentio n that folinic acid is found naturally in foods but do not mention what those foods are, could you give some examples please? I do have the MTHFR variant, IV vitamin B infusion has made me much worse and I have been advised to avoid leafy green vegetables etc. It seems as though this is in relation to your statement above mentioning that too much fortified food with MTHFR variant results in the inability to turn folic acid into folate due to decreased production of dihyrofolate reductase. I appreciate your consideration. Nicole
Potential side effects (Which my wife and I both experienced)
As with any biologically active supplement or drug, certain people may experience unwanted side effects.
Unfortunately it is quite common with L-Methylfolate.
These are the most common symptoms and may appear after 2 weeks, 1 week, or even 1 day:
sore muscles and aches
acne or rash
insomnia and irritability
nausea, headaches and migraines
If you experience this then you should speak with your doctor as soon as possible to reduce the dose or take a break. Persistent supplementation through symptoms can be dangerous.
There are also reported steps you can take to relieve some of the L-methylfolate side effects. This includes a small 10-50 mg dose of niacin, or a glutathione supplement (which I’m sceptical actually helps).
Additionally, the idea of taking more supplements to offset side effects of another is the same as taking more pharmaceutical drugs to offset the side effects of another drug.
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