Folate and folic acid represent two distinct forms of vitamin B9, yet their names are frequently used interchangeably, leading to considerable confusion. Even among healthcare professionals, the differences between these two forms often remain unclear.

This article seeks to clarify the distinctions between folic acid and folate, providing valuable insights into their unique characteristics and significance in nutrition.

Vitamin B9

Vitamin B9 is a vital nutrient that is naturally found in the form of folate. This essential vitamin plays numerous significant roles within the human body, particularly in supporting cell growth and facilitating DNA synthesis.

When vitamin B9 levels are low, individuals may face a heightened risk of various health issues, which include:

  • Increased homocysteine levels. Elevated homocysteine has been linked to a greater likelihood of developing heart disease and experiencing strokes.
  • Congenital abnormalities. Insufficient folate intake during pregnancy is associated with several birth defects, particularly neural tube abnormalities.
  • Heightened cancer risk. A deficiency in dietary folate can lead to an increased risk of certain cancers; however, it is also important to note that higher levels of supplemental and/or serum folate may correlate with an elevated risk of prostate cancer. Further investigation into this relationship is warranted.

Due to these potential health implications, vitamin B9 supplementation has become quite prevalent. In fact, many countries, including Australia, Canada, and India, mandate the fortification of foods with this crucial nutrient to ensure public health.

Understanding Folate

Folate is the naturally occurring variant of vitamin B9, essential for numerous bodily functions. Its name is derived from the Latin term “folium,” which translates to leaf, highlighting that leafy greens are among the richest sources of this vital nutrient. This term encompasses a collection of related compounds that share similar nutritional benefits, all contributing to overall health. The predominant active form of vitamin B9 is known as 5-methyltetrahydrofolate (5-MTHF). Before it can be utilized by the body, your digestive system transforms dietary folate into this biologically active form of vitamin B9, specifically 5-MTHF.

Within your digestive tract, a significant portion of the dietary folate consumed is converted into 5-MTHF, which then enters your bloodstream, allowing your body to absorb and utilize this essential nutrient efficiently.

Understanding Folic Acid

Folic acid is a synthetic variant of vitamin B9, also referred to as monopteroylglutamic acid or pteroylmonoglutamic acid. This crucial nutrient is commonly found in dietary supplements and is often added to processed foods, including flour and breakfast cereals. Unlike its natural counterpart, folate, not all folic acid ingested is converted into the active form of vitamin B9, which is 5-MTHF (5-Methyltetrahydrofolate), within your digestive system. A portion of folic acid undergoes conversion to 5-MTHF in the liver.

This conversion process can be slow and inefficient for some individuals. Following the intake of a folic acid supplement, it may take considerable time for your body to transform the entire amount into 5-MTHF. Even low doses, typically between 200 and 400 mcg per day, may not be fully metabolized until the subsequent dose is consumed. This situation can be exacerbated when fortified foods are consumed alongside folic acid supplements.

Consequently, unmetabolized folic acid is frequently observed in the bloodstream of individuals. Even a modest daily intake of 400 mcg has the potential to lead to the accumulation of unmetabolized folic acid in your blood. While there is some evidence linking elevated levels of unmetabolized folic acid to certain health risks, further research is essential for confirmation. Interestingly, one study indicates that combining folic acid with other B vitamins, particularly vitamin B6, enhances the conversion efficiency.

Are Elevated Levels of Unmetabolized Folic Acid Detrimental to Health?

A growing body of research suggests that persistently high levels of unmetabolized folic acid could lead to various negative health outcomes, including a potential increase in cancer risk. Some studies have drawn connections between elevated folic acid levels and heightened cancer susceptibility; however, there are also studies that present contradicting findings. As of now, there is no definitive evidence establishing a direct causal relationship between unmetabolized folic acid and cancer incidence.

While concerns regarding excessive intake of folic acid are valid, the precise health implications remain ambiguous, necessitating further investigation to fully understand its effects.

What is the Healthiest Source of Vitamin B9?

The optimal way to obtain vitamin B9 is through whole foods, which provide a wealth of nutrients and health benefits.

Foods that are particularly high in folate include:

  • asparagus (shatavari)
  • avocados (makhanphal)
  • Brussels sprouts (brussel sprouts)
  • leafy greens such as spinach (palak) and lettuce (salad patta)

For specific groups, especially pregnant individuals, it is crucial to consider supplements to ensure sufficient vitamin B9 levels, as this can help prevent neural tube defects in the developing fetus. This is particularly important for those with the MTHFR gene variant, which influences folate metabolism within the body.

While a diet abundant in natural folate-rich foods is essential, the use of folic acid supplements is often advised. Moreover, current research does not support the effectiveness of alternative folate supplements, such as MTHF, in preventing neural tube defects. Folic acid is the most prevalent form of supplemental vitamin B9 and can be easily found at various pharmacies and online platforms.

Alternatively, some supplements offer 5-MTHF as a substitute for folic acid. However, neither the Centers for Disease Control and Prevention (CDC) nor the World Health Organization (WHO) recommends this alternative for those planning pregnancy or during gestation. 5-MTHF supplements are available in forms like levomefolate calcium or levomefolate magnesium, marketed under names such as Metafolin, Deplin, and Enlyte, with availability online.

The Bottom Line

Folate, the natural variant of vitamin B9 found in various foods, contrasts with folic acid, which is a synthetic derivative. While folic acid supplements are widely used, excessive consumption may lead to elevated blood concentrations of unmetabolized folic acid. Some researchers are concerned that this accumulation could potentially result in negative health consequences over time, although more comprehensive studies are necessary to draw definitive conclusions.

For those seeking alternatives to folic acid supplements, options like 5-MTHF (levomefolate) or incorporating whole foods, particularly leafy greens (????), into the diet can be beneficial. However, it is essential to note that folic acid continues to be the most recommended choice for individuals planning to conceive and those who are pregnant. Always seek advice from a healthcare professional before initiating or altering any supplement regimen.