Folate vs. Folic Acid: A Nuanced (But Important) Discussion

One question that comes up often is: what is folate? What is folic acid? Are they the same thing? Which one should I be taking?

Let’s break it down.

Vitamin B9 is an essential nutrient, which means your body cannot make it on its own and you have to get it from food or supplements.

You’ll often hear the terms vitamin B9, folate and folic acid being used interchangeably; though they are not exactly the same thing. Understanding the difference can be important.

Vitamin B9 plays a key role in:

• Making red blood cells

• Supporting DNA and RNA production

• Cell growth and division

Why Vitamin B9 Matters in Pregnancy

According to Health Canada and the Society of Obstetricians & Gynaecologists of Canada (SOGC), individuals who could become pregnant are recommended to take:

• 400 mcg of folic acid daily (minimum) for low-risk individuals

• Starting at least 2-3 months before conception and continuing through pregnancy

Higher doses (eg. 1 mg or more daily) may be recommended in certain situations, such as:

• A previous pregnancy affected by a neural tube defect

• Certain medical conditions

• Use of specific medications

Because individual needs vary, it’s important to consult your healthcare provider to determine the most appropriate dose (and form) for you.

Folate: The Natural Form

Folate is the naturally occurring form of vitamin B9 found in foods like:

• Leafy greens (spinach, broccoli, Brussels sprouts, asparagus)

• Legumes (lentils, kidney beans, black-eyed peas)

• Citrus fruits

• Liver

Before your body can use folate, it needs to be broken down in the gut into a simpler form so it can be absorbed.

Folic Acid: The Synthetic Form

Folic acid is the synthetic (man-made) version of vitamin B9.

It’s commonly added to foods through a process called fortification, meaning nutrients are added during manufacturing. You’ll find folic acid in foods like:

• Bread

• Pasta

• Cereals

• Rice and grain products

As of 1998, both Canada and the U.S. have required folic acid to be added to certain foods. This public health initiative led to a significant drop (about 28%) in neural tube defects in newborns.

Folic acid is more stable and more efficiently absorbed than natural food folate, but it still needs to be converted into its active form.

Absorption: Important, But Not the Whole Story

Here’s where it gets interesting:

• Folic acid is very well absorbed

  • ~85% absorbed when taken with food

  • Nearly 100% absorbed on an empty stomach

• Natural folate from food is less efficiently absorbed (~50-60%) because it requires more processing.

From a more technical perspective, natural folate exists primarily in a “polyglutamate” form. To be absorbed, it must first be:

1. Released from the food it is complexed with

2. Converted into a simpler, monoglutamate form in the gut.

Not to mention, folate is a fragile, water-soluble vitamin, meaning it can be lost during cooking. For example, boiling your foods can cause your water soluble vitamins (vitamins B and C) to leach out into the cooking water.

Folic acid, on the other hand, is already in the monoglutamate form, allowing it to bypass these initial steps.

HOWEVER, absorption isn’t the whole story. Your body still needs to convert folic acid into its active form before it can be used. In this sense, absorption does not equal usability.

A Better Option: 5-MTHF

You may have seen or heard of 5-MTHF (5-methyltetrahydrofolate) on supplement labels. This is the active form of folate; the form your body actually uses.

The benefit is that it bypasses several conversion steps and it is easily absorbed, meaning your body can use it more directly.

This form is especially beneficial for some people with genetic mutations in the MTHFR gene, which is the enzyme responsible for converting folate (and folic acid) into the active 5-MTHF form.

Folate Deficiency: Who Is At Risk?

Even though deficiency is relatively uncommon, some people are at higher risk:

1. Alcohol use

   • Reduces absorption and increases folate loss

2. Pregnancy

   • Requirements increase significantly

3. Digestive issues

   • Conditions like celiac disease or IBD can impair absorption

4. Genetic differences (MTHFR variants)

   • As mentioned above, some people have a reduced ability to convert folic acid into its active form

Do Most People Need a Supplement?

More is not necessarily better.

High doses of folate can interact with certain medications & potentially mask other nutrient deficiencies. This is why it’s always best to individualize supplementation with a healthcare provider.

For many people, a balanced diet rich in fruit, vegetables, whole grains, and healthy fats & proteins will provide adequate folate. However, supplementation is often recommended in specific situations, especially preconception and pregnancy.

If you’re unsure what’s right for you (especially when it comes to prenatal supplements), it’s worth having a personalized conversation rather than guessing.

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