Folate and Folic Acid Are Not the Same Thing

You probably know folic acid as something pregnant women should take.

Folic acid is a synthetic form of a vitamin called folate, which is also known as vitamin B9.

This vitamin with many names is important for cell development and production, especially during pregnancy. It’s vital for the development of a fetus’ neural tube, the structure that results in the formation of the brain and spinal cord. The neural tube develops very early — four to six weeks into pregnancy. Without adequate folic acid, the neural tube will not develop properly, which can result in spina bifida, a birth defect that can cause a range of physical and cognitive disabilities.

Folic Acid and Spina Bifida

When the neural tube doesn’t close during pregnancy, the vertebrae that protect the spinal cord don’t form properly, which can result in damage to the spinal cord and the nerves coming out of it when an infant is born.

Symptoms of spina bifida can range from difficulty walking or loss of function of the arms and legs, to the most severe form, anencephaly. Anencephaly is when half of the brain doesn’t develop, resulting in severe cognitive disability.

Although folic acid drastically reduces the risk for spina bifida, there are still forms of spina bifida and brain development disorders not related to folic acid.

How to Get Enough Folic Acid

It’s important that all women of reproductive age (who have their period) get an adequate amount of folic acid. Dr. Krupka says there are a few key reasons for this recommendation:

• So many pregnancies are unplanned.
• The neural tube develops often before a woman may miss a period and realize she’s pregnant.

Luckily, many enriched grain products in the U.S, such as breakfast cereals, pastas, bread and rice, are fortified with folic acid. Although eating foods fortified with folic acid is beneficial for your overall health, the folic acid you get from your diet is not enough to reduce the risk of a fetus developing a neural tube defect. In fact, folic acid from fortified foods represents only about half of the folic acid you need to prevent spina bifida, according to Dr. Krupka. With the popularity of low-carb, grain-free diets, many women are not getting much folic acid from their diets.

That’s why women of reproductive age who are not planning for a pregnancy should still take a daily multivitamin with folic acid.

Dr. Krupka says that if you are actively trying for a pregnancy, you should take a prenatal vitamin with at least 400 micrograms of folic acid along with iron, vitamin D, calcium and other vitamins and minerals that help promote the healthy development of a baby. You should start taking the prenatal vitamin one to three months prior to conception, if possible. Many prenatal vitamins use L-methylfolate instead of folic acid. The reason behind this is that many people have a genetic makeup that prevents them from converting folic acid into its active form in the body, L-methylfolate. If you see L-methylfolate on your prenatal vitamins, know that it’s folic acid.

Some people are at a higher risk of having a child with a neural tube defect. You are at a higher risk if you:

• Were born with a neural tube defect
• Have had a previous child with a neural tube defect
• Are taking medication for a seizure disorder (some medications may lower folic acid levels)
• Have Type 1 or Type 2 diabetes prior to pregnancy (high blood sugar levels interfere with proper cell formation and reproduction)
• Have an absorption disorder, such as celiac disease, or inflammatory bowel disorder, in which your body cannot properly absorb certain nutrients

If you are at higher risk, your physician may want you to take up to 10 times the recommended amount of folic acid per day, or 4,000 micrograms. If your physician says you need more folic acid, choose a pure folic acid supplement instead of several multivitamins or prenatal vitamins. Prenatal vitamins and multivitamins contain other vitamins and minerals that can be harmful to pregnant women if taken in excess.

Can You Get Too Much Folic Acid?

You can get too much folic acid, but it’s not necessarily toxic or dangerous to your body, according to Dr. Krupka.

Most people with healthy functioning kidneys will simply urinate out the excess folic acid.

“I recommend that people with an average risk of having a child with a neural tube defect stick to taking 400 micrograms of folic acid and not more than that, simply because we don’t know the long-term effects of taking more than recommended,” says Dr. Krupka.

Other Health Benefits of Folic Acid

Health benefits associated with folic acid may include reducing your risk for heart disease, stroke and some types of cancers. Folic acid is good for any cells that rapidly divide and grow, which is why it’s also great for the health of your hair, skin and nails.

“I can’t emphasize enough the importance of taking a multivitamin for all women of reproductive age,” says Dr. Krupka.