Folate vs. folic acid
Folate is vitamin B9. It is found naturally in foods like leafy greens, beans, and citrus fruit. The word comes from the Latin word for leaf.
Folic acid is the synthetic version. It is the form used in most supplements and added to foods like bread, pasta, rice, and cereal. Folic acid is actually absorbed better than natural folate. Your body converts both into the same active form, called methylfolate, which it uses to build DNA and new cells.
Why it matters so much
Your body makes billions of new cells every day. Folate is needed to copy DNA for every one of them. That is why folate matters most in times of fast growth: pregnancy, infancy, and healing.
Folate also works with vitamins B12 and B6 to break down homocysteine, a substance that can damage blood vessels when it builds up. And it is needed to make healthy red blood cells. Without enough folate, you can develop a type of anemia where red blood cells are too large and do not work well.
Folate and pregnancy
This is the most important and best-proven use of folic acid. In the first few weeks of pregnancy, often before a woman knows she is pregnant, the baby's brain and spine form from a structure called the neural tube. If it does not close properly, the baby can be born with spina bifida or a condition called anencephaly.
Randomized trials in the 1980s and 1990s proved that folic acid taken before and during early pregnancy prevents most of these defects. Because of this, the U.S. Preventive Services Task Force (USPSTF) recommends that every woman who could become pregnant take 400 to 800 micrograms of folic acid daily. The CDC gives the same advice. In 1998, the FDA required folic acid to be added to enriched grain products, and neural tube defects in the U.S. dropped by about a third afterward.
How much you need
The National Institutes of Health (NIH) recommends 400 micrograms of dietary folate equivalents a day for adults. Pregnant women need 600 mcg and breastfeeding women 500 mcg.
The safe upper limit for folic acid from supplements and fortified foods is 1,000 mcg (1 mg) a day for adults. Natural folate from food has no upper limit. There is one important reason for the limit: too much folic acid can hide a vitamin B12 deficiency. It fixes the anemia but not the nerve damage that low B12 causes, so the problem can go unnoticed until it is serious.
Signs of low folate and who is at risk
Low folate can cause fatigue, weakness, irritability, shortness of breath, a sore tongue, and mouth sores. A blood test can measure folate directly.
People at risk include those who drink alcohol heavily (alcohol blocks folate absorption), people with celiac or Crohn's disease, people on certain medicines like methotrexate, some seizure drugs, or sulfasalazine, and women who are pregnant or breastfeeding. Some people carry a common gene variant called MTHFR that makes converting folic acid to the active form less efficient. Most people with this variant do fine with regular folic acid, though some clinicians recommend methylfolate instead.
Foods high in folate
Beef liver, spinach, black-eyed peas, asparagus, Brussels sprouts, romaine lettuce, avocado, broccoli, and oranges are all strong sources. Fortified cereals and breads add a reliable amount. Folate breaks down with heat, so lightly cooked or raw vegetables keep more of it.
How Zen IV Spa can help
If you are planning a pregnancy, feeling run down, or have a condition that affects absorption, a Zen IV Spa nurse can draw folate, B12, and other labs at your home in New York or New Jersey. A clinician reviews the results with you on a video visit and can prescribe what you need through Zen IV Spa's everyday prescriptions, starting at $79 per month. Learn more at zenivspa.com/everyday-health/ or call (332) 239-2005.
Common Questions
Is folic acid the same as folate?+
They are two forms of the same vitamin, B9. Folate is the natural form in food. Folic acid is the synthetic form in supplements and fortified foods. Both become active methylfolate in the body.
When should I start folic acid if I want to get pregnant?+
At least one month before trying, and keep going through the first trimester. USPSTF recommends 400 to 800 mcg a day for all women who could become pregnant.
Can I take too much folic acid?+
Yes. Stay under 1,000 mcg a day from supplements unless prescribed. Too much can mask a vitamin B12 deficiency.
Do I need methylfolate instead of folic acid?+
Most people do not. Some clinicians suggest methylfolate for people with an MTHFR gene variant, but regular folic acid still works for most of them.
How do I know if I am low in folate?+
A simple blood test measures it. Symptoms like fatigue, mouth sores, and a sore tongue can be clues.
Sources: NIH Office of Dietary Supplements, Folate Fact Sheet for Health Professionals; U.S. Preventive Services Task Force 2023 recommendation on folic acid for neural tube defect prevention; CDC folic acid guidance; FDA 1998 folic acid fortification rule.
All treatments are medical services. Every guest is screened, and every treatment is prescribed by a licensed provider. Nothing on this page is medical advice for you personally, and the opinions summarized here belong to the doctors named, not to Zen IV Spa. Talk to a provider before starting or stopping anything.
