Folic Acid

Folic Acid: Everything You Need to Know


What is folic acid?

Water-soluble vitamins include folic acid. It’s a synthetic version of folate, a B vitamin.

Getting folate from your diet would be best since your body cannot make it.

Some foods naturally contain folate. It is added to other foods to provide folic acid. Supplements that contain folic acid are also available.

Is there a difference between folate and folic acid?

Folic Acid

Notably, “folate” and “folic acid” are actually different forms of the same vitamin: vitamin B9.

There is a slight difference between folic acid and folate in terms of their structure and effects on the body. Folate is any form of vitamin B9, including folic acid and 5-MTHF. Vitamin B-12 is synthesized as synthetic folic acid.

These spinach leaves contain folate, which is found in plants and animals

  • Kale
  • Broccoli
  • Avocado
  • Citrus fruits
  • Eggs
  • Beef liver

Foods such as flour, breakfast cereals, and pieces of bread contain folic acid.

Dietary supplements, such as multivitamins, also have it.

What does the body use folate for?

Your body uses folate to

  • Make and repair DNA
  • Help cells grow, divide, and work properly
  • Produce certain proteins
  • Help red blood cells mature

A folate deficiency can lead to a variety of health problems, including.

  • The anemia condition
  • Heart disease and certain cancers are at an increased risk
  • Infant development problems if pregnant women don’t get enough folate

The United States requires that certain grain products be fortified with folic acid. A fortified diet with helps prevent neural tube abnormalities in infants.

Recommended intake levels 

Dietary Folate Equivalents (DFEs) are used to calculate the Recommended Dietary Allowance (RDA) for folate. The unit of measure accounts for folate absorption from foods and folic acid absorption from supplements and fortified foods.

Folic acid from supplements is absorbed about half as well as natural folate.

An adult needs 400 micrograms of DFE of folate each day. In pregnancy and breastfeeding, folate needs can increase. In pregnancy, the RDA for DFE is 600 mcg.

In your body, you store 15-30 mg of folate. Approximately 90 percent of that folate is stored in the liver, with the remainder in the blood and tissues.

Children, adolescents, and infants should consume the recommended daily allowance of folate.

  • Birth to 6 months: 65 mg DFE
  • Ages 7–12 months: 80 mcg DFE
  • Ages 1–3: 150 mcg DFE
  • Ages 4–8: 200 mcg DFE
  • Ages 9–13: 300 mcg DFE
  • Ages 14–18: 400 mcg DFE

Benefits and uses

Folic Acid

Folate and are both used in supplements. Even though both substances are used for similar conditions, they are metabolized differently and have different effects on health.

Folic acid supplements have a variety of uses and benefits.

Treating folate deficiency

Folate deficiency can happen for many reasons. Some possible causes of folate deficiency are.

  • Dietary folate deficiency
  • Gastric bypass surgery, short bowel syndrome, and celiac disease can affect how your body absorbs folate.
  • A lack of stomach acid (achlorhydria) or a low level of stomach acid (hypochlorhydria)
  • Methotrexate and sulfasalazine (Azulfadine) can affect folate absorption.
  • Alcohol use disorder
  • Pregnancy
  • Hemolytic anemia
  • Dialysis

Deficiencies in folate can result in anemia, impaired fetal development, mental impairment, and depression. Supplements that contain folic acid or folate can raise your levels and prevent these problems.

Preventing congenital disabilities and pregnancy complications

Spina bifida and anencephaly can be controlled with folic acid supplements. By getting enough folic acid during pregnancy, you can reduce the chance of your baby being born with one of these conditions by getting enough folic acid during pregnancy.

As well as preventing fetal development issues, folic acid supplements lower the risk of pregnancy complications like preeclampsia.

Maintaining brain health

Dementia risk increases when blood folate levels are low. The risk of mental impairment is increased even in older adults whose folate levels are technically normal but low.

It has also been suggested that adequate folate intake may help prevent Alzheimer’s disease.

Taking 400 micrograms of folic acid daily for two years reduced blood levels of proteins associated with Alzheimer’s disease. This was done in 180 adults with mild cognitive impairment.

In a second study, 121 people with newly diagnosed Alzheimer’s disease were treated with donepezil (Aricept).

In addition to Aricept, those taking folic acid at a dose of 1,250 mcg per day for six months had improved cognitive abilities.

Treating mental health conditions

The production of neurotransmitters is aided by folate. Depression, schizophrenia, and other mental illnesses have been linked to low folate consumption.

The folate levels in the blood of people suffering from depression may be lower than those without.

Postpartum depression, schizophrenia, and bipolar disorder may be treated with folate and supplements.

A combination of folate supplements and antidepressant medication may reduce depression symptoms more than antidepressant medication alone.

People with schizophrenia may benefit more from folate supplementation plus antipsychotic medication than just antipsychotic medication alone, according to a review of seven studies.

Further evidence supporting these findings will need to come from larger, more robust studies.

Reduce heart disease risk factors.

Taking folate supplements, such as folic acid, may reduce heart disease risk and improve heart health.

Heart disease is thought to be associated with high levels of homocysteine, an amino acid. Hyperhomocysteinemia, also known as high homocysteine levels, is caused by low folate levels, which break down homocysteine.

In addition to lowering homocysteine levels, supplements may also reduce the risk of heart disease.

According to a review of 30 studies with more than 80,000 participants, supplementing with folic acid reduced overall heart disease risk by 4% and stroke risk by 10%.

supplements may lower blood pressure more effectively than antihypertensive medications alone. A supplement may also improve blood vessel function in people with heart disease.

Other possible benefits

These other health conditions may also benefit from supplements:

  • Diabetes. In people with diabetes, folate supplements may improve blood sugar regulation and reduce insulin resistance. You may need a folate supplement if your folate levels are low due to the diabetes drug metformin.
  • Fertility issues. Folate increases egg quality and helps eggs grow and implant in the uterus. Folate may increase the chances of getting pregnant and carrying a baby to term. Those using assisted reproductive technology may be more likely to have a baby if they consume more folate.
  • Inflammation. There are many diseases associated with inflammation. Studies have shown that folate supplements reduce markers of inflammation, such as C-reactive protein.
  • Kidney disease. In normal circumstances, the kidneys filter waste out of the blood, but homocysteine can accumulate in the blood if the kidneys are damaged. Homocysteine levels in the blood are too high for 85% of patients with chronic kidney disease. Taking folic acid supplements may lower homocysteine levels and heart disease risk in kidney disease patients.

More extensive studies still need to confirm the benefits of folate supplementation.

Folic acid has many benefits that can’t be included in this list. The use of folate-based supplements may also be justified for a variety of other reasons.

Folic acid for pregnancy

Folate plays an essential role in a baby’s development.

This protein regulates cell division and tissue growth. As well as helping the brain and spine of the baby develop, it also helps the neural tube. Anencephaly, spina bifida, and other neural tube anomalies can be prevented by taking during and before pregnancy.

The U.S. Preventive Services Task Force recommends, an independent group of disease prevention experts that women trying to become pregnant take 400–800 milligrams of daily one month before conceiving and one to three months after becoming pregnant.

In practice, however, people of childbearing age who are engaging in sexual activity that could result in pregnancy are encouraged to take supplements. This is because many pregnancies are unplanned.

Foods containing have been fortified since the 1990s. Consuming fortified foods and during and before pregnancy can reduce the risk of neural tube defects.

As well as preventing fetal development issues, taking supplements during pregnancy may improve the mental function of a child and reduce the likelihood of the child developing autism spectrum disorder (ASD).

The next section discusses how too much can negatively affect a child’s brain development and increase their chances of autism.

A pregnant woman’s health also depends on folate. Preeclampsia is a pregnancy-related complication that can be reduced by taking folic acid supplements. Preterm births may be reduced if a pregnant woman has high folate levels.

Getting enough folate through your diet alone can be difficult for pregnant women and their babies.

Gene changes that affect folate levels.

Your liver must convert 5-methyltetrahydrofolate (5-MTHF) from folic acid.

Your blood can become contaminated with folic acid if your liver does not convert it fast enough. This can be prevented by eating foods containing 5-MTHF instead of folic acid.

Foods that contain 5-MTHF include.

  • Leafy greens
  • Beans and lentils
  • Asparagus
  • Avocado

Your body uses folate differently if you have specific gene changes. Homocysteine is broken down by the enzyme methylenetetrahydrofolate reductase (MTHFR). A mutation in the code for MTHFR can affect your health by altering the folate levels in your body.

The C677T mutation is one of the most common mutations in MTHFR. People with this variant have less homocysteine-breaking enzyme activity. High homocysteine levels may increase heart disease.

This variant can also increase the risk of neural tube abnormalities in a developing fetus in pregnant women.

MTHFR variants can be tested genetically, but few people need them.

You do not need treatment if you have an MTHFR mutation alone. A healthcare professional may recommend supplements if your homocysteine levels are high.

Side effects and precautions

In general, folate-rich foods and natural forms of folate, such as 5-MTHF, are considered safe. Taking high doses of supplements could result in blood levels of unmetabolized building up.

“Unmetabolized” means your body hasn’t broken down or converted into another form of folate. It is unknown if unmetabolized folic acid poses any health risks, but there may still be unknown risks.

In the United States, children and adults get enough folate from food and do not need supplements.


The consumption of folic acid during pregnancy helps prevent neural tube defects. You may increase your child’s chances of developing autism if you have high levels of unmetabolized folic acid in your blood.

Blood levels of unmetabolized folic acid are unlikely to be high in people who take less than 400 mcg of folic acid daily.

The mental development of children may be adversely affected by high levels of unmetabolized folic acid during pregnancy.

According to a study of 1,682 mother-child pairs, children whose mothers took more than 1,000 mcg of folic acid daily during pregnancy performed worse on a test of mental abilities than those whose mothers took 400–999 mcg daily.

Research is still needed to confirm these findings, but recent studies suggest risks may be associated with high doses of folic acid during pregnancy.

Intake of high levels of folic acid is associated with other possible risks.

Several health conditions may be associated with high dosages of folic acid, including the following.


Cancers of the head and neck, pancreas, esophagus, and bladder could be reduced by folic acid. However, prostate cancer may also increase as a result.

The topic has yet to be conclusively studied, and more research is needed.

In contrast, some research suggests folate may suppress cancer during its early stages. In contrast, high doses of folic acid taken after precancerous cells have formed may accelerate cancer growth.

Taking high doses of folic acid supplements can weaken the immune system by reducing the activity of white blood cells, such as natural killer cells (NK cells). People may be at risk of infection if these immune changes occur.

How to take 

There are many forms of folate and folic acid. They are added to multi-nutrient supplements, such as multivitamins and B-complex vitamins. Adult supplements typically contain 680–1,360 milligrams of DFE (400–800 milligrams of folic acid).

There is a Tolerable Upper Intake Level (UL) for folic acid that you can take without experiencing harmful side effects.

Only fortified foods and dietary supplements are included in the UL. A natural folate in food is not associated with any adverse effects.

Folate in supplements and fortified foods should not exceed the UL

30–66% of Americans ages 1–13 who take folic acid supplements exceed their UL for their age group because they get enough folate from food. To ensure a folic acid supplement is safe for your child, speak to your pediatrician.

Food or no food, you can take all forms of folic acid.

Before taking folic acid

Your healthcare professional might prescribe folic acid supplements if you are deficient in them or planning a pregnancy.

Inform your healthcare professional about any other prescription and over-the-counter medications you are taking. Some medicines may interact with folic acid.

Storage and handling

Folic acid supplements should be stored in a cool, dry place. Do not store accessories in humid areas, such as the bathroom.


It is not possible to consume too much folate in foods. Your body eliminates any excess folate you down since it is water-soluble. Folic acid supplements that are more significant than the UL may cause side effects.

Your healthcare professional may recommend higher doses if you have a folate deficiency. It would be best if you did not take more than the UL without consulting your healthcare professional.


In the world of folate, there are many versions. Dietary supplements most commonly contain folic acid, folinic acid, or 5-methyltetrahydrofolate.

Foods contain folinic acid, a natural form of folate. Leucovorin is what healthcare professionals call it. Methotrexate, a cancer treatment, can cause toxic side effects when taken with this medication.

Regarding raising blood folate levels, folinic acid is more effective than folic acid.

In some studies, 5-MTHF is more absorbable than other forms of synthetic folate. It also has a lower risk of interaction with medications. 5-MTHF may be a better supplement than folic acid. Others, however, have yet to find a significant difference. 

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