Looking on the back of a package of vegetables, you may have noticed that sometimes folate is listed, while in your fortified cereal, folic acid is listed.

Even your doctor might confuse you when referring to folate vs. folic acid, referring to them interchangeably as if they are the same thing.

It is understandable that these two terms might sometimes be mixed up.  After all, they sound a lot alike, and they are related.  But folic acid and folate are not the same substance.

What Are Folate and Folic Acid?

Let’s start by establishing some simple definitions.

Here is what folate and folic acid have in common: They are both water-soluble forms of vitamin B9.

But there, the similarities end.  Here is the difference between the two:

Folate is a naturally occurring substance which you can consume through food.

Folic acid on the other hand is a synthetic form.  This is the form which is added to supplements and fortified foods.

Why The Confusion With the Terms?

Even though “folate” and “folic acid” may sound alike, you may wonder why even medical professionals sometimes refer to folic acid as folate.

In some cases, this may be lazy usage.  But even the National Institutes of Health Office of Dietary Supplements considers “folate” an acceptable umbrella term for both forms of vitamin B9.  In short, they consider folic acid to be a “type” of folate.

Why Do You Need Vitamin B9?

Now that you know the relationship between folic acid and folate as well as the distinction between them, let’s talk about why both of them are vital to your health.

Your body needs vitamin B9 to synthesize RNA and DNA.  It is also essential for the development of cells.  It plays a key role in the metabolizing of amino acids as well.

At any given time, your body contains around 10-30 mg of folate, about half of which can be found in your liver.  The rest is scattered throughout other tissues and is also in your blood.

When a doctor checks your folate, he or she is measuring your blood plasma folate levels.  But this may reflect the presence of dietary folate, not just the amount of folate you actually are storing (1).

The average adult living in the US is consuming 450 to 650 mcg of DFEs (dietary folate equivalents) (2).  This is more than the daily recommended intake of 400mcg of DFEs (1), so deficiency in the US is rare.  It should be noted however that childbearing women may be at risk for inadequate levels of vitamin B9.

The reason the term “dietary folate equivalents” is used is that this measurement includes both folate and other forms such as folic acid.

What Happens If You Do Not Get Enough Vitamin B9?

Not only are pregnant women at higher risk for vitamin B9 deficiency (2), but that deficiency can have severe consequences.

Women who do not get enough vitamin B9 may have children with neural tube birth defects (34).  Congenital heart defects are another possible adverse outcome (5).  Premature birth and problems involving fetal growth and birth weight may also occur (9).

Other possible health problems resulting from insufficient vitamin B9 include:

  • Higher risk of stroke, cardiovascular disease, and cognitive decline as a result of higher levels of homocysteine in the blood (678).
  • It has been discovered that supplementation with folate can combat the growth of cancer (10).  A link has also been made between low folate and increased cancer risk (11).
  • If your folate levels are low, it is possible that you will have a heightened risk for depression (12).  The linked study also found that low folate levels may correlate with reduced responsiveness to medications for depression.  It is also possible that folic acid supplementation may be a suitable treatment for depression on its own (13).

Many people would struggle to get sufficient vitamin B9 in their diets without assistance.  For this reason, the FDA requires that grain products such as cereal, rice and bread be enriched with vitamin B9 when they are processed (14).

Just how big a difference does this make?  These efforts have increased the average American’s consumption of folic acid by around 190 mcg daily (15).

Note that when B9 is added to foods which have been processed and fortified, it is in the form of folic acid, not folate.

The Vitamin B9 Naturally Present In Certain Foods Is Folate

So now that you know that your supplements and fortified grains contain folic acid, you may be wondering where you get folate, the naturally occurring form of vitamin B9.

The hint lies in the etymology of the name.  “Folate” is derived from the Latin “folium,” which in turn translates to “leaf.”  Indeed, some of the best sources of folate are green leafy veggies.

So when you go out and buy some spinach, you are buying a food which contains vitamin B9 as folate.

One advantage of folate is that this form is relatively easy for your body to convert in the intestines into 5-MTHF for use (16).

Folic Acid Has Its Advantages and Drawbacks

Now let’s talk a little bit more about folic acid, the synthetic form of vitamin B9.

Also known as “pteroylmonoglutamic acid,” folic acid has to be manufactured in a lab.

Again, this is the type of vitamin B9 present in your fortified breads and cereals as well as your supplements.

On the plus side, it is actually more bioavailable than folate (17).

On the downside, most of it is not converted into 5-MTHF in the intestines like natural folate is.

Instead, it is sent for processing to the liver as well as other body tissues.

The result is that these tissues may become saturated with folic acid if a person is taking too much of it at one time.  When this happens, unprocessed folic acid is left floating around in the blood (16, 18, 19, 20).

The Problem with Excess Folic Acid

This is not a good thing.  Appropriate amounts of folic acid can result in a decrease in the likelihood of cancer, but an excess of it may actually increase the risk of colorectal cancer (21) while also causing precancerous lesions to develop more swiftly (26, 27, 28).

Health problems resulting from unmetabolized folic acid are particularly pervasive among the aging population (23, 24, 25).

Another risk posed by an overabundance of folic acid is that it can interfere with the effectiveness of various medications.

For example, folic acid can disrupt the anti-cancer medication Methotrexate, and it can also decrease the amount of antiepileptic medications present in the blood (22).

Then there is the problem of vitamin B12 deficiency.  If you do not have enough vitamin B12, you could suffer from nerve and cognitive impairment (29, 30).

If someone is deficient in vitamin B12, they may develop anemia, which helps doctors pinpoint the deficiency.  But folic acid supplementation can mask the anemia, masking the deficiency as a result.

It is also useful to know that if you are taking Sulfasalazine for ulcerative colitis or another condition, that medication may decrease your body’s folate uptake.

If you do need help metabolizing your folic acid, try taking it with other forms of vitamin B.  This can help your body to convert it more effectively (23).

In short, you should increase or decrease your intake of folic acid and/or folate relative to your needs if you are on any of these medications.

Those who eat a lot of foods which are fortified with folic acid while also taking folic acid supplements are most likely to develop dangerous excesses.  Keep an eye on your intake to prevent problems.  You do not have to be consuming a huge amount of folic acid to start accumulating it.  It may even happen with 400 mcg per day.

What Is the Best Way to Get Your Recommended Daily Amount of Vitamin B9?

If you do need to increase your vitamin B9 intake, the best way to do it is to eat foods which are rich in folate like spinach, asparagus, Brussels sprouts, and avocados (31).

In terms of supplements, you want to try and steer clear of those which are likely to cause problems with excess unprocessed folic acid.  You can do this by taking a 5-MTHF supplement (32, 33, 34, 35, 36).

Conclusion

You now know that both folate and folic acid are forms of vitamin B9 (37).

Folate is the naturally-occurring form found in spinach, Brussels sprouts, asparagus, and other foods high in vitamin B9.

Folic acid is the synthesized form which is found in fortified foods and supplements.

Folate deficiency is relatively rare in the US because the FDA requires so many processed grains to be fortified, but pregnant women may be susceptible.

If you do decide to supplement with vitamin B9, make sure you go with 5-MTHF.  This is the form that your body is more readily able to use, and will help prevent a dangerous buildup of excess unmetabolized folic acid in your body.

So long as you are getting a healthy amount of folate and/or folic acid, you will be in great shape.  This vital nutrient will keep your body running strong, and may even help to prevent depression, cognitive decline, stroke, certain forms of cancer, and other diseases.

Sources:

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14. https://www.gpo.gov/fdsys/pkg/FR-1996-03-05/pdf/96-5014.pdf

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