Folic Acid and Folate: The Important Difference

From the time we start thinking about having a baby we’re reminded by our GP, specialists, the media and friends about the importance of folic acid, or did they say folate?  Aren’t they the same thing? The answer is no.

There is a very important difference between folic acid and folate, that can impact your chances of conception, your risk of miscarriage and your risk of birth defects.

Folic acid is the synthetic supplemental source of folate, which is the natural nutrient, found in food. Research show’s that around 50% of the population struggle to metabolise folic acid into the natural, useable form of folate due to a common polymorphism of the MTHFR gene. ^{[i] [ii] [iii]}  This inability to properly metabolise folic acid has been shown to affect ovarian stimulation and reduce your ability to conceive. [iv]  Those affected who do conceive are at a 60% greater risk of neural tube defects. ^[v]  The impairment of folic acid metabolism has been found to be significantly more common on mothers of children born with neural tube defects ^[vi].

Why is folate so important during pregnancy?

Folate is required to support the healthy development of the neural tube, which connects the brain and the spinal cord.  Lack of sufficient folate to support this important development, can result in neural tube defects, the most common being spina bifida.  Spina bifida is a serious condition.  Babies born with spina bifida will generally have paralysis of the legs and loss of bowel and bladder function.  Others do not survive.  Neural tube defects still affect around 1 in 2000 live births in Australia. ^[vii]  In addition, the number of NTDs among spontaneously aborted fetuses is 10-fold higher. [viii]  More than 77% of pregnancies affected with neural tube defects in Australia were foetal deaths or were managed by termination[ix].

Neural tube defects develop during the 3^rd and 4^th week of pregnancy, before you may even be aware you are pregnant.

For the past 20 years, a dose of 500mg of folic acid per day has been recommended as an adequate intake to provide protection against neural tube defects.  However 40% of women are not achieving the required protective red blood cell folate level, despite consumption of fortified foods and prenatal multivitamins containing folic acid.^[x]

How do I ensure adequate folate for my precious baby?

There is a test available, to show whether you are affected by this folic acid metabolism issue.  Many obstetricians and medical professionals are already recommending this test.  Or you can request to have your MTHFR status tested if you have concerns.

Alternatively there are newer supplemental forms of folic acid available, which are more directly metabolized. Calcium folinate (folinic acid) are commonly known as ‘activated’ folic acid, meaning that they by pass many of the steps involved in folic acid metabolism, including the MTHFR gene.  Calcium folinate/folinic acid has been shown to raise plasma folate more effectively than folic acid supplements.[xi]  Calcium folinate supplementation is very safe with no adverse effects. 

Do I really need to supplement my diet?

I’m often asked, “What about diet?  Don’t we get enough folate from food?  Why should we supplement?”

I definitely advocate diet as one of the best sources of all nutrients and you should definitely boost your intake of folate rich foods such as broccoli, spinach, asparagus, lentils, kidney greens, pinto beans, black beans, cauliflower, parsley, brussel sprouts, celery, bok choy, cabbage, avocado and quinoa.

It’s important to remember that folate is a very unstable nutrient.

What this means is that if you heat it, cook it or otherwise process it you can lose it.  For this reason, many of our processed foods have lost their natural folate and are fortified with folic acid.  This fortification carries the same metabolism issues as supplemental folate.

Lifestyle factors such as stress and the contraceptive Pill also deplete the body of natural folate.

I commonly hear of women falling pregnant very soon after stopping the Pill, only to sadly miscarry.

We know how important adequate folate is during the conception and pregnancy period. More so than any other time in our lives. Yet our body is entirely dependent on dietary sources for adequate intake. For these reasons I believe it is too important to rely on dietary sources during this crucial time.

I always recommend supplementing with a good prenatal vitamin providing calcium folinate/folinic acid during this important period. I see this acting as your ‘insurance policy’ to help ensure you’re getting adequate amounts to help protect against neural tube defects, alongside a healthy diet.

My grandparents didn’t take supplements, why should I have to?

I recently read a magazine article comparing the diet of our grandparents to today’s average diet. Unfortunately it wasn’t favourable. I’d love to say I pick all my veggies fresh out of the garden and never use store bought cereals or bread. However, even though I consider myself pretty healthy, I’m sure most of you can agree this is not the case. Most people today are unaware of which fruits and vegetables are in season, because they are available all year round, packed shipped, frozen and thawed from all over the world before they hit the supermarket shelves, which greatly diminishes their nutrient content. Any further processing increases the depletion of natural nutrients to the point where pretty much anything with a barcode will have lost its natural folate. Many of these foods are instead fortified with folic acid.

Unless you are picking your spinach fresh from the organic vegetable patch in your backyard, it’s difficult to know how much folate you’re actually getting from your food.

So whether your baby plans are weeks, months or even years away, boosting your folate intake through a healthy diet and consumption of a good supplement providing calcium folinate/folinic acid will help ensure adequate levels of folate are immediately available to support the healthy development of your precious baby during these crucial first few weeks, whenever your decide the time is right.

About the Author:

Tasha Jennings holds degrees in naturopathy, nutrition and herbal medicine with over 10 years experience in the field. She is also a health writer, published author (The Vitamins Guide) and speaker. As a new mum herself, Tasha now specializes in fertility, pregnancy and breastfeeding as Managing Director of Zycia Premium Pregnancy Nutrition. Tasha enjoys using her knowledge to support other new mum’s and mum’s-to-be during this exciting, often overwhelming, time.

References:

^[i] Van der Put NM, Blom HJ. Neural tube defects and disturbed folate dependent homocysteine metabolism. Eur J Obstet Gynecol Reprod Biol. 2000 Sep;92(1):57-61

^[ii] Frosst P., Blom H. J., Milos R., Goyette P., Sheppard C. A., Matthews R. G., Boers G.J.H, den Heijer M., Kluijtmans L.A.J, van den Heuvel L. P., Rozen R. A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahyrofolate reductase. Nat. Genet. 1995;10:111-113

^[iii] Gudnason V., Stansbie D., Scott J., Browron A., Nicaud V., Humphries S. C677T (thermolabile alanine/valine) polymorphism in methylenetetrahydrofolate reductase (MTHFR): its frequency and impact on plasma homocysteine concentration in different European populations. Atherosclerosis 1998;136:347-354

[iv] Laanpere M et. Folate-metabolizing gene variants and pregnancy outcomes of IVF. Reprod Biomed Online. Jun 2011;22(6):603-14

^[v] Van der Put NM, Eskes TK & Blom HJ. Is the common 677C→T mutation in the methylenetetrahydrofolate reductase gene a risk factor for neural tube defects? A meta-analysis. Quarterly Journal of Medicine 1997 90, 11-115

^[vi] Christensen B, Arbour L, Tran P, Leclerc D, et al. Genetic polymorphisms in methylenetetrahydrofolate reductase and methionin synthase, folate levels in red blood cells and risk of neural tube defects. Am J Med Genet. 1999 May 21;84(2):151-7

^[vii] Koren G, Goh I, Klieger C. Folic Acid - The Right Dose, Mother Risk Update - Canadian Family Physician Vol 54: Nov 2008; 1545 - 1547

[viii] Koren G, Goh I, Klieger C. Folic Acid - The Right Dose, Mother Risk Update - Canadian Family Physician Vol 54: Nov 2008; 1545 - 1547

[ix] http://www.aihw.gov.au/publication-detail/?id=6442468181

^[x] Bar-Oz B, Koren G, Nguyen P, Kapur B. Folate fortification and supplementation— are we there yet? Reprod Toxicol 2008;25(4):408-12. Epub 2008 May 3.

[xi] R Prinz-Langenohl et al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C,T polymorphism of methylenetetrahydrofolate reductase. British Journal of Pharmacology, 2009, 158, 2014–2021