Folic Acid
Folic acid (also called folate or vitamin B9) is one of the vitamins commonly discussed in the health world among everyone from herbalists to medical doctors to everyday folks – especially new parents! It’s considered an essential part of daily nutrition, since every human being needs folic acid to survive. Our bodies use it to make new cells every day, including those used for the growth of hair, skin, nails. Folic acid also supports the body’s development from birth throughout the aging process, helping to maintain a healthy heart, brain, nervous system, and much more! Learn about the importance of folic acid in this article.
What is Folic Acid?
Vitamin B9: Folic Acid vs. Folate
Although their names are often used interchangeably, folate and folic acid are different forms of vitamin B9 – one of eight essential B vitamins that are crucial to the human body’s development, especially during the early stages of life. Folate is a naturally-occurring, water-soluble form of vitamin B9 that can be obtained through a healthy diet of dark leafy green vegetables, fruits, beans, nuts, and other whole foods. The synthetic form of vitamin B9 is folic acid, found in fortified foods such as enriched breads or grains and fortified cereal products, as well as in dietary supplements. (1)
Countries such as the U.S. and Canada have mandatory regulations in place that ensure foods such as grains and cereals are fortified with folic acid to meet consumers’ nutritional needs and to avoid unnecessary folic acid deficiencies. Read on to find out how this very special B vitamin helps promote your optimal health. (2)
The Importance of B Vitamins
Folic acid (vitamin B9) is often combined with other B vitamins in supplements known as B complexes. B vitamins help the body convert the carbohydrates from the foods we eat into fuel (or glucose), which the body uses to produce energy to metabolize fats, proteins, and other compounds. (3) Three of the essential B vitamins often referenced together for their synergistic ability to support optimal health are vitamin B9 (as folate or folic acid), vitamin B6 (pyridoxine), and vitamin B12 (cobalamin). Vitamin B9 and vitamin B12 work together to create new red blood cells and help iron work properly in the body. Vitamin B12 is also carried from the mother through the placenta to the baby, helping to develop the child’s brain and spinal cord. In addition, vitamin B9 helps vitamins B6 and B12 maintain normal blood levels of the amino acid homocysteine already in the normal range, high levels of which are associated with heart disease. (4)
The Institute of Medicine recommends the following daily intake of these essential B vitamins for healthy adults, depending on age and gender.
- Vitamin B9 (folate): 400 micrograms (mcg) per day, not to exceed 1,000 mcg per day. Sources: fruits and vegetables, whole grains, beans, breakfast cereals, and fortified grains.
- Vitamin B6: 1.3 to 1.7 milligrams (mg). Sources: fortified cereals, beans, poultry, fish, dark leafy greens, papayas, oranges, and cantaloupe.
- Vitamin B12: 2.4 mcg per day. Sources: fish, poultry, meat, eggs, dairy, fortified breakfast cereals, and enriched soy or rice milk. (5)
According to Harvard T.H. Chan School of Public Health, “only a fraction of U.S. adults currently gets the recommended daily intake of all B vitamins [including vitamin B9 as folate or folic acid] by diet alone.” (6) However, this can be rectified by taking a daily multivitamin or folic acid supplement.
How It Works
Vitamin B9 in the form of folate is a coenzyme that plays an important role in the metabolism of nucleic acid precursors, DNA, and amino acids, as well as in methylation reactions. (7)
The active form of vitamin B9 is levomefolic acid or 5-methyltetrahydrofolate (5-MTHF). The majority of natural folate from foods is easily hydrolyzed and converted into 5-MTHF in the digestive system before being transported across the intestinal mucosa and into the bloodstream. The body typically stores about 10 to 30 mg of the vitamin – half in the liver and the rest in blood and body tissues. (8)
Folic acid from fortified foods or supplements, however, has to undergo several biochemical conversions in the body before it becomes 5-MTHF. The majority of folic acid is converted into 5-MTHF in the liver or other tissues, instead of in the digestive system, as is the case with folate. The normal aging process, internal challenges, dietary restrictions, and other factors may disrupt the body’s ability to convert folic acid into 5-MTHF. In addition, some people may have genetically inefficient enzymes that make this conversion difficult. Therefore, the process of converting folic acid into 5-MTHF may take a long time. That’s why many health experts recommend relying on a diet containing a variety of folate-rich foods in addition to supplementing with folate. For individuals with an impaired ability to absorb, convert, or utilize folic acid, methylated folate supplementation may also make a difference to their health. (9, 10)
Vitamin B9 (as folate or folic acid) supports several functions in a healthy body, including healthy fetal development; a healthy cardiovascular system; a healthy skeletal system; a healthy brain; healthy-looking skin, hair, and nails; and the healthy function of the eyes, liver, and nervous system. It also aids in the body’s production and maintenance of genetic material (DNA and RNA), the building blocks of cells, which is vital when cells and tissues are growing rapidly during pregnancy, infancy, and adolescence. In addition, folate helps metabolize and maintain normal levels of the amino acid known as homocysteine already within the normal range, potentially lowering the risk for atherosclerosis, unnecessary blood clotting, vascular disease, stroke, dementia, Alzheimer’s disease, and osteoporosis-related fractures in the elderly. (11)
Folic Acid Deficiency
Not getting enough vitamin B9 (as folate or folic acid) is often associated with these and other health risks.
- Anemia
- High homocysteine levels, which may lead to heart disease or stroke
- An increased risk of certain cancers (12)
- Birth defects
Folic acid deficiency is very serious, especially during pregnancy. Birth defects due to a folic acid deficiency may include anencephaly or spina bifida, the most common major congenital malformations of the central nervous system, among other developmental issues. Anencephaly is a serious birth defect in which a baby is born without parts of the brain and skull. Spina bifida is a neural tube defect that occurs when the backbone that protects the spinal cord doesn’t form and close as it should, resulting in permanent damage to the spinal cord and nerves, which may cause physical and intellectual disabilities that could range from mild to severe. A folic acid deficiency may also disrupt the normal functions of the liver, skin, hair, and the eyes. (13, 14)
Those at Risk for Folic Acid Deficiency
- Women of childbearing age
- Pregnant women
- People who excessively consume alcohol
- People with digestive disorders that affect absorption in the gastrointestinal tract
- People taking certain medications
- People with certain genetics
- People with a poor diet lacking enough whole foods with folic acid (15, 16)
Signs of a Folic Acid Deficiency
- Megaloblastic anemia
- Weakness
- Fatigue
- Difficulty concentrating
- Irritability
- Headache
- Heart palpitations
- Changes in skin, hair, or fingernail pigmentation
- Elevated blood concentrations of homocysteine
- Depression
- Poor growth
- Tongue inflammation
- Gingivitis
- Loss of appetite
- Shortness of breath
- Diarrhea
- Forgetfulness
- Mental sluggishness
- Neural tube defects in infants
- Low infant birth weight
- Preterm delivery (17, 18)
Prevention and Treatment of Folic Acid Deficiency
Fortunately, folic acid deficiency is largely preventable and treatable with folic acid or folate supplementation and dietary intake of folate. According to the Centers for Disease Control and Prevention (CDC), folic acid is found in fortified grains and cereals or in dietary supplements such as multivitamins, prenatal vitamins, tablets, capsules, veggie caps, softgels, liquid extracts, lozenges, or chewables. Folate, on the other hand, is the natural form of vitamin B9 found in foods such as dark leafy greens and other whole foods. It is important to get enough folic acid and folate in the diet to support optimal health during all stages of life. Here are some recommended dosages. (19)
Folic Acid for Men
The University of Maryland Medical Center recommends that men ages 19 and older get 400 mcg of folic acid per day. People who drink alcohol excessively should get 600 mcg of folic acid per day. However, adults should not exceed 1,000 mcg of folic acid from fortified food or as a supplement, not including folate from food. (21)
Folic Acid for Women
The University of Maryland Medical Center recommends that women ages 19 and older get 400 mcg of folic acid per day. Pregnant women need 600 mcg of folic acid daily, and breastfeeding women need 500 mcg per day. (22) It’s important not to take more than 1,000 mcg of folic acid per day, because high folic acid supplementation might cause other health difficulties, or mask vitamin B12 deficiency. (23)
Folic Acid for Children
Keep in mind that breast milk, formula, and food should be the only sources of folic acid (in the form of natural folate) for infants. The University of Maryland Medical Center recommends that infants from birth to 6-months-old get 65 mcg of folate, and infants age 7 months to 12 months get 80 mcg of folate (adequate intake) daily. Children age 1 to 3 years need 150 mcg of folic acid daily; children 4 to 8 years need 300 mcg of folic acid daily; children age 9 to 13 years need 300 mcg of folic acid daily; and teens age 14 to 18 years need 400 mcg of folic acid daily. (24)
Brief History of Folic Acid
Health experts have long considered folic acid to be a better option for supplementation for its absorption rate over naturally-occurring folate. However, recent research suggests that a nutritious diet containing a variety of folate-rich, whole foods has been shown to be almost as effective, and 5-MTHF supplementation even more effective.(25)
Because approximately 50% of pregnancies in the U.S. are unplanned, daily folate intake is important, especially for all women of childbearing age. Unfortunately, folic acid deficiency is still a problem throughout the world, even with our knowledge of the risk it poses for birth defects. According to the CDC, there are 3,000 pregnancies of babies with neural tube defects reported in the U.S. each year. (26) Only an estimated 40% of women of childbearing age in the U.S. population reported taking folic acid daily. (27) Many instances of neural tube defects could be prevented if these women took 400 mcg of folic acid daily, before and during early pregnancy. (28)
In 1998, the U.S. Food and Drug Administration (FDA) required that all enriched grain and cereal products be fortified with folic acid. Since then, the CDC has reported 35% fewer cases of neural tube defects. That’s about 1,300 healthy U.S. babies that will be born without a neural tube defect each year. (29, 30) However, factors such as genetics, maternal diabetes, obesity, and intake of other nutrients such as vitamin B12 are also believed to affect the risk of neural tube defects. Even so, taking folic acid supplements may make a difference to your health. Here’s how.
Potential Health Benefits of Folic Acid
Folate many important roles in the body, including supporting:
- Heart health
- Healthy homocysteine levels already in the normal range
- Production of red blood cells
- Healthy nervous system
- Healthy cognitive function
- Healthy blood sugar levels already in the normal range
- Healthy pregnancy
- Healthy fetal development
- Men’s sexual health
- DNA synthesis and repair
- Cell growth and maintenance
- Healthy metabolism of amino acids
- Skeletal health (31)
Folic Acid and the Heart
People with high levels of the amino acid homocysteine are more likely, studies say, to have heart-related health problems such as stroke or coronary artery disease. Folic acid may help protect heart health by helping maintain healthy homocysteine levels already in the normal range. (32) A study on animal test subjects demonstrated that dietary folate may increase tissue concentrations of Docosahexaenoic acid (DHA), an essential omega 3 fatty acid that may protect against mood disorders and cardiovascular disease. (33)
Folic Acid and Blood Sugar
Diabetes prevents the body from converting the sugars and starches (carbohydrates) it gets from foods into energy. Instead, the body has irregular insulin levels causing extra sugar to build up in the blood. Poor control of diabetes during pregnancy is dangerous not only to the mother but also to the baby. According to the American Journal of Obstetrics and Gynecology, babies born to mothers with pre-existing diabetes who did not take a folic acid supplement before and during early pregnancy increase their baby’s risk of birth defects and other health complications. Folic acid supplements of 400 mcg daily taken by women before and during early pregnancy may help prevent irregular blood sugar levels and help maintain healthy blood sugar levels already in the normal range. (34)
Folic Acid and Red Blood Cells
Adults and children need vitamin B9 for red blood cell production. Red blood cells transport oxygen throughout the body, including to tissues and organs, so they function properly. Red blood cells also transport carbon dioxide or waste away from the tissues. A folic acid deficiency may cause anemia (also referred to as iron deficiency), a blood disorder. When your body lacks enough healthy red blood cells or hemoglobin – the main part of red blood cells that binds oxygen – anemia may occur and the cells in your body will not get enough oxygen to function properly. Taking a folic acid or folate supplement may help maintain healthy red blood cell production throughout the body. (35, 36)
Folic Acid, Women’s Health, and Pregnancy
Folic acid is believed to support healthy neural tubes in the female reproductive system, and support the healthy development of fetal tissue. Folic acid is also used to make the extra blood a mother’s body needs during pregnancy. Therefore, folic acid is considered essential for women looking to become pregnant, after conception, and during fetal development. As mentioned earlier, the CDC recommends that women take 400 mcg of folic acid every day starting at least one month before conception and during pregnancy to help prevent major birth defects of the baby’s brain and spine. (37)
There is ongoing research around the world studying the folic acid’s potential health benefits for the human body from conception through adulthood. The National Birth Defects Prevention Study is considered the largest population-based U.S. study of risk factors and causes of birth defects. The study is researching women’s behaviors, alcohol use during pregnancy, and intake of micronutrients, such as folic acid affecting specific birth defects. In addition, the National Health and Nutrition Examination Survey (NHANES) combines interviews and physical exams to track and evaluate the health and nutrition of adults and children in the U.S., including folic acid intake and blood levels of folate and other micronutrients.
The CDC and the Peking University Health Science Center in China have also been collaborating on research regarding women’s daily intake of 400 mcg of folic acid before and during early pregnancy. It has been discovered that this daily recommended amount of folic acid reduces 85% of instances of neural tube defects in high-prevalence areas and 41% in areas with prevalence similar to the U.S. (38)
According to the University of Maryland Medical Center, “studies show that women who take folic acid supplements before conception and during the first trimester may reduce their risk of having children with neural tube defects by 72% to 100%. … Folic acid may also help prevent miscarriage, although the evidence is not clear.” (39) Neural tube defects and other birth defects can be detected as soon as 16-18 weeks’ gestation with an AFP test if the mother has abnormally high levels of alpha-fetoprotein (AFP), the substance produced by the fetus and secreted into the amniotic fluid. An elevated AFP may also indicate the presence of twins or a possible problem with the placenta. AFP in the mother’s blood peaks at around 30-32 weeks. (40)
To help prevent birth defects, in addition to folic acid, pregnant women also need vitamin B6, vitamin B12, and many other important vitamins and minerals during pregnancy. The best way to get these nutrients is by taking prenatal vitamins at least one month or more before pregnancy. A folic acid supplement may also be ideal to fill in nutritional gaps. Always consult with your healthcare provider to find the best nutritional plan for you and your baby.
Folic Acid and Men’s Health
Research suggests men need folic acid as much as women do, especially as men age. Not only does folic acid help protect a healthy heart, but it is also believed to help maintain blood pressure and cholesterol levels already in the normal range. In fact, one U.S. study suggests that folic acid could cut men’s risk of a stroke by one-fifth. Its potential support of maintaining healthy homocysteine levels already in the normal range may also have an effect on protecting the body against depression, Alzheimer's disease, diabetes, and cancer. (41)
In addition, a news report discussed a study that found that there may be a link between male folic acid intake and healthy sperm cells. “High folic acid intake was associated with 19% fewer abnormalities (all types) than moderate intake and 20% fewer than men with a low micronutrient intake.” (42) Another article concurs. “This study is the first to suggest that paternal diet may play a role in the development of healthy offspring.” (43)
There is also some research that suggests a link between the lack of folic acid and male depression. Taking a folic acid or folate supplement may help support mood health. (44)
Folic Acid and Healthy Aging
Folic acid supplementation may also help with other aspects of the aging process. According to one study on hearing loss in seniors, folic acid supplements helped slow the progression of age-related hearing loss in elderly people with high homocysteine levels. In addition, another study found that folic acid supplementation helped reduce elderly women’s risk of vision loss. (45)
How to Get Folic Acid
Everyone needs folic acid – including men, women, and children. The CDC recommends that especially women of childbearing age, and those trying to get pregnant or who are already pregnant, get enough folic acid in their diet every day. It is important to make sure adult women are getting at least 400 mcg of folic acid (not to exceed 1,000 mcg) daily, at least one month before becoming pregnant, to avoid possible birth defects. The best way to get enough folic acid is in the foods you eat and through dietary supplementation.
Folic Acid Intake Options
- Take a vitamin containing your recommended amount of folic acid every day.
- Eat a bowl of breakfast cereal everyday that has 100% of the daily value (DV) of folic acid.
- Eat a diet with plenty of fortified grains and foods like beans, peas, and leafy greens, which are rich in folate. (46)
Folic Acid in Foods
Many of the foods we eat regularly contain some amounts of folic acids. Here are some of them. (47)
Folic Acid Availability
The Institute of Medicine recommends taking a multivitamin, a prenatal vitamin, or a single supplement of folic acid per day, depending on your age and gender. Approximately 85% of the folic acid in supplements, when taken with food, is bioavailable. When eaten without food, nearly 100% of the folic acid from a supplement is bioavailable and able to be absorbed and utilized by the body. (48, 49)
Prenatal vitamins, multivitamins, and folic acid supplements can be purchased at most local pharmacies or natural health stores. If you’re looking for trusted brands of natural, high-quality folic acid supplements and folate products that have been pre-vetted for meeting quality ingredients and manufacturing standards by a certified nutritionist, shop NaturalHealthyConcepts.com. (50, 51) We are also proud to offer fast, free domestic shipping on all orders!
No matter what your folic acid needs are, be sure to consult with your healthcare provider first to create the best nutritional plan for you, especially if you’re pregnant or planning on getting pregnant. Try folic acid for yourself today and see if it makes a difference to your health!
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