Part 2: The Folate Debate- Folic Acid v Folate

and why we might need it

So this is Part 2 of my writings about folic acid- you can read Part 1 below.

Part 1: The Folate Debate- Fortifying Foods with Folic Acid

I will be focusing on the differences between folic acid and folate, our genetics and methylation and why folate can help reduce homocysteine levels- a key marker for cardiovascular disease. Head straight to the conclusion for the TL;DR!

What is Folic Acid?

Folic acid is the synthetic form of folate that you will find in fortified foods and supplements.

It has a slightly different molecular structure to natural folate which makes it more stable.

Basically natural folate is sensitive to heat, light and processing, its very fragile - think of it like a shy woodland creature that disappears before you can take a photo.

If you eat fresh food you get folate, when you process it, it goes (liver being an exception).

Whereas folic acid is a lot more confident and can withstand the pressure of cooking so it can be added very easily to fortify processed foods.

I am not pro mass fortification of foods but I appreciate the Western diet can easily be deficient in folate (a lot of people do not eat fresh veg, pulses or liver)! Folic acid is cheap and potentially life saving for people who lack the resources to nourish themselves.

However, if you are reading this, then this is probably not you! I’m guessing you are interested in health and so would find it easy to get enough folate through the diet without needing to supplement with folic acid.

There is one caveat though as people with digestive disorders such as coeliac disease or inflammatory bowel disease may find folic acid is easier to absorb than natural folate.

Because folic acid is a different structure to folate, our body has to process it differently.

Without wanting to get too technical (but I will a tiny bit) we have enzymes that convert folic acid firstly into dihydrofolate (DHF) and then into tetrahydrofolate (THF).

Natural folates are directly converted into THF skipping out the DHF part.

So that means we have extra work to convert folic acid into the useable form of folate.¹

This could be fine some of the time but what we see is that excessive folic acid intake can result in unmetabolised (so it hasn’t converted into the form of folate we can use) folic acid circulating in the bloodstream. ²

High levels of unmetabolised folic acid have been associated with potential negative health effects, including lowering natural killer cell activity, decreased memory in elderly, colorectal cancers and insulin resistance in babies.³⁴

Researchers are also hypothesising a link between folic acid and tongue tie in babies. ⁵

There seems to be a rise in tongue-tie diagnosis in infants which can cause issues from latching during breast-feeding to speech, breathing and eating difficulties. Is this correlated with folic acid supplementation?

From my personal observations only, my pregnant clients and friends who I have suggested using a natural form of folate supplementation have had babies who do not have difficulties with latching. But I appreciate that is v.objective!

Testing: A serum folate test measures both artificial folic acid (from supplements and “enriched” foods) and natural folates (from whole foods). Therefore, cut out the folic acid before testing to get a more meaningful indication.

With regards to folic acid supplementation in pregnancy- its a tough one. All the studies regarding using folate to prevent spina bifida in pregnancy is with folic acid…so this is why health professionals recommend synthetic folic acid as a supplement in pregnancy. It is hard to dispute…

However, intuitively it would not make sense for our body to need a synthetic lab-made supplement to create a healthy baby. If folic acid works then it is because we can convert it into the form that our body uses which is natural folate. So we could skip out the folic acid and go straight to nature and get the same (if not more) benefits from food-state folate?

And when I say more benefits from using natural folate, we are also reducing the risks associated with unmetabolised folic acid (see above).

Another concern is that folic acid can block the natural form of folate from getting into our cells. So if you eat more foods that contain folic acid than leafy green vegetables, the natural folate could struggle to be absorbed.

However, there is another reason why folic acid could be a potential issue and that is in our genetics!

Next, I’ll be covering an overview of methylation, genetic issues with folic acid and homocysteine.