What's The Difference Between Folate Vs. Folic Acid?
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Medically reviewed by Paria Sanaty Zadeh, PharmD
The terms folate and folic acid are often used interchangeably. However, despite both being forms of vitamin B9, the two compounds are quite different.
Folate is naturally found in various whole foods, while folic acid is a synthetic form of folate commonly found in fortified foods and supplements.
This article explores the differences between folate and folic acid, plus their sources, benefits, and potential risks.
Is Folate The Same As Folic Acid?
Folate is an umbrella term used to describe all forms of vitamin B9, including folic acid.
Natural folate is the form of vitamin B9 found primarily in dark leafy greens, citrus fruits, and beans.
Folic acid is the synthetic (man-made) form of folate found in dietary supplements and fortified foods like breakfast cereals, rice, pasta, and bread.
Compared to naturally occurring folate in foods, the body absorbs folic acid more efficiently. Around 85% of folic acid from supplements and fortified foods is absorbed, while only 50% of naturally occurring folate is absorbed.
How Much Folate Do I Need?
The Recommended Dietary Allowance (RDA) for folate is based on dietary folate equivalents (DFEs). This unit of measure was developed to account for the increased absorption of supplemental folic acid.
One microgram (mcg) DFE is equal to:
1 mcg of folate found naturally in foods
0.6 mcg of folic acid from fortified foods or dietary supplements taken with foods
0.5 mcg of folic acid from dietary supplements taken on an empty stomach
The amount of folate you need depends on your age and gender. The RDA for folate in DFE is:
Birth to 6 months: 65 mcg
Ages 7 to 12 months: 80 mcg
Ages 1 to 3: 150 mcg
Ages 4 to 8: 200 mcg
Ages 9 to 13: 300 mcg
Adults and teens over 14: 400 mcg
Pregnant adults and teens: 600 mcg
Lactating adults and teens: 500 mcg
Why Is Folic Acid Important?
Folic acid helps the body make new, healthy red and white blood cells. It also aids in DNA production.
Folic acid is a water-soluble vitamin, which means it is not stored in the body and needs to be replenished regularly. Because of this, your blood levels of folate can drop after only a few weeks of inadequate dietary folate intake.
Not consuming enough folate can lead to folate-deficiency anemia, a blood disorder that causes fatigue, weakness, difficulty concentrating, shortness of breath, and irritability.
Folic acid is especially important during pregnancy because it helps prevents miscarriages and protects babies from birth defects. In particular, folic acid provides protection against neural tube defects, which are severe birth defects of a baby's brain and spine.
To reduce the risk of neural tube defects, it is recommended that all women of reproductive age consume 400 mcg of folic acid per day. This can be met by consuming fortified foods, supplements, or a combination of both, in addition to eating a healthy diet that includes naturally occurring folate from food.
It's important to note that supplements containing folate in forms other than folic acid, such as 5-methyltetrahydrofolate (5-MTHF), have not proven to be effective at protecting against neural tube defects.
Other groups at risk of folate deficiency include people with the following conditions:
Alcohol use disorder: People with alcoholism often have poor diet quality and inadequate folate intake. In addition, alcohol interferes with folate absorption and increases folate excretion, further increasing the risk of deficiency.
Malabsorptive disorders: People with celiac disease, inflammatory bowel disease (IBS), and atrophic gastritis (chronic stomach inflammation) may not absorb folate as well as those without these conditions. Folate deficiency is also common after weight loss surgery.
MTHFR polymorphism: People with the MTHFR C677T gene variant have a reduced ability to convert folate to 5-MTHF, one of its active forms. For some people with this genetic variation, supplementation with 5-MTHF (the active form of folate) may be beneficial. However, due to limited research, 5-MTHF should not be used in place of folic acid before or during pregnancy, even in individuals with the MTHFR C677T gene variant.
Natural Sources of Folate
The richest natural sources of folate include:
Beef liver
Spinach
Mustard greens
Oranges and orange juice
Black-eyed peas
Kidney beans
Sources of Folic Acid
In 1998, the U.S. Food and Drug Administration mandated that folic acid be added to enriched grain products to reduce the risk of neural tube defects during pregnancy.
Foods commonly fortified with folic acid include:
Breakfast cereal
Bread
Flour
Cornmeal
Pasta
White rice
Products made from a type of flour called corn masa, including tortilla chips, taco shells, and tortillas
If you're unsure whether a food has been fortified with folic acid, look for the word "fortified" or "enriched" on the food labels. The amounts of folate in mcg DFE and folic acid per serving will be listed on the nutrition facts label.
Who Should Not Take Folic Acid?
The folate naturally found in food and beverages is safe. Folic acid is also safe for most healthy adults and children. However, it may not be appropriate for everyone.
Consult with your healthcare provider before taking folic acid if you:
Have a history of an allergic reaction to folic acid or any other medications
Are receiving dialysis, a treatment for kidney failure that filters extra water and waste products from your blood
Have cancer without a confirmed diagnosis of folate deficiency anemia
Have a heart stent
Other Considerations
Always consult a healthcare provider before taking any dietary supplements or making significant changes to your diet.
Additionally, avoid consuming folic acid from dietary supplements and/or fortified foods in amounts that exceed the daily upper limit unless otherwise instructed by a healthcare provider.
The daily upper limits for folic acid from supplements and fortified foods are:
Birth to 12 months: None established
Ages 1 to 3: 300 mcg
Ages 4 to 8: 400 mcg
Ages 9 to 13: 600 mcg
Ages 14 to 18: 800 mcg
Adults 19+: 1,000 mcg
Unlike the RDAs, the upper limits for synthetic forms of folate are listed in mcg rather than mcg DFE. This is because high intakes of folate from food have not been linked to any adverse effects.
Taking high doses of folic acid supplements may mask a vitamin B12 deficiency, which may delay treatment and cause permanent damage to the brain and nervous system. There's some evidence that it may also increase the risk of certain types of cancer, such as colorectal cancer, in some people.
In addition, when large amounts of folic acid are consumed, the body may not completely process or metabolize it, causing unmetabolized folic acid to accumulate in the bloodstream. This has been linked to immune system changes and cognitive impairment in older adults. However, further studies are needed to fully understand these effects.
In certain situations, higher doses of folic acid may be recommended under medical supervision.
For example, people at high risk for having a baby with neural tube defects are often advised to take 4,000 mcg of folic acid daily for the first three months before and through week 12 of pregnancy.
People at high risk include those with a history of neural tube defects or with a partner or a child affected by these defects.
Medication Interactions
Folic acid may interact with the following medications:
Methotrexate: Folic acid may interfere with methotrexate (Rheumatrex, Trexall) when taken as a cancer treatment.
Anti-seizure medications: Folic acid may decrease blood levels of phenytoin (Dilantin), carbamazepine (Carbatrol, Tegretol, Equetro, Epitol), and valproate (Depacon). These medications may also decrease blood levels of folate.
Sulfasalazine: Taking sulfasalazine (Azulfidine) for ulcerative colitis may prevent the body from effectively absorbing folic acid, leading to a deficiency.
Talk to your pharmacist or healthcare provider if you take any medications or dietary supplements to ensure no interactions exist.
A Quick Review
Folate is the general term used to describe all forms of vitamin B9. Folate is found naturally in various foods, including leafy greens, beans, and citrus fruits. Folic acid, on the other hand, is a synthetic form that is added to fortified foods and used to make dietary supplements.
Getting enough folate is important, especially during pregnancy, because it protects against birth defects and miscarriage.
Folate from whole foods is considered safe. However, high amounts of folic acid supplements may cause adverse health effects. Always take folic acid supplements as your healthcare provider recommends to avoid potential side effects.
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