Pregnancy – The Importance of Folate vs Folic Acid

Many of my patients – soon to be pregnant or currently pregnant – come in already taking a prenatal vitamin with folic acid in it. With recent research coming out stating that excessive amounts of folate can dramatically increase autism risk, I wanted to explain the whole story.

During pregnancy our body needs extra folate – this is the natural form of folic acid. Our body cannot use folic acid properly and therefore, in some instances, this can be an issue. I’ll explain further.

Why is folate needed?

Methyl folate is needed in our system, pregnant or not. Ben Lynch, an ND focused in the area of epigenetics, calls it the ‘quarter back of the body’. It supports the production of: neurotransmitters (those things that make us happy, relaxed, stimulated or not), energy (ATP to be exact), blood cells, our immune cells and therefore their proper function. In general it supports over two hundred ‘reactions’ that are run by methylation in our bodies. Sounds like a quarterback’s job to me :) 

During pregnancy – folate supports the production of the neural tube. The neural tube is built via building blocks of DNA. It is responsible for building our brain and spinal chord. If defects occur, you can imagine the implications this has on development of the fetus.

What’s the difference between folate and folic acid?

Folic acid is synthetic, manmade, not found in nature (do you get it now?) and has to be transformed before your body can use it. Methyl folate (5MTHF), on the other hand, is the major form of folate circulating in your blood. It is the ‘activated version’ of this vitamin/molecule. Folic acid is not methyl folate and can not be converted easily to methyl folate. It is the methyl group on methyl folate that supports those 200 plus enzymes (ie the ones that help to produce a healthy neural tube) in your body. The methyl group is the most important part of the folate. Folic acid DOES NOT have it.

Furthermore, folic acid can only be incorporated into our cells (where it is used) if it is reduced by an enzyme called dihydrafolate reductase (DHFR). But the problem is that this enzyme in humans is really slow. If we continuously are supplementing with folic acid, it then leads to a build up of un-metabolized folic acid lingering in the blood like a group of 16 year olds at a bush party. Ie – smells like trouble.

Well it is.  

Why? Because when we have too much un-metabolized folic acid in our blood, it slows down another enzyme called methyltetrahydrafolate reductase (MTHFR). This enzyme is the exact one responsible for making the methyl folate – which is exactly what we need to support the development of the neural tube!

Its all interconnected…is this making sense? Its not straight forward by any means. Bare with me here…

Important side note:

As mentioned already, MTHFR is the enzyme that helps to produce methyl folate. 60% of us have a MTHFR enzyme that is not operating at its full capacity. MTHFR defects are actually linked to a list of neural tube defect conditions along with numerous medical conditions including autism. MTHFR defects are possibly the area we should be focusing our study on, as well as treating, to reduce the number of these neural tube defects and other medical conditions such as autism.

What are sources of folate and folic acid?

Folic acid is found in enriched, processed foods, things like energy bars, breads, cereals, and lots of other packaged goods. Point is – always check the label.

Folate is found in your green leafy vegetables!! Point is? Eat your greens.

So what do we do with this information?

First of all, in the article link above, it would be good to know a) what type of folate is in the serum folate levels (methyl folate or unmetabolized folic acid?) and b) what % of mothers and babies have MTHFR defects. After this article was published, the author and researcher came out saying ‘There's this danger that the message would be that folate supplementation is bad. And that's not at all what we saw.”

Lastly here are some key take aways:

1.     During your pregnancy (and in general, for that matter) supplement with methyl folate instead of folic acid. Current recommendation right now is 800 mcg of folic acid during pregnancy. Scratch this. I typically put my patients on 1 mg / day of methyl folate. For me, dosage depends on age, current state of health, any MTHFR defect, and diet.

2.     Test for an MTHFR defect!! By testing this and subsequently treating for it, may be just the ticket to prevent the neural tube defects and 100’s of other disorders such as autism, that are linked to this defect.