Tuesday, June 1, 2010

Is Folic Acid the Only and the Best Choice?

What is Folic acid?
Folic acid is the synthetic form of Folate. Folate is the name for Vitamin B9, which is an essential vitamin for a variety of processes within the body. Folic acid and Folate are recognized primarily in the subject of pregnancy and neural tube defects because a deficiency can lead to neural tube defects in the developing embryo in the first 3 weeks of pregnancy.

Vitamin B9 has a hand in preventing a long list of diseases and syndromes including severe defects such as neural tube defects and Down syndrome. It also impacts homocysteine conversion, increasing the risk of blood clots, cardiovascular disease, chronic fatigue, IBS, anxiety, fibromyalgia, depression, migraines and strokes. It also plays a part in some cases of infertility, miscarriage/stillbirth, pre-e/eclampsia and placental problems. This is only a small list of examples of the way b9 deficiency can wreck havoc on our bodies.

What is the history of Folic acid in our food?
The development and promotion of Folic acid has been accepted as a miraculous creation in our country. Most people generally associate widespread supplementation and marketing geared towards pregnant women as saving countless babies from defects. Women attempting to conceive or already pregnant are encouraged to take Folic acid in a daily prenatal pill, and some are even told to take an additional Folic acid pill on its own. Additionally, almost the entire nation is exposed to Folic acid daily because our government pushed supplementation of store-bought breads, pastas, baby formula, baby food, granola bars, cereals and more.

Perhaps the most concerning part about all the hype surrounding Folic acid is how little we know from a scientific standpoint. Folic acid has only been supplemented in our foods since 1998. Guess when the MTHFR defect was discovered? Yup, 1999. 

What is the catch?
Can you take a step away from this promotion and the accepted conclusion on Folic acid to consider some other aspects that aren’t miraculous or healthy? I’m not asking you to instantly agree with me or to altogether throw out the perceptions you’ve been given. Just consider. Consider the deeper implications. Consider the newer science. And think again about your options.

What is the problem with the synthetic version? On a genetic basis, only 49-56% of the population can actually process Folic acid effectively enough to use it. The body uses the natural version (Folate) in the form of 5-methyltetrahydrofolate, also abbreviated to 5-MTHF on a cellular level. For Folic acid to enter into this process, the body has to convert it using enzymes in the methyl process.

For roughly half the population with MTHFR genetic variations, Folic acid is not “bio-available” enough for their bodies to use. So despite supplementation, they are still at risk and remain deficient. This helps to explain why the studies that show Folic acid supplementation “saves babies” from neural tube defects have roughly 50% success rates (studies below). For roughly half the population of the pregnant study participants, they were unable to use the synthetic vitamin and were thus still at risk for defects.

Concerns about supplementation during pregnancy have only been seriously looked at in very recent years. So although the media and pamphlets in your doctor’s office might have given you the perception that this is a great and safe practice, in reality, this is a huge experiment. I am not in ANY way dismissing the concerns of deficiency. In fact, I am encouraging everyone to pay MORE attention to it. If you don’t know what genetic variation you have, why take the risk with synthetic Folic acid?

See, FolATE and FolIC are very different from a chemistry point of view. Folate is oxidized with glutamate molecules, which are then removed during absorption. It is then freely able to bond to other molecules, which makes it biologically active, or “bio available.” Also, when you obtain Folate naturally, you are getting a broad spectrum of other vitamins and enzymes with complimentary molecules in the normal ratios needed to assimilate and utilize Folate. Remember also that enzymes only identify specific versions of molecules, so FolIC acid bypasses a big part of the enzymatic process and makes transcellular protein transporters useless. In short, Folic acid, the lab-made product, is inferior even if your body is able to use it.

What can be done for those of us who can't use Folic acid?
What if we as a country promoted a healthy diet with wholesome foods rich in real b9? Those who are at risk would receive levels of b9 in their diets. And what if we routinely screened with a simple blood test for MTHFR variations? Those who have more concerning genetic cases could then make an informed decision to use an active supplement that doesn't have to be converted. Active forms go by several names such as l-methylfolate and 5-mthf. They have already been "converted" so to speak so your body can use them immediately. 

Where can I find natural b9?
Easy to find, cheap and healthy!

Romaine lettuce
Turnip Greens
Mustard Greens
Collard Greens
Black beans
Pinto beans
Garbanzo beans
String beans

And this is just a sampling! It’s clear when reading this small list that we can all easily and inexpensively add natural b9 into our diet. For those who really can’t stand green veggies, simply mixing a handful of greens into a fruit smoothie with a bit of honey will do the trick. Imagine the health benefits of drinking fresh green smoothies daily versus taking synthetic prenatal pills daily! Do you see what I am getting at? We have options here.

Any special concerns?
If you are on certain medications, they can interfere with your body's ability to absorb and use b9 whether natural or synthetic. These medications can also deplete your supply. Typically any drugs for cancer, cholesterol, diabetes and epilepsy do this. Also, contraception, diuretics and antibiotics have a tendency to interfere. When you read the list, it makes you wonder about the real reason we as a nation actually have problems with Folate deficiency and tube defects in our babies! These are all very common drugs used by a lot of people!

What about supplements?
For those who are healthy and have normal folate levels, continue to eat a healthy, balanced diet. When trying to conceive, during pregnancy or while lactating, if you want an additional supplement, consider using a product that contains Folate and not Folic acid. If you've identified low folate levels or MTHFR/genetic defects, consider using a product that contains active (converted) forms of Folate to overcome gut issues and genetic defects.

Who sells these active forms?
Thorne Pharmaceuticals, Metagenics, Garden of Life Raw and New Chapter are several companies I know of that offer either natural Folate or active forms. None of these companies have solicited my opinion or paid me in any way. 

Why is this important to know when trying to conceive or pregnant?
Neural tube defects and other midline defects such as cleft palate, sacral dimples, heart defects and tongue ties tend to occur in the first 3-4 weeks after conception. This is early, sometimes before women even realize they are pregnant. So ensuring you have adequate levels of Folate before conception can reduce the risk of defects. Already pregnant? Rmember that Folate powers the methyl cycle, which in turn powers the body, working to create vital things such as glutathione and methionine from homocysteine. Even if you've missed the pre-conception time period, continue to get adequate levels of Folate through diet or necessary supplementation to support a healthy pregnancy!

Okay, so what do I buy?

Folic acid: synthetic b9. Studies show increased cancer risks for everyone. For half the population, can't be used. Added to most processed foods, formulas, vitamins and drinks.

Folinic acid: another altered form, but not as bad as Folic acid. Often given in conjunction with chemotherapy but also in some supplements. Still not ideal.

5-MTHF: also metafolin or l-methylfolate. Active form, so the body doesn't have to convert it. Helpful if experiencing gut problems, gut disease or genetic defects such as MTHFR.

other name for vitamin B9. When you see this name it should mean that it is a food-source (natural source) and safe to take. BUT, keep an eye out for the asterisk and small print as some companies like to say folate then say "from folic acid" somewhere else on the packaging.

Here are some links for further study on this topic:

"The researchers concluded that the data indicates the prevalence of ASDs in those with MTHFR SNPs is 1.7 times greater than for those with normal versions of the MTHFR genes. Additionally it was a mutation in the C677T gene that appeared to impart the greatest risk."

”In plain English, the body is attacking itself by targeting the folate receptors.”

Really interesting article tying vitamin D3, casein (dairy products) and folate receptors together:

This is a thorough yet easy to read blog post on MTHFR and its connection to miscarriage. It also contains an easy to understand explanation about the genetic differences I mentioned above:

Folic Acid Supplements Linked To Asthma, Study Suggests:

Folic Acid: Mandatory Fortification May Be Unnecessary:

About HALF of the folate-related neural defects are explained by the most common genetic mutation at the MTHFR locus:

“Conclusions: Our results do not support the hypothesis that high folate intake reduces breast cancer risk; instead, they suggest that a high intake, generally attributable to supplemental folic acid, may increase the risk in postmenopausal women.”

“Furthermore, although food folate intake was not significantly related to breast cancer risk, total folate intake, mainly from folic acid supplementation, significantly increased breast cancer risk by 32%.”

"Folic acid supplementation was associated with increased risk of prostate cancer. By contrast, baseline dietary folate was inversely associated with prostate cancer risk."

“In fact, a 2009 meta-analysis of studies of folic acid supplementation showed that those receiving supplements for over three years had an increased risk of pre-cancerous bowel adenomas and bowel cancer.”

"Asthma was reported in 11.6% of children at 3.5 years (n = 57) and in 11.8% of children at 5.5 years (n = 50). Folic acid taken in supplement form in late pregnancy was associated with an increased risk of childhood asthma at 3.5 years (relative risk (RR) = 1.26, 95% confidence interval (CI): 1.08, 1.43) and with persistent asthma (RR = 1.32, 95% CI: 1.03, 1.69)."

"Conclusion Treatment with folic acid plus vitamin B12 was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods."

"In women randomised to high doses of supplemental folate, all cause mortality was about a fifth greater, and the risk of deaths attributable to breast cancer was twice as great."

"Conclusion: Our data provide new evidence that a folate fortification program could be associated with an additional risk of colon cancer."

"CONCLUSIONS: These data suggest that it may be prudent for women to consume a diet rich in vegetables and adequate in protein prior to and during pregnancy as a possible means of reducing childhood ALL risk in their offspring."

"Increased intake of fruits and vegetables has been associated with decreased leukemia risk and, relatedly, lack of maternal folate supplementation has been associated with increased childhood leukemia risk, possibly by causing DNA hypomethylation and increased DNA strand breaks. Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms modify this risk."

"Thompson et al. (45) reported that offspring of women who during their pregnancies received supplements with folate (naturally found in several leafy vegetables) had lower risk of ALL. Additionally, Jensen et al. (46) have found that increased maternal intake immediately before the index pregnancy (and inferentially, during that pregnancy) of vegetables and fruits was associated with decreased risk of ALL. "

"However, recent human studies have suggested that FA supplementation and fortification may promote the progression of already existing, undiagnosed, preneoplastic and neoplastic lesions, thereby corroborating earlier observations from animal and in vitro studies."

A study of 81,922 women and men, specific to folate from food sources.
"CONCLUSION: Our results suggest that increased intake of folate from food sources, but not from supplements, may be associated with a reduced risk of pancreatic cancer."

Antacids and birth control pills inhibit folate bio-availability:

L-methyl folate is the most biologically active and usable form of supplemental folate.

Conclusion: Maternal intake of synthetic folic acid leads to the appearance of unmetabolized folic acid in milk and, seemingly, a down-regulation of milk FBP synthesis. The impact of these changes on the bioavailability of folate in infants requires further exploration.

© Guggie Daly


  1. putting this in the next Sunday Surf. Thank you

  2. awesome post! im going to check out the prenatal vitamins now! thank you so much for sharing these in-depth articles :)

  3. Since this post was written, New Chapter has become the first vitamin company to be non-GMO certified and they added folate (not folic acid) to their Everywoman multivitamin. It is also in their B-complex vitamin.

    1. Shame how New Chapter has since sold themselves out.. Sharing current ties with Monsanto.

  4. Thanks so much for this post! My son (recovering from autism) and I (with ME/CFS) both take 5-MTHF, and I have been meaning to do more research about this whole issue.

  5. Good post. And there has been more negative research on folic acid in the last few months. I hope all multis eventually use folate.

  6. Thorne does make a folate-only supplement. 5-MTHF. I've been taking it for over a year.

  7. Very informative! I've linked to this post in my blog, http://nedranesting.blogspot.com/2011/04/first-foods-rice-paste.html

  8. I have a triple MTHFR mutation. Is there any way I can personally email you

  9. Great post, thank you for so much information in one place! I took/take Innate Response prenatal and postnatal supplements. The too have folate.

  10. Just an update - New Chapter has sold out to P&G - meaning they're involved with Monsanto now :(

    1. That is quite disappointing. Does that mean its now GMO and synthetic?

    2. At this point, I don't know. P&G might continue to produce a non-GMO/whole-foods based product, or they might change it. Additionally, some people might not be bothered by P&G owning it, while I know others who boycott P&G due to animal/human research issues.

  11. I just now found this blog. I wish I had found this 2 years ago! This is some wonderful information. I have MTHFR and I recently started a blog dedicated to raising awareness and educating others on MTHFR. I will be sending people over to this article. Thanks so much!

  12. What happened with your third pregnancy and the tongue tie issues? I am curious b/c DD has TT and lip tie, we didn't know and my supply plummeted and she is no longer BF :o( I am 24 wks with #2 and just researching ties and MTHFR (I suspect I have it). I guess its too late for this pregnancy, although I'm still going to start MTHFR supplements, but for our future babies I want to prevent ties and other issues.

    1. Third baby has an upper maxillary labial tie. Otherwise no signs. Seems the most robust of the bunch. :)

      I also got typed and I am double homozygous for C667T, considered the most severe form that often comes with multiple miscarriages or stillbirths. So it seems my babies are blessings in more than one way.

  13. I'm a Lactation Consultant who has been practicing for more than 20 years. The increase in midline oral anomalies (ankologlossia and Tight Maxillary Labial Frenulum) have been seen in recent years. These appear to have appeared with the nearly constant telling of TTC and pregnant women to take their folic acid. Some of my clients not only are taking 800mcgs. daily, but however much their Prenatal vitamins supply etc. I've been wondering about a link between folic acid and these anomalies for a while. If folate can reduce incomplete closures of the neural tube in fetal development (causing either spina bifida or, on the other end of the tube, cleft lip, cleft palate or both) would an overdose of these supplements serve to "overclose" the neural tube, leading to Tongue Tie, Maxillary Tight Labial Frenulum, as well? Thank you for the article. There is still a lot of work to do.

  14. Tongue tie is questionable as a defect since appearance is not diagnosis. Symptoms have to go along with that appearance. No symptoms no tie. Frenula don't set until the 12-13 week of pregnancy, not at the same time as neural tube or cleft palates and they don't always go together. I have two children with upper lip ties, two with tongue tie, two with both and none of us has mthfr or other defects. The studies we have show genetic inheritance and obvious dominant and recessive traits. But nobody has done studies on what gene it is or how its effected, if its mutated, or if methylation or folate/folic acid is a factor. So saying its mthfr related is not fact.

    1. Ankyloglossia might only need revision for function (which is my personal stance) but that does not mean it ceases to exist if the child can suckle well at the breast. Ankyloglossia IS accepted as a midline defect and its presence is absolutely connected to MTHFR and other mutations such as COMT/VAL.

      For example:

      That being said, mutations and other congenital defects can occur due to malnourishment or environmental exposure prenatally. Ankyloglossia and other midline defects are not *exclusively* caused by the cascade of MTHFR mutations. (Nor will every person with MTHFR display all or any midline defects as presentation is based on numerous factors.)

      What I'm saying is that 1) your assertion is incorrect. Midline development certainly begins earlier than 12-13 weeks. When the medial nasal processes approach each other is typically closer to 4-6 weeks.

      2) Just because MTHFR is not the exclusive etiology, does not automatically mean MTHFR is therefore unrelated. Genetic mutations are related to midline defects, even though other distinct etiological phenomena are valid, too.

      3) I highly doubt that you tested at least 40 SNPs for the various MTHFR mutations present in the population. Scientists estimate more than half the population has some variation of this MTHFR polymorphism. The odds that your children have more than one midline defect and popped negative on 40-50 different mutations is extremely low. I could see if you elected to do the blood test for them, which only tests the 2 most common mutations, and your doctor said they didn't have it.

      Please continue your research. I do not intend to come across as cold or mean here. You have a lot more to learn about this!

  15. Thanks for practical matters such as you talk about..sharing this information. I found it very informative as I have been researching a lot lately on
    new chapter vitamins