Folate is the water-soluble vitamin known as vitamin B9, and formerly as folacin. There are many folate health benefits that make this nutrient very important for various functions in the body. For instance, folate plays a vital role in DNA formation and cell growth. Folate deficiency is associated with an increased risk of birth defects, heart disease and stroke, and cancer.
This is why folate food sources and supplementation with vitamin B9 is crucial for overall health. However, many supplements and fortified foods often contain folic acid, and not folate. At the same time, there are natural vitamin B9 supplements and folate foods that you should know about.
Folate vs. Folic Acid
Let’s first explain folate vs. folic acid. In the U.S., approximately 35% of adults and 28% of children use supplements with folic acid. However, folic acid and folate are not the same thing, and there are noteworthy differences between them.
1. What is Folate?
Folate comes from the Latin word “folium,” which translates as leaf. In fact, the best folate sources are leafy vegetables. Folate is actually considered a generic name for a related compound group with similar nutritional properties. In the digestive system, the majority of dietary folate converts into the active form of vitamin B9 called 5-methyletrahydrofolate (5-MTHF), before entering the bloodstream. The body also naturally and easily absorbs and utilizes folate when metabolized in the small intestines.
2. What is Folic Acid?
How does folate differ from folic acid? It is the synthetic version of vitamin B9, which you will often find added to processed foods like breakfast cereals and flours.
Folic acid was once thought to be better absorbed than folate; however, research shows folate-rich whole foods are just as effective. Folic acid was first introduced around the 1940s and required the enzyme dihydrofolate reductase, which manages folate in the body. Also, studies indicate folic acid is not easily converted to active vitamin B9, and may be converted in organs and tissues outside the digestive system.
3. Problems with Folic Acid
Folic acid supplements take time for the body to convert to 5-MTHF. Even small doses of folic acid may not be completely metabolized until the next dose is taken. This is also a problem with folic acid-fortified foods. Unfortunately, un-metabolized folic acid has been linked to various health problems like trouble concentrating, changes in sex hormones, mood changes, inability to sleep, and nutrient deficiencies like vitamin B12. Studies also link folic acid to increased cancer risk and the growth of pre-cancerous cells and tumors.
Folic acid remains on the U.S. Food and Drug Administration (FDA) list of mandatory food fortifications.
Symptoms of Folate Deficiency
The body content of folate is estimated to be around 10mg to 30mg, and about half is stored in the liver and the rest is stored in the body tissues and blood.
Folate deficiency can be a serious health concern. Although many Americans obtain adequate folate levels, some groups are still at risk of insufficient amounts. People at higher risk of experiencing folate deficiency than others include alcoholics, anyone on kidney dialysis, anyone with liver disease, anyone taking diabetes medications, anyone taking methotrexate, those that often use laxatives or diuretics, breastfeeding mothers, and pregnant women, or those looking to become pregnant.
The following are common signs and symptoms you may be suffering from folate deficiency:
- Pale skin
- Premature hair graying
- Mood changes like irritability
- A tender, swollen tongue, and canker sores in the mouth
- Poor immune function; and frequently getting sick
- Developmental problems during infancy and pregnancy like stunted growth
- Poor digestion; like IBS, bloating, and constipation
- Chronic low energy, such as chronic fatigue syndrome
Folate Health Benefits
There are several health benefits of folate. For instance, folate is one of the most crucial vitamins there is for a healthy pregnancy. For pregnant women, a folate deficiency can potentially lead to neural tube defects, including anencephaly, spina bifida, heart complications, and limb malformations. Besides eating plenty of folate-rich foods, pregnant women should also take a prenatal vitamin during pregnancy to help meet their folate needs.
The following are four more potential folate health benefits:
1. May Prevent Cancer
Low folate blood levels are linked with a higher risk of lung, breast, cervical, brain, and colon cancer. According to the journal Biofactors in 2011, epidemiologic evidence indicates that a high amount of folate foods offers protection against some cancers. It is also important to note that cancer is caused from DNA damage in individual cells. Folate helps ensure proper DNA replication, and may therefore prevent DNA from becoming damaged.
2. Aids in Nutrient Utilization
Folate deficiency is associated with anemia, which develops when red blood cells aren’t formed properly. In the formation of DNA, the methylation of deoxyuridylate to thymidylate is necessary for proper cell division. Megaloblastic anemia will form when this process is impaired. Folate also is required for vitamin B12 absorption, and therefore high folic acid may mask vitamin B12 deficiency until neurological problems become reversed.
3. May Support Heart Health
All B vitamins, including folate, play a major role in decreasing elevated homocysteine levels in the blood. Homocysteine is linked to an increased risk of stroke and heart attack. In general, people who consume high folate levels have a lower risk of heart disease. Although folic acid and vitamin B12supplements can decrease homocysteine levels, these supplements will not decrease the risk of heart disease, but they may protect against stroke.
4. May Prevent Dementia
Observational studies associate high homocysteine levels and a greater risk of Alzheimer’s disease and dementia. Some studies also link low folate and poor cognitive function. A good approach to treating Alzheimer’s disease is to focus on obtaining nutrients, including natural and unprocessed folate foods.
Recommended Daily Intake of Folate
According to the Institute of Medicine at the National Academy of Sciences, the following is the recommended dietary allowance (RDA) for folate per day:
- Infants and babies: 65mcg
- Children aged 1-8: 80-150mcg
- Teens aged 8-13: 300mcg
- Adult men and women age 14 and above: 400mcg
- Pregnant women: 600mcg, which is about 50% higher than the recommendation of non-pregnant women
- Breastfeeding women: 500mcg
Top Food Sources of Folate
Folate is largely found in plant-based foods, so the best way to get enough folate and prevent folate deficiency is to consume five or more servings of folate-rich whole foods daily like vegetables and fruit. The best natural folate food sources include leafy greens, Brussels sprouts, broccoli, and citrus fruits. Folate is also found naturally in animal products like poultry and liver.
Increasing your intake of natural folate-rich foods is the best way to protect against folate deficiency and complications associated with folic acid supplementation. The following are the top folate food sources:
|Food||Serving Size||Amount (mcg)||Daily Value %|
|Calf’s Liver||4 oz.||860.7||215.2%|
|Chickpeas||1 cup cooked||282.1||70.5%|
|Spinach||1 cup cooked||262.4||65.6%|
|Navy Beans||1 cup cooked||254.6||63.7%|
|Beef Liver||3 oz.||215||54.0%|
|Black Eyed Peas||1 cup cooked||210||52.0%|
|Lentils||1/2 cup cooked||179||45.0%|
|Collard Greens||1 cup cooked||176.7||44.2%|
|Brussels Sprouts||1 cup cooked||156||40.0%|
|Pint beans||1/2 cup cooked||146||37.0%|
|Broccoli||1 cup cooked||104||26.0%|
|Mustard Greens||1 cup cooked||104||26.0%|
|Kidney Beans||1 cup cooked||92||24.0%|
|Beets||1/2 cup cooked||68||17.0%|
|Romaine Lettuce||1 cup raw||64||16.0%|
|Avocado||1/2 cup raw||59||15.0%|
|Cauliflower||1 cup cooked||54.6||13.6%|
|Wheat Germ||2 tbsp.||40||10.0%|
|Summer Squash||1 cup cooked||36.2||9.0%|
|Celery||1 cup raw||33.6||8.4%|
|Cabbage||1 cup cooked||30||7.5%|
|Tomatoes||1 cup raw||27||6.8%|
|Bell Peppers||1 cup raw||20.2||5.1%|
Adding folate-rich foods to your diet can definitely be a positive step for your health, and folate from whole food doesn’t carry as many risks.
Folic Acid Supplement Precautions
However, as mentioned, folic acid supplementation can aggravate health conditions and can interact with certain medications, including methotrexate, and drugs used to treat autoimmune diseases and cancer. Also, taking antiepileptic medication used for epilepsy or psychiatric diseases, along with folic acid supplementation, may cause lower serum levels of these drugs. There may also be reductions of the ulcerative colitis treatment sulfasalazine when folic acid is also used.
Mateljan, G., The World’s Healthiest Foods: Essential Guide for the healthiest way of eating (Seattle: George Mateljan Foundation), 756-757.
Arnarson, A., “Folic Acid vs Folate – What’s the Difference?” Authority Nutrition website, October 2015; http://authoritynutrition.com/folic-acid-vs-folate/.
“Folate,” National Institutes of Health Office of Dietary Supplements; https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/, last reviewed Dec. 14, 2012.
“Folic Acid: Uses, Deficiency, Natural Sources,” Medical News Today, July 16, 2015; http://www.medicalnewstoday.com/articles/219853.php.
Mason, J.B., “Unraveling the complex relationship between folate and cancer risk,” Biofactors, July to August 2011; 37(4): 253-260, doi: 10.1002/biof.174.