Chances are you’ve been told you need to take folate if you’re trying to conceive. Sounds simple, right? But when it comes trying to choose a type of folate supplement, it gets a bit more complicated. It really comes down to the various forms of natural folate vs folic acid. So what’s the difference between folate vs folic acid and does it matter which one you take?
The first thing to know is that the folate vs folic acid debate is a fairly new one so the evidence is just emerging. This also means that many healthcare professionals may not be up to date with the latest research. If you’re unsure, it’s best to speak to a specialised prenatal dietitian to find out the best option for you.
Folate is a B vitamin, also known as B9. It is an essential nutrient needed to make DNA and for cell division.
There is very strong evidence that supports the use of folate supplementation in pregnancy for preventing neural tube defects (NTD). Supplements have been shown to be safe and may also have other benefits including improving the chances of conception.
For this reason, it’s pretty much universally agreed folate is the most important preconception nutrient. You can read more about folate in our post about The Number One Prenatal Vitamin.
Folic acid in fortified food and supplements must be converted to another form for the body to be able to use it. This form is called 5-methyltetrahydrofolate or 5-MTHF.
This conversion requires two enzymes in the liver, one of these is called MTHFR. The gene that tells your body how to make the MTHFR enzyme is slightly altered in some people which means folic acid is not converted as effectively. Having the altered gene is called having a MTHFR polymorphism and can reduce the amount of usable folate available for your body. It has been suggested that it may also lead to a build-up of homocysteine, which is known to be harmful and the build-up of unconverted folic acid in the blood, which has been suggested to be harmful.
It follows that if you weren’t able to convert folic acid to the active 5-MTHF form very well, it might be a good idea to skip that step and take 5-MTHF, also known as “natural folate” or just “folate”. Indeed, those with known polymorphisms of the MTHFR gene are likely to benefit from taking a supplement with 5-MTHF rather than folic acid, so this conversion step isn’t required. Particularly if they have the polymorphism on both copies of the gene, which is called being homozygous.
In fact, supplementing 5-MTHF, has been found to be more effective at improving long term folate status regardless of MTHFR polymorphism. However, current guidelines for the general population, those without known MTHFR polymorphisms, still recommend supplementing with folic acid. Why?
The effect of supplementing 5-MTHF rather than folic acid has not been studied in regards to the prevention of neural tube defects and randomised controlled studies comparing the two in pregnancy would likely be considered unethical. This is because the evidence that folic acid supplements helps prevent NTD is very strong, so telling pregnant women not to take it is considered high risk and unethical. It seems likely that taking 5-MTHF would have the same effect on preventing NTD but we don’t have the evidence to prove that.
Although it is thought that 30-50% of people have a MTHFR polymorphism, most people aren’t tested as it’s still an emerging area of research. If you have been diagnosed with infertility, have struggled to conceive, had multiple miscarriages or have a family history of neural tube defects, it might be a good idea to speak to your healthcare professionals about having it tested.
Whichever form you decide to supplement with, getting adequate folate is vital.
If you choose to supplement with folic acid, you can also ensure you’re getting lots of natural folate by consuming folate rich food like leafy greens and legumes (which is a great idea anyway!)
If you choose to supplement with natural folate (5-MTHF), you can still get some folic acid in by consuming for fortified food such as breads and cereals
Or you can hedge your bets and alternate between folate and folic acid supplements
If you have questions about whether folate vs folic acid might be best for you personally, talk to your health professional or book a consult with our fertility experts.
back to top
Fertility dietitian, ovulation expert, lover of food and squishy newborn baby cuddles. I help people get pregnant (fast) and have the healthiest pregnancies possible.