Is folate and folic acid the same? What should you know?

There is no straight answer to this question, as folate and folic acid are and are not the same thing. The most successful would be a “yes, but…” or a “no, but…”. It’s a bit confusing, I know, but although both terms are used to refer to vitamin B9 , they can’t be accessed in the same way.

Vitamin B9 is necessary for many processes in the body , as evidenced by the disorders that occur due to its lack. The body cannot produce it on its own , so it must be ingested with supplements or food, in the form of folic acid or its salts, the so-called folate. But does it really matter which form of vitamin B9 is used? Although both forms are related to vitamin B9, today you will know how to distinguish them.

Folate is vitamin B9 found naturally in foods such as green leafy vegetables, asparagus, nuts, beef liver, legumes, or citrus fruits. Meat and dairy products are also good sources of folate, but choose those that are lower in fat. Meanwhile, it could be said that folic acid is an artificial folate, that is, the synthetic vitamin B9 that is added to certain supplements or foods. Among the foods enriched with folic acid we can find cereals, pasta, bread, rice, or corn flour among others. We highlight “enriched” because many countries, such as the US since 1998, add folic acid to the products mentioned by law.

Importance of vitamin B9

As we have already mentioned, vitamin B9 is necessary for many processes in our body. It is a vitamin that participates in the formation of proteins , the maturation of red blood cells , the repair and production of DNA , and the growth of tissues and cell work . Therefore, it is useful to alleviate the toxicity caused by the drug methotrexate on the bone marrow. Taking folic acid by mouth seems to reduce the nausea and vomiting of methotrexate treatment.

It should be noted that, as with so many other products, there are many benefits attributed to folic acid. Some do have evidence to support the claims, while others do not. We will comment on both cases throughout the article. For example, some argue that folic acid helps implant a fertilized egg in the uterus. However, there is not enough evidence to support this claim.

On the other hand, as far as pregnancy and its development are concerned, it is true that it helps us avoid some birth defects of the brain and spine (neural tube birth defects). Daily intake of 600-800 mcg of folic acid by mouth during pregnancy reduces the risk of these birth defects. In this aspect, the benefits have been demonstrated whether we are talking about folic acid or folate, indistinctly. Some people may require higher doses.

For this reason, the intake of folic acid is recommended if pregnancy is planned, in order to prevent poor development of the neural tube of the fetus and neurological disorders of the child, such as spina bifida.

You may be thinking that it does at least help reduce the risk of preterm labor. However, this is one of the most likely incorrect claims based on the evidence available to date. Taking folic acid by mouth during pregnancy does not lower the risk of having a premature baby. But it does help prevent other health problems in the baby. By the way, taking folic acid by mouth, alone or with other ingredients, also doesn’t seem to improve male fertility.

But this does not end here, there are other proven benefits (and claims without head or tail). One of the claims with growing evidence (not enough yet, but promising and “on the right track”) is at the neurological level , due to its involvement in the production of neurotransmitters. There is a growing number of studies arguing that people who get enough folic acid have a lower risk of developing certain neurodegenerative diseases such as Alzheimer’s. Specifically, folic acid taken by mouth, with or without other supplements, appears to improve memory and cognitive abilities in older people who have a greater than expected decline for their age. However, it does not seem useful in older people who experience the usual decline in their cognitive abilities.

And speaking of mounting evidence, taking folic acid along with antidepressants seems to improve symptoms in some people with depression. However, there have been claims that low levels may increase the risk of schizophrenia. This, at the moment, lacks sufficient evidence.

At the cardiac and renal level , vitamin B9 reduces the levels of homocysteine, an amino acid found in the blood and that, when it reaches high levels, can cause a malfunction of the heart and kidneys. Therefore, a reasonable claim is that, by reducing the risk of a disease correlated with heart attacks and strokes, homocysteinemia, we can reduce the risk of suffering from these two undesirable conditions. Basically, controlling homocysteine levels with the intake of vitamin B9 reduces the risk of heart attack, stroke, and promotes good kidney function. In this case, it is indeed a claim worth considering.

Another of the most frequent claims of any supplement is always its benefits to prevent some types of cancer. Unfortunately, however, we have no evidence that this is the case with any type of cancer.

Vitamin B9 deficiency

Its deficiency is mainly due to the fact that it is a water-soluble vitamin . This means that the amounts of vitamin not absorbed by the body leave the body through the urine, which means that our body does not have reserves of vitamin B9, but rather needs a regular supply of this vitamin in the daily diet. .

Even so, we must not forget that this deficit is not due exclusively to the lack of storage in our body or to insufficient intake of vitamin B9. It can also be caused by a reduction in stomach acidity, certain diseases of the digestive system (celiac disease, E. Crohn’s,…), intestinal surgery, dialysis, excessive alcohol consumption, or certain medications.

The first symptoms that may appear are fatigue and irritability, diarrhea, a red and ulcerated tongue, weight loss, or depression, among others. Some of the consequences of vitamin B9 deficiency can be mental damage, poor fetal development in pregnancy, growth retardation, or anemia.

In short, folic acid and folate are the same active substance, with the same benefits for the body, but they differ only in their origin, which is why folic acid and folate are sometimes used as synonyms.

One important thing is that, although it seems that everything is beneficial for health, the intake of vitamin B9 should preferably be done naturally through food (folates), and if you need supplements (folic acids), you should consult with your doctor , as certain medications, medical conditions, or mutations may affect the ability to absorb or eliminate folic acid, which, if not metabolized to folate in the liver and absorbed, can lead to chronically high amounts of unmetabolized folic acid , with its consequent health risks still unknown and under study.

References:

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Berry, J. & Sullivan D. (2019). What to know about folate deficiency. Medical News Today. https://www.medicalnewstoday.com/articles/325310

FOLIC ACID: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews. (2012). Webmd.com. https://www.webmd.com/vitamins/ai/ingredientmono-1017/folic-acid

‌ Johnson , L.E. (2020). Folic acid deficiency. MSD Manuals. https://www.msdmanuals.com/en/home/nutritional-disorders/vitamins/deficiency-of-%C3%A1cid-f%C3%B3lico?query=Deficiency%20de%20%C3%A1cido%20f%C3 %B3lic

‌Kaye, A. D., Jeha, G. M., Pham, A. D., Fuller, M. C., Lerner, Z. I., Sibley, G. T.,et.al. (2020). Folic Acid Supplementation in Patients with Elevated Homocysteine Levels. Advances in therapy, 37(10), 4149–4164. https://doi.org/10.1007/s12325-020-01474-z

Oliai Araghi, S., Kiefte-de Jong, J. C., van Dijk, S. C., Swart, K., van Laarhoven, H. W., van Schoor, N. M., et.al. (2019). Folic Acid and Vitamin B12 Supplementation and the Risk of Cancer: Long-term Follow-up of the B Vitamins for the Prevention of Osteoporotic Fractures (B-PROOF) Trial. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 28(2), 275–282. https://doi.org/10.1158/1055-9965.EPI-17-1198

Sissons, C. & Chiampas, T. D. (2019). Folate vs. folic acid: What to know. Medical News Today. https://www.medicalnewstoday.com/articles/327290