Navigating the world of prenatal supplements can feel like navigating through a labyrinth, especially during conception and early pregnancy—a time already fraught with nerves and uncertainty. Amidst this whirlwind, the debate on folic acid or folate emerges, casting doubt on which form of this essential B vitamin is optimal for expecting mothers and their healthcare providers. As discussions intensify, factors like the MTHFR gene mutation and absorption concerns only add layers of complexity to the decision-making process. In this article, we’ve consulted with nutritional and fertility experts to lend their expertise and insights, delving into the differences between folic acid and folate, exploring their distinctiveness, their impact on pregnancy, and the evidence underpinning their effectiveness.

Understanding Folic Acid and Folate:

According to fertility expert Zita West, “There can be confusion around the difference between folic acid and folate as they are often used interchangeably.” She highlights the distinction between folate, the naturally occurring form of vitamin B9 found in various foods, and folic acid, its synthetic counterpart. Folic acid and folate are often used interchangeably, but they are not identical. Folate refers to the naturally occurring form of vitamin B9 found in foods such as leafy greens, legumes, and citrus fruits. On the other hand, folic acid is the synthetic form of this vitamin used in dietary supplements and fortified foods. While both forms serve the same biological function, their metabolic pathways differ, influencing how they are absorbed and utilised by the body. 

The MTHFR Gene Mutation:

A significant aspect of the folic acid vs. folate debate revolves around the MTHFR gene mutation. The MTHFR gene encodes an enzyme crucial for folate metabolism. Certain mutations in this gene, particularly the C677T and A1298C variants, are associated with reduced enzyme activity, potentially affecting the body’s ability to convert folic acid into its active form, methylfolate. This has led to speculation that individuals with MTHFR mutations may benefit more from supplementation with methylfolate rather than folic acid. 

West says “It is estimated that 40-60% of the population have a mutation in their gene which lowers the amount of MTHFR, meaning they have a reduced capacity to transform folic acid into the active form. These individuals may struggle to raise their folate levels to the recommended levels using a standard folic acid supplement. As it is not possible for everyone to test for this mutation, we chose to use a superior, active form of folate in our supplements, Quatrefolic. Quatrefolic is the active form of folate, readily available for transport and use in the human body and tissues. Quatrefolic doesn’t require conversation by the enzyme MTHFR and therefore, can effectively raise folate levels in all individuals.”

Absorption Concerns:

Another point of contention is the absorption of folic acid versus folate. Some argue that synthetic folic acid is less efficiently absorbed compared to naturally occurring folate, particularly in individuals with certain genetic variations or conditions affecting absorption. 

Megan Hallett specialises in women’s hormone health and nutrition, from endocrine and reproductive conditions such as PCOS, PMDD, endometriosis, hypothalamic amenorrhea, perimenopause and menopause and fertility/pregnancy. She explains “When working with preconception clients, my first step is to carefully assess their supplement routines. I prioritise swapping out folic acid, whether it’s standalone or included in a prenatal supplement, with methylated folates like methylfolate or 5-methyltetrahydrofolate. This practice isn’t exclusive to preconception; I implement it with all my clients, recognising that the benefits of folate extend beyond pregnancy alone. Adequate folate levels are crucial for energy, hormone metabolism, cardiovascular health, and DNA synthesis. When I make this adjustment to someone’s supplement regimen, I emphasise that while folic acid and methylated folate are essentially the same, the latter is significantly preferred due to its high bioavailability and pre-existing biological activity.”

However, the extent of this difference and its clinical significance remain areas of ongoing research and debate.

Evidence and Recommendations:

Despite the ongoing discourse regarding the superiority of folate vs folic acid, it is essential to acknowledge the substantial body of evidence supporting the effectiveness of folic acid in preventing neural tube defects and promoting overall maternal and fetal health. For over three decades, public health initiatives have successfully implemented folic acid supplementation programs, leading to significant reductions in NTDs worldwide. The efficacy of folic acid in this regard is well-established and supported by numerous clinical trials and observational studies.

When it comes to prenatal nutrition, the debate between folic acid and folate persists, fueled by concerns over genetic factors like the MTHFR gene mutation and absorption differences. While these considerations warrant attention and further research, it is crucial not to discount the extensive evidence supporting the efficacy of folic acid. Ultimately, individualised healthcare approaches may be necessary to address the needs of pregnant women, taking into account genetic factors, dietary patterns, and clinical recommendations.

DISCLAIMER: Features published by Hip & Healthy are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.