This article is a look at Folate or its more commonly known synthetic version: Folic Acid. The issue is in some cases this highly crucial vitamin (during pregnancy and breastfeeding in particular) is not being properly absorbed by some people. Specifically in the synthetic form. We also look at the wildly different levels people are consuming in various supplements and how this can potentially have an impact. Most crucially, we look at what you can do about this, and what the science suggests is the ideal amount to take for your stage. We firmly believe that knowledge and awareness here is empowering. 

Lets’ take a step back:

A question we often get asked is: what supplements are best to take for conception, pregnancy and breastfeeding?

Alas, there are three tricky things about this question:

1. It is very person/situation specific

2. Depends what type/where you get them from

3. Believe it or not, too much can be as bad as too little: hypervitaminosis

What is hypervitaminosis?

As you may have guessed, this is where high storage levels of vitamins in the body can lead to negative symptoms.

We hadn’t realised that such a condition existed until conversations with one of our resident expert advisors and leading Harley Street gynaecologist: Mahantesh Karoshi.

He tells us that this is a real problem. Click here for more.

The statistics back it up:

People have become much more health conscious. As a result, the supplement and vitamin market is booming. In fact, in the US more than 50% of non pregnant women consume a micronutrient supplement (1). That climbs to 70-90% when it comes to pregnant women consuming multivitamins and/or single nutrient supplements containing Folic Acid. (1)

The trouble comes however, when we are taking micronutrients that we may not need. The issue comes with those that are not water soluble/can be ejected easily by the body. These are vitamins like A, D, E and K which instead get stored in fat. The trouble comes when we build up excess levels as this can potentially be harmful.

Now, when it comes to pregnancy there is one thing for sure. We absolutely do need folate. This is ‘crucial to development. It is beyond dispute that supplementation of the diet of women during pregnancy with multivitamins that include folic acid in order to prevent neural tube defects has been a successful public health programme.’ (2)

So, what is Folate/Folic Acid? What do we really need to know? 

Folic Acid is the synthetic version of a B vitamin (B9) called Folate. It is found naturally in dark leafy green vegetables, beans, eggs, asparagus, avocado, nuts/seeds and citrus fruits. It is also worth noting that Folate is relatively fragile and does degrade during processing. What does this mean? Practically speaking fresh fruit and veg is key. Fresher the better and ideally eaten raw or steamed. Boiling can in fact cause the folate to seep into the water. So unless you’re having a soup its best to boil or steam.

It has also been added by government initiatives to certain foods/grains like breakfast cereals. You’ll probably labels saying ‘fortified’ with Folic Acid for example.

The crucial question is: how much do you need and in what form?

Back to Goldilocks…

As above – ensuring you have adequate intake is super important. However, research suggests that ensuring your body absorbs the right amount is important:

What type is best? (Yes – there are different types and this is key!)

• Folate is the form that we get from foods.

• Folic Acid: is the man made synthetic form.

Of course eating a healthy balanced diet full of vegetables is a great starting point. During pregnancy however it is crucial to make sure that your body is getting the right amount.

So, in order to make sure you’re getting enough it is a good idea to supplement during pregnancy.

Here’s where it gets interesting:

Folic Acid and Folate are not entirely identical. In fact, they are processed differently by the body. Folate (the form from food) is metabolised in the intestines. The man-made supplement form (Folic Acid) is instead metabolised by the liver.

Why does that matter?

The issue with this is that the enzymes that make it usable by the body are at lower levels in the liver. The trouble is that can lead to higher levels of unmetabolized and non-useful folic acid in the blood. This has been linked to side effects in animal models (2).

It is also the case that some people have a genetic mutation: known as MTHFR. This means they cannot process folic acid. So, ideally you should go for Methylfolate supplements (5MTHF). This is the body’s most active form of folate (4) Our personal favourite is the one made by Cytoplan. However, the first port of call if you do have any questions on which supplement suits you best is of course your doctor. Always speak to them first when it comes to taking any supplement.

So how much is ideal?

The official recommendation is 400 micrograms (mcg) before, during pregnancy and whilst breastfeeding (3) In fact, it is important to have it in your system BEFORE pregnancy as birth defects can occur at the earliest stages. By taking it ahead of time you are reducing your risks. Always good to be proactive.

Some higher risk women (when there is a family history/diabetes) are advised to take 500 mcg. Research suggests that above that level is not necessary.

The tricky part comes when you look at lots of different prenatal supplements. Unhelpfully, the amounts of Folic Acid contained within can vary dramatically. We have seen anything from 400 mcg up to 2000 mcg! (2) That is also before any food intake (particularly fortified foods). So, if you’re eating a healthy balanced diet the chances are you’ll be getting more.

In fact taking too much has been linked to negative metabolic effects in animal models for both mother and offspring. It has even been linked to epigenetic changes (this is where your environment impacts how your genes express themselves) based excess on maternal micronutrient consumption. (1)

‘Pregnant women under adequate medical care consume 2.5 – 7 fold the RDA of several micronutrients, including folic acid and vitamins B12 and B6, and even consume beyond the upper limit for folic acid (>1000 mcg).’ (1)

The tolerable safe upper limit for Folic Acid has been suggested to be 1000 mcg/day (2) so a 400 mcg supplement plus a good diet is absolutely fine.

Once again, awareness is usually 90% of the battle.

On top of this, if you have any other concerns or feel unwell/like you could be deficient in certain nutrients (vegans and vegetarians can be vulnerable to this particularly during pregnancy) you should speak to your doctor. Knowledge of your own individual situation is best. A simple blood test is always the best way to assess what you are deficient in/how you are reacting before taking supplements. 

Our key take-away: Folate is essential. Even pre pregnancy. In order to avoid an issue where your body may not be able to absorb it adequately we think the best way is the food based form. Taking Methylfolate vs the synthetic version helps your body along. It also reduces the risk that you may not be able to absorb it properly. We also think it is worth checking the label carefully to ensure you’re getting the ‘right’ amount. 400mg is what is recommended and too much above that may not be the best approach. If in doubt however always speak to your doctor. Asking for a simple blood test can give you a good picture. Everyone is different and knowledge of your own body can only be a good thing.

References:

1. PANNIA E, CHO CE, ANDERSON HG: Role of maternal vitamins in programming healthy and chronic disease. Nutrition Reviews. 2016 Mar: 74(3): 166-180

2. WIENS D, DeSOTO CM: Is High Folic Acid Intake a Risk Factor for Autism? A Review: Brain Science: 2017 Nov: 7(11): 149

3. RCOG: Royal College of Gynaecology and Obstetricians:  https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-healthy-eating-and-vitamin-supplements-in-pregnancy.pdf

4. https://www.brainmdhealth.com/blog/folic-acid-vs-folate-everything-you-need-to-know/

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This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.

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