Although the words folate and folic acid are often used interchangeably, these vitamins are distinct. Synthesized folic acid differs structurally from folate and has slightly different biological effects in the body. That said, both are considered to contribute to an adequate dietary intake. Folate is found in a number of plant and animal foods , including spinach, kale, broccoli, avocado, citrus fruits, eggs, and beef liver.
Folic acid, on the other hand, is added to foods like flour, ready-to-eat breakfast cereals, and bread. Folic acid is also sold in concentrated form in dietary supplements.
Your body uses folate for a wide array of critical functions, including 1 , 2 , 3 , 4 :. Folate is involved in a number of vital metabolic processes, and deficiency leads to an array of negative health outcomes, including megaloblastic anemia, increased risk of heart disease and certain cancers, and birth defects in infants whose mothers were deficient in folate 1.
Many countries, including the United States, require grain products to be fortified with folic acid to reduce the incidence of folate deficiency. This is because folate deficiency is somewhat common, and some populations, including older adults and pregnant women, find it difficult to obtain the recommended dietary intake through diet 2.
Folate stores in the body range between 10—30 mg, most of which is stored in your liver, while the remaining amount is stored in blood and tissues. The main form of folate in the blood is called 5-methyltetrahydrofolate 1 , 5. Dietary Folate Equivalents DFEs is a unit of measure that accounts for the differences in absorbability of folic acid and folate. When taken in supplement form, 5-methyltetrahydrofolate has the same — if not slightly higher — bioavailability than folic acid supplements 3.
Because of this variability in absorption, DFEs were developed according to the following equation 4 :. Adults need about mcg DFE of folate per day to replenish daily folate losses. Pregnant women and breastfeeding women have increased folate needs and need to take in mcg and mcg DFE of folate per day, respectively 6. Although folic acid and folate supplements are typically used to treat the same conditions, they have different effects in the body and, therefore, may affect health in different ways, which will be explained later in this article.
One of the most common uses of folic acid and folate supplements is the prevention of birth defects, specifically neural tube defects, including spina bifida and anencephaly — when a baby is born without parts of its brain or skull 7. Maternal folate status is a predictor of neural tube defect risk, which has led to national public health policies regarding folic acid supplementation for women who are or may become pregnant.
For example, the U. Preventive Services Task Force, an independent panel of national disease-prevention experts, recommends that all women who are planning to become pregnant or capable of becoming pregnant supplement daily with — mcg of folic acid starting at least 1 month before becoming pregnant and continuing through the first 2—3 months of pregnancy 7.
Folic acid supplements are prescribed to pregnant women to prevent fetal birth defects and may also help prevent pregnancy-related complications, including preeclampsia 8.
Folate deficiency can occur due to a variety of causes, including inadequate dietary intake, surgery, pregnancy, alcoholism, and malabsorptive diseases 6. Deficiency can result in serious side effects, including megaloblastic anemia, birth defects, mental impairment, impaired immune function, and depression 9 , Research has shown that low blood folate levels are associated with poor brain function and an increased risk of dementia.
Even normal but low folate levels are associated with an increased risk of mental impairment in older adults 11 , People with depression have been shown to have lower blood levels of folate than people without depression Studies show that folic acid and folate supplements may reduce depressive symptoms when used in conjunction with antidepressant medications.
A systematic review demonstrated that, when used alongside antidepressant medication, treatment with folate-based supplements, including folic acid and methylfolate, were associated with significantly greater reductions in depressive symptoms, compared with antidepressant medication treatment alone Supplementing with folate-based supplements, including folic acid, may help improve heart health and reduce your risk of heart disease risk factors.
Having elevated levels of the amino acid homocysteine is associated with an increased risk of developing heart disease. Blood levels of homocysteine are determined by both nutritional and genetic factors. Folate plays a major role in the metabolism of homocysteine, and low folate levels can contribute to high homocysteine levels, known as hyperhomocysteinemia Research has shown that supplementing with folic acid may reduce homocysteine levels and heart disease risk.
Additionally, folic acid supplements have been shown to improve blood flow, which may help improve cardiovascular function This list is not exhaustive, and there are many other reasons why people use folate-based supplements. Some people have genetic variations that affect how they metabolize folate. Genetic polymorphisms in folate metabolizing enzymes, such as methylenetetrahydrofolate reductase MTHFR , can affect health by interfering with folate levels in the body.
One of the most common variants is CT. People with the CT variant have lower enzyme activity. As such, they may have elevated levels of homocysteine, which may increase heart disease risk. These variants may also increase the risk of birth defects, migraine , depression, pregnancy loss, anxiety, and certain cancers 30 , The incidence of genetic variants that influence folate metabolism varies depending on ethnicity and geographical location.
Recommended treatment typically involves supplementing with biologically active 5-methyltetrahydrofolate and other B vitamins. However, individualized treatment is often necessary Folate plays essential roles in fetal growth and development.
Usually your dose will stay the same. What if I forget to take it? If you stop taking your folic acid: in pregnancy - the risk of your baby having neural tube defects may increase for folate deficiency anaemia - your symptoms may get worse or new symptoms may appear to reduce the side effects of methotrexate - you'll be more likely to get side effects from methotrexate If you forget to take folic acid: once a day - take your missed dose as soon as you remember.
If it's nearly time for your next dose, skip the missed dose and just take your next dose as normal. If you remember on the day you take your methotrexate, wait a day and take your missed dose the following day. After this, go back to taking your weekly dose on your usual day. Never take 2 doses to make up for a forgotten one. If you forget doses often, it may help to set an alarm to remind you. What if I take too much? Folic acid is generally very safe.
Taking too much is unlikely to harm you or your child. If you're worried, speak to your pharmacist or doctor. Common side effects Talk to your pharmacist or doctor if these side effects bother you or do not go away: feeling sick nausea - but if you're pregnant, this is more likely to be morning sickness loss of appetite bloating or wind Serious allergic reaction In rare cases, folic acid can cause a serious allergic reaction anaphylaxis.
What to do about: feeling sick - take folic acid with, or just after, a meal or snack to ease feelings of sickness. If you're pregnant, it could be morning sickness that's making you feel sick. If it helps, eat smaller meals more often than usual.
Snack when you're hungry. Have nutritious snacks that are high in calories and protein, such as dried fruit and nuts. If the symptoms get worse, contact your doctor straight away.
Usually, folic acid is safe to take during pregnancy. Folic acid and breastfeeding Folic acid is safe to take while you're breastfeeding. But if your baby is premature or has health problems, check with your doctor first. Important Tell your doctor if you're trying to get pregnant, already pregnant or breastfeeding. There are some medicines that may interfere with how folic acid works. Folic acid can also affect the way other medicines work. Tell your doctor if you're taking these medicines before you start taking folic acid: methotrexate, a medicine used to treat rheumatoid arthritis, Crohn's disease, psoriasis and some types of cancer phenytoin, fosphenytoin, phenobarbital or primidone, medicines used to treat epilepsy fluorouracil, capecitabine, raltitrexed or tegafur, medicines used to treat some types of cancer antibiotics, medicines used to treat or prevent bacterial infection medicines or alternative remedies that contain zinc including throat lozenges and cold remedies sulfasalazine, a medicine used to treat the inflammatory bowel conditions ulcerative colitis and Crohn's disease cholestyramine, a medicine used to reduce cholesterol Mixing folic acid with herbal remedies or supplements Talk to your pharmacist or doctor before taking any herbal remedies or supplements together with folic acid.
Some vitamin and mineral supplements may already contain folic acid. Tell your pharmacist or doctor if you take any supplements or remedies that contain zinc. Folic acid can stop zinc working as well as it should. Important For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
How does folic acid work? In anaemia Folic acid helps make healthy red blood cells, which carry oxygen around the body. This causes folate deficiency anaemia, which can cause tiredness and other symptoms. In pregnancy A baby's body and most of their internal organs are formed during the first 12 weeks of pregnancy.
Women need up to 10 times more folate in pregnancy to help the baby develop. To reduce the side effects of methotrexate Methotrexate works by blocking some of the effects of folate. Taking folic acid can help prevent the side effects of folate deficiency. How long does folic acid take to work? Folic acid usually starts to work in a few hours. It's important to keep taking your folic acid for as long as it's recommended. How long will I take it for?
This depends on why you're taking folic acid: In pregnancy - women are recommended to take folic acid while they're trying for a baby and for the first 12 weeks of pregnancy.
Are there other sources of folate? Good sources of folate include: spinach, kale, asparagus, brussels sprouts, cabbage and broccoli peas, lentils and beans including chickpeas and black eyed beans yeast and beef extracts including Marmite and Bovril oranges and orange juice wheat bran and other wholegrain foods poultry, pork, shellfish and liver fortified foods with added folic acid including some brands of breakfast cereals.
Do I need to take folic acid in pregnancy if I already eat foods that contain folate? Yes, you still need to take folic acid. Women need up to 10 times more folate in pregnancy to help the baby grow. It's unlikely that you would be able to achieve this through diet alone.
Why do I need to take folic acid before getting pregnant? Some foods have high amounts of folic acid. Some women, especially women who could get pregnant, may not get enough folic acid from food. African-American women and Mexican Americans are also at higher risk for not getting enough folic acid each day. Talk to your doctor or nurse about whether you should take a vitamin to get the micrograms of folic acid you need each day.
Folate-deficiency anemia is a type of anemia that happens when you do not get enough folate. Folate-deficiency anemia is most common during pregnancy. Other causes of folate-deficiency anemia include alcoholism and certain medicines to treat seizures, anxiety, or arthritis. If you have folate-deficiency anemia, your doctor may recommend taking folic acid vitamins and eating more foods with folate. Yes, you can get too much folic acid, but only from man-made products such as multivitamins and fortified foods, such as breakfast cereals.
You can't get too much from foods that naturally contain folate. You should not get more than 1, micrograms of folic acid a day, unless your doctor prescribes a higher amount. Too much folic acid can hide signs that you lack vitamin B12, which can cause nerve damage.
Women who have gone through menopause still need micrograms of folic acid every day for good health. Talk to your doctor or nurse about how much folic acid you need. Under the Affordable Care Act the health care law , all Health Insurance Marketplace plans and most other insurance plans cover folic acid pills for women who could get pregnant at no cost to you. Check with your insurance provider to find out what's included in your plan. For more information about folic acid, call the OWH Helpline at or contact the following organizations:.
Department of Health and Human Services. ET closed on federal holidays. Breadcrumb Home A-Z health topics Folic acid. Folic acid. Folic acid Folic acid is a form of folate a B vitamin that everyone needs.
What are folic acid and folate? Why do women need folic acid? Everyone needs folic acid to be healthy. But it is especially important for women: Before and during pregnancy. Folic acid protects unborn children against serious birth defects called neural tube defects. These birth defects happen in the first few weeks of pregnancy, often before a woman knows she is pregnant.
Folic acid might also help prevent other types of birth defects and early pregnancy loss miscarriage. Since about half of all pregnancies in the United States are unplanned 1 , experts recommend all women get enough folic acid even if you are not trying to get pregnant.
To keep the blood healthy by helping red blood cells form and grow. Not getting enough folic acid can lead to a type of anemia called folate-deficiency anemia. Folate-deficiency anemia is more common in women of childbearing age than in men. How do I get folic acid? You can get folic acid in two ways. Through the foods you eat. Folate is found naturally in some foods , including spinach, nuts, and beans. Folic acid is found in fortified foods called "enriched foods" , such as breads, pastas, and cereals.
Look for the term "enriched" on the ingredients list to find out whether the food has added folic acid. As a vitamin. Check the label to make sure. How much folic acid do women need? If you: Amount of folic acid you may need daily 2 Could get pregnant or are pregnant — micrograms. Your doctor may prescribe this amount. Research shows taking this amount may lower the risk of having another baby with spina bifida. Have spina bifida and want to get pregnant 4, micrograms. Women with spina bifida have a higher risk of having children with the condition.
Take medicines to treat epilepsy , type 2 diabetes , rheumatoid arthritis , or lupus Talk to your doctor or nurse. Folic acid supplements can interact with these medicines. Are on dialysis for kidney disease Talk to your doctor or nurse.
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