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Folate vs. Folic Acid: Why the Difference Matters

Your tissues, your cells, your DNA — to function well, they all need folate. In fact, this natural form of vitamin B9 is crucial. But not everyone gets enough of it.

We spoke to Lisette Breto, PharmD, a clinical pharmacist with Banner Health, about folate and folic acid. She explained how folate deficiency may be connected to other medical conditions, which groups should boost their folate intake, and the important differences between folate and folic acid.

What is folate?

Folate helps in the making of DNA and other genetic material. Folate shows up in lots of different foods, including:

  • Asparagus
  • Avocados
  • Bananas
  • Beets
  • Black beans
  • Broccoli
  • Brussels sprouts
  • Edamame
  • Eggs
  • Lentils
  • Nuts and seeds
  • Spinach
  • Oranges

Folic acid, meanwhile, is the synthetic version of folate. Dr. Breto explained that in 1998, the U.S. Food and Drug Administration (FDA) approved fortifying certain foods with folic acid, such as cereal, flour, and bread, to decrease risk of neural tube defects (NTD). Because certain foods are now fortified with folic acid, Dr. Breto said it’s now uncommon in the U.S. for someone to have low folate. Instead, it can show up with or be the result of other medical conditions.

When your folate levels are low, you might have symptoms like those of anemia: feeling fatigued, lethargic, out of breath or lightheaded.

Who gets folate deficiency?

The National Institutes of Health (NIH), outlines the following groups typically at risk for folate deficiency:

  • People with alcohol use disorder
  • Women of childbearing age
  • Pregnant women
  • People with malabsorptive disorders
  • People with MTHFR polymorphism

With some of these groups, low folate usually comes from poor folate absorption. Dr. Breto also mentioned that for some people it can be due to poor nutrition or a restricted diet.

Researchers have also studied low folate’s possible role in conditions like Alzheimer’s disease, hypertension, and autism spectrum disorder, but results have so far been inconclusive.

Can I get too much folate/folic acid?

Yes! But it really only happens with folic acid — not folate — since folic acid doesn’t always fully metabolize. For some folks, that metabolizing process is slow. And when too much folic acid builds up in your bloodstream, it can cause an undetectable vitamin B12 deficiency. It can also mask or hide a vitamin B12 induced megaloblastic anemia, a condition where your bone marrow produces unusually large and abnormal red blood cells. This masking can be dangerous because B12 deficiency doesn’t just cause anemia; it can also lead to serious nerve damage.

The active form of vitamin B9, known as 5-MTHF, can be purchased as a supplement. Dr. Breto explained that these supplements can interact with other medications, so it’s important to involve your health care provider first.

It’s easy to mistakenly think folate and folic acid are interchangeable terms, Dr. Breto said. But some folks may benefit more from one than the other. She mentioned that the following groups are more likely to be prescribed folic acid supplements.

  • Pregnant women
  • Women of childbearing age
  • Tobacco smokers
  • People with chronic alcohol abuse disorder
  • People with poor nutrition
  • People with gastrointestinal or malabsorptive disorders
  • People on hemodialysis

When should I involve my doctor?

The answer is simple: always.

Your health care provider can help determine how much folate or folic acid is best for you. Reviewing your medical history is an important part of dialing in the right amount. And because low folate levels may relate to other medical conditions, getting medical guidance for these other conditions will help your folate levels.

Eager to learn more? You may also want to read these related articles, written with help from other Banner Health experts:

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