A lot of women are told they must take folic acid if they are considering having a baby or if they're pregnant however, I'm here to tell you to STAY AWAY from folic acid. Huh? What? Are you insane Tara?! Let me clarify: I want you to take folate not synthetic folic acid. Let me explain.
What is “folic acid”
“Folic acid” is manmade. It's a synthetic vitamin that is not found in nature. It has to be transformed via a complicated process in the body in order for your body to be able to use it.
Folic acid is found a lot in processed foods because these foods are devoid of their nutrition, (think white bread – stripped of the bran) and hence manufacturers have to add back in some vitamins. They do this by way of synthetic vitamins. So if the package says “enriched” you want to stay away from that food as it’s likely enriched with synthetic folic acid. Don't be fooled by “enriched” foods. These aren't healthy foods, and the synthetic folic acid is potentially doing you harm (more on that in a moment).
Synthetic folic acid looks very similar to active folate, but synthetic folic acid is missing a key component; a methyl group. That methyl group supports 200+ enzymes in the body, so suffice to say it's kinda important.
What is “folate”
Folate however, is natural. It's the active form of B9 in your body and it's found in food sources such as leafy greens, which are the best source. There are actually over 200 different types of folate in leafy greens and the word folate actually comes from the word foliage.
You can also find folate in beans, but it’s sometimes hard to absorb the folate from these. And it’s important to know that cooking can dramatically reduce the folate content in these healthy foods, that’s why eating raw dark leafy greens every day is important. Even just rinsing your beans can dramatically reduce folate content.
Folate is also what’s found in your own body, and the pathway in your body that makes folate is called the methylation pathway. More on this in a moment.
Something to remember is that the 3 primary folates, (remember, there are over 200) include:
- Folic acid – synthetic, manmade, not found in nature (avoid)
- Folinic acid (5-FormylTHF) – useful for DNA protection and repair, also found in nature
- Methyl-folate (5-MTHF) – primary type of folate in your body – makes up 80% of circulating folate in your blood – very important
Why is folate so important?
So why do we care about folate so much? Well, because folate:
- Supports all types of blood cell production
- Supports how you think
- Supports your detoxification
- Supports the immune system
- Supports DNA, (protects and repairs it)
- Supports ATP (energy) production
- Supports the production of neurotransmitters
- Supports over 200 reactions that support methylation – this is super important for those with an MTHFR mutation, which is very common
- Supports a healthy pregnancy, because it's needed for rapid cell division and growth
And a deficiency in folate is associated with:
- Neural tube defects
- Certain cancers
- Elevated homocysteine (a risk factor for cardiovascular disease)
MTHFR and folate
Genes make enzymes and then enzymes work to make “something” in the body. But enzymes only work if the correct co-factors, (vitamins and minerals) are available to them. Mold, pesticides, glyphostate, arsenic, heavy metals, stress and more can also impact how your enzymes work.
If you’re lacking in co-factors then your enzymes cannot work efficiently. This is an even bigger problem if you have MTHFR, a very common genetic variant that occurs in up to about 50% of the population, (myself included).
So remember, I said that enzymes work to make something in the body. Well the MTHFR enzyme works to make methyl-folate in the body. MTHFR is the last step in a long process that makes methyl-folate.
Recall: methyl-folate is the active form of folate that our body can use.
So if you’re supplementing with synthetic folic acid instead of methyl-folate issues can arise because the body finds it very difficult to put that methyl group, (“methyl-folate”) onto synthetic folic acid.
The body has to convert synthetic folic acid into methyl-folate by adding a methyl group and it does this primarily via the enzyme: MTHFR.
Folic acid has to go through many enzymes that require many co-factors before it even gets to this last MTHFR step.
Folic acid can only be incorporated into the cell, (remember: transformed into methyl-folate – the active form of folate) if it's reduced by another enzyme first. And this enzyme is called dihydrofolate reductase (DHFR).
If it doesn't go through this enzyme, and therefore isn't reduced, then that folic acid does little for you because it’s not active.
And here’s the rub: the DHFR enzyme, (the enzyme synthetic folic acid has to go through in order to “turn into” the active form of folate: methyl-folate) is a very slow enzyme in humans. This is where some of the confusion lies.
Why doctors are still recommending folic acid instead of methyl-folate
Much of the research that was done on folic acid enriched in food was done in rats. And the DHFR enzyme is a lot faster in rats than it is in humans. Furthermore, the DHFR enzyme speed varies greatly in humans. There’s up to a five-fold difference in how quickly it works amongst us humans.
So the reason why doctors are still suggesting folic acid is because initially the studies that showed synthetic folic acid was beneficial for humans were done in rats, and rats convert folic acid to the active form of methyl-folate a lot more quickly than humans do.
But what's worse is that DHFR is a potent inhibitor of MTHFR. Remember, that last step in the process that's crucial for applying a methyl group to the synthetic folic acid in order to make it into the active form that our body can use? So, that's a problem, too.
High folic acid consumption has been shown to lead to pseudo MTHFR deficiency.
And to add insult to injury: synthetic folic acid has been shown to be more bioavailable in the body; meaning; it has more of an affinity to bind to folate receptors than folate does, essentially taking up space on these receptors where the otherwise helpful active folate would reside. This can prevent active folate getting into the brain, which is a problem because folate plays a crucial role in the development of our neurotransmitters. Only methyl-folate can get into the brain through the blood brain barrier by way of the folate receptor alpha [FRa] receptors.
Unmetabolized Folic Acid
Then we have a little thing called unmetabolized folic acid.
When folic acid can't make it's way through the enzyme DHFR it turns into unmetabolized folic acid. Unmetabolized folic acid has been found in the blood of 96% of people not taking folic acid supplements. Why? Because they're eating foods enriched with folic acid such as cereal, bread, orange juice, energy bars, vitamin water, etc.
Why do we care about unmetabolized folic acid? Because it’s been associated with decreased natural killer cytotoxicity. Natural killer cells play a role in tumour cell destruction, hence why researchers have been warning about excess folic acid and it’s association with increased cancer risk.
When synthetic folic acid is given in 220mcg or more this has been shown to lead to unmetabolized folic acid in the majority of people.
In fact, folic acid has been implemented as a big culprit in colon cancer. Some studies have shown it’s a hyperproliferator of cancer – meaning it can make cancer grow quicker.
So whilst it's true that incidents of neural tube defects have dramatically reduced since fortification of folic acid into processed foods, concerns of chronic exposure have emerged.
It is estimated that this practice of synthetic folic acid fortification has resulted in 15,000 additional cancers per year in the US alone because excess folic acid may stimulate the growth of established neoplasms (growths), which can eventually lead to cancer.
Breastfeeding mamas are at risk too
Unmetabolized folic acid can also get to baby via mama’s breast milk. Remember, folate plays a vital role in blood cell development, cell production, neurotransmitter production etc – it’s a crucial vitamin for baby’s development. We don’t want baby drinking folic acid or worse, unmetabolized folic acid.
What can you do?
Here’s what you can do to reduce your exposure to synthetic folic acid and boost your exposure to the correct, active and helpful form of folate:
- Avoid all white processed foods such as flours, breads, rice – these are likely enriched with folic acid
- Avoid orange juice and energy bars, “vitamin” water, etc – anything that is processed or says “enriched”.
- Check your vitamins, most contain synthetic folic acid as it’s cheaper than active folate. If you’re unsure then check with the supplement company by way of a quick phone call or email.
- Consume folate-rich foods including: lentils, pinto beans, garbanzo beans, asparagus, spinach, navy beans, black beans, kidney beans, turnip greens, broccoli, calf’s liver and chicken liver. However, know that folate is water-soluble and much will get lost in the cooking process. Especially if you boil your food. Instead, steam and always use fresh, not canned beans or vegetables as canned goods contain less folate. Far and away your best bet is to consume raw dark leafy greens every, single day.
- Potentially avoid dairy. If a dairy antibody attaches to the folate receptor alpha [FRa] on the blood brain barrier then the [FRa] receptor site gets blocked and methyl-folate cannot get into the brain. Not all people make these antibodies against the FRa receptor but those who do need to avoid dairy products.
I work with mamas who have the MTHFR variant so that we can optimize their methylation before, during and after pregnancy. Please get in touch if you're looking for a practitioner who's able to help you on your journey to optimal health.
- Dr. Ben Lynch: podcast and courses