What does Folic acid do in the body?
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A folic acid is a synthetic form of folate. Folate is a type of B vitamin found naturally in food.
It is an essential nutrient that is required to make red blood cells, DNA, and certain enzymes to make protein. It is also required to break down vitamins in the body.
You need more folic acid during pregnancy because it is required for the growth and development of your baby in the womb. Folate deficiency may cause abnormalities in both mother and baby. (1)
It helps to support heart health and enhance brain function, folic acid is a water-soluble nutrient that you definitely want to be sure you get enough of it.
Let’s dive in to answer the below questions about folic acid. Follow me closely.
In this article:
What’s folic acid?
Folic acid is a water-soluble vitamin. It’s a synthetic version of folate, one of the B vitamins. (2)
Because your body can’t make folate, you need to get it from your diet.
Some foods naturally contain folate. Folic acid is added to other foods. You can also get folic acid from dietary supplements. (3)
What’s the difference between folate and folic acid?
Most times you may hear medically inclined people use the terms “folate” and “folic acid interchangeably, they are actually different forms of the same vitamin: vitamin B9 in precisely.
Folic acid has a different structure than folate and has slightly different effects on your body. “Folate” is the generic name that encompasses all forms of vitamin B9, including folic acid and 5-MTHF.
Folic acid is a specific synthetic form of this vitamin. (2, 3, 4 )
Why do you need folic acid?
Folate, also known as vitamin B9, is an important water-soluble vitamin that plays a role in many aspects of health. It aids in cell division and helps make new blood cells by copying and creating DNA. (5)
It also helps the body use vitamin B12 as well as certain amino acids.
Research indicates that a folate deficiency can have serious consequences, including fatigue, painful mouth sores, and even an increased risk of birth defects like heart problems, neural tube defects, spina bifida, and anencephaly. (6)
In fact, in 1991, the Centers for Disease Control and Prevention recommended that women with a history of pregnancies affected by neural tube defects should begin taking 4,000 micrograms of folic acid daily from the time they begin planning a pregnancy.
A year later in 1992, the U.S. Public Health Service advised that women of childbearing age should start getting at least 400 micrograms of folic acid or folate daily through diet, supplementation, or fortified folic acid foods. (7)
In an effort to prevent dangerous birth defects caused by folate deficiency, many countries around the world have strict regulations in place requiring food manufacturers to fortify certain products with folic acid.
In the United States, for example, the fortification of enriched cereal grains with folic acid was fully authorized in 1996 and fully implemented just two years later, in 1998. (8)
Today, 53 countries around the globe have regulations in place for mandatory fortification of wheat flour in an effort to reduce the risk of birth defects. (9)
Studies suggest that folate is also associated with improved cognitive function and protection against depression and Alzheimer’s disease. It may also help support strong bones, decrease symptoms of restless legs syndrome, and promote the health of the nervous system. (10)
If you eat many high-folate foods, there’s no reason to supplement with 100 percent or more of your daily folic acid requirement as provided by the U.S.
Food and Drug Administration. For multivitamins and other supplements containing folic acid, around 15 percent to 20 percent of the daily recommended amount of folic acid is plenty.
Fermented folic acid is also preferable. Fermentation is a process of pre-digestion that may be able to prevent unmetabolized folic acid buildup.
Filling your plate with folate sources is the best option to meet your daily needs because these foods are also high in other essential nutrients that are important to health.
While folic acid supplementation may be a useful tool for preventing deficiency in some, incorporating plenty of nutrient-dense folates and folic acid foods can help most people meet their daily folate requirements while also supplying an array of other crucial vitamins and minerals.
Health Benefits & Uses of folic acid
What does Folic acid do in the body?
Both folic acid and folate are used in supplements. Although these two nutrients treat the same conditions, your body breaks them down differently and can affect health in different ways. (2)
Here are some common uses and health benefits of folic acid:
1. To treat folate deficiency
Folate deficiency can happen for many reasons. (2, 3)
Some possible causes of folate deficiency are:
- a lack of folate in your diet
- diseases or surgeries that affect how your body absorbs folate, including celiac disease, short bowel syndrome, and gastric bypass surgery.
- no stomach acid (achlorhydria) or low stomach acid (hypochlorhydria)
- drugs that affect folate absorption, including methotrexate and sulfasalazine (Azulfadine)
- alcohol use disorder
- pregnancy
- hemolytic anemia
- dialysis
Having too low folate in your body can cause complications such as anemia, fetal development issues, mental impairment, impaired immune function, and depression.
Taking folic acid or folate supplements can bring up your levels and prevent these complications (7, 8, 10, 11).
2. Preventing birth defects and pregnancy complications
Folic acid supplements can help to prevent neural tube irregularities, including spina bifida and anencephaly. Getting enough folic acid during pregnancy can reduce the chance that your baby will be born with one of these conditions. (8, 9)
Folic acid supplements not only help prevent fetal development issues but also help lower the risk of pregnancy complications such as preeclampsia. (12)
3. To maintain brain health
Low blood folate levels are linked to poor mental function and an increased risk of dementia. Even folate levels that are technically normal but on the low side might increase the risk of mental impairment in older adults.
Adequate folate intake may also help protect against Alzheimer’s disease. (12, 13)
In a 2019 study of 180 adults with mild cognitive impairment, taking 400 mcg of folic acid supplements daily for 2 years improved measures of brain function and reduced blood levels of proteins that are involved in Alzheimer’s disease. (14)
Another study looked at 121 people with newly diagnosed Alzheimer’s disease who were being treated with the medication donepezil (Aricept).
Those who also took 1,250 mcg of folic acid per day for 6 months had improved thinking ability and less inflammation than those who took Aricept alone. (15)
4. To treat mental health conditions
Folate is involved in the production of brain chemicals called neurotransmitters. Consuming too little folate has been linked to depression, schizophrenia, and other mental health conditions.
For example, people with depression may have lower blood levels of folate than people without depression. (16)
A 2022 review of studies suggests that folic acid and folate supplements may help reduce symptoms of mental health conditions such as postpartum depression, schizophrenia, and bipolar disorder. (17).
Taking folate supplements in addition to antidepressant medication may reduce depression symptoms more than taking antidepressant medication alone. (18)
A review of seven studies found that treatment with folate supplements plus antipsychotic medication may improve symptoms in people with schizophrenia more than antipsychotic medication alone. (19)
However, larger studies are needed to further support these findings.
5. To Reduce heart disease risk factors
Folate-based supplements, including folic acid, may help improve heart health and reduce the risk of heart disease.
High levels of the amino acid homocysteine are thought to increase heart disease risk. Because folate helps break down homocysteine, low folate can lead to high homocysteine levels, also known as hyperhomocysteinemia.
Folic acid supplements can help bring down homocysteine levels and may lower heart disease risk. (20)
For example, a review that included 30 studies with more than 80,000 total participants showed that supplementing with folic acid led to a 4% reduction in overall heart disease risk and a 10% reduction in stroke risk. (20)
What’s more, using folic acid supplements along with antihypertensive medications may reduce high blood pressure significantly more than antihypertensive medications alone.
Folic acid supplements may also improve blood vessel function in people with heart disease (21, 22).
Other possible benefits
Folic acid may also help with other health conditions such as:
Folate supplements may help improve blood sugar regulation and reduce insulin resistance in people with diabetes. Because the diabetes drug metformin can lower folate levels, you may need a supplement if your levels are low. (23, 24, 25).
Folate can improve egg quality and help eggs grow and implant in the uterus. Taking folate may increase the chance of getting pregnant and carrying a baby to term. People who use assisted reproductive technology to conceive may be more likely to have a baby if they have a higher intake of supplemental folate. (26, 27).
Inflammation plays a role in many diseases. Folic acid and folate supplements have been shown to reduce markers of inflammation such as C-reactive protein. (28).
Larger studies are still needed to confirm the health benefits of folate.
There may be other reasons your doctor prescribes folic acid to you but the ones I discussed above are the main benefits.
Kidney disease
The kidneys usually filter waste out of the blood, but when the kidneys are damaged, homocysteine can build up. About 85% of people with chronic kidney disease have too much homocysteine in their blood.
Folic acid supplements may help reduce homocysteine levels and heart disease risk in people with kidney disease. (29)
Tip
Please before starting folic acid supplements, it’s important to talk with a healthcare professional. They can make sure the supplements will not interact negatively with other medications you may be taking.
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Food sources
You can find folate in plant and animal foods like these. (3)
Such as:
- spinach
- Ayara leaf
- Awa leaf
- kale
- Ugu leaf(fluttered pumpkin)
- Ayu leaf (a type of pumpkin with round edible fruit)
- broccoli
- Fresh akidi (fresh black beans)
- avocado
- citrus fruits
- eggs
- beef liver
Folic acid is added to foods such as flour, ready-to-eat breakfast cereals, and bread. (6, 7 )
It’s also in dietary supplements, such as multivitamins. (2, 5)
Some studies have found that folic acid is actually well-absorbed than folate from food sources. A study published in the American Journal of Clinical Nutrition found that the folate in food is about 78 percent as bioavailable as folic acid. (12)
Folic acid & Pregnancy
Why do pregnant women take folic acid?
Folate plays an essential role in a baby’s development.
It’s involved in cell division and tissue growth. It also helps the baby’s brain and spine, called the neural tube, develop. Taking folic acid both before and during pregnancy can help prevent neural tube irregularities such as anencephaly and spina bifida. (2, 8, 9)
The U.S. Preventive Services Task Force, an independent panel of national disease-prevention experts, recommends that anyone who is trying to become pregnant start taking a daily folic acid supplement containing 400–800 mcg at least 1 month before becoming pregnant and through the first 2–3 months of pregnancy. (7, 8, l0)
However, there’s nothing like natural food. Eating natural food rich in folate will be wiser whether you’re a man, woman, young or old, pregnant or not.
Since the 1990s, flour, and other foods have been fortified with folic acid in the U.S. and perhaps other countries.
Taking folic acid supplements before and during pregnancy can help reduce the risk of neural tube irregularities. (6, 8, 9)
But if you have access to enough folate-rich foods during pregnancy there may be less need for overdosing with folic acid supplements. Folate in natural food comes with little or no side effects.
Beyond preventing fetal development issues, taking folic acid during pregnancy may improve a child’s mental function and reduce the chance of the child developing autism spectrum disorder (ASD).
However, taking too much folic acid (a synthetic form of folate) may have a negative effect on a child’s brain development and increase their chances of developing autism, which I will be explaining in the next section. (30)
Folate is also important for the health of the pregnant woman. Supplementing with folic acid has been shown to reduce the risk of pregnancy-related complications, including preeclampsia.
Higher folate levels in a pregnant person may lower the risk of preterm birth. (11, 31)
Getting enough folate may be difficult for some people due to financial stress or in the availability of such food in your location.
On the other hand, it may not be a lack of money but because some people don’t know a healthy diet or how to combine food properly to have a healthy diet at any time. In a situation like this, it’s necessary you replace your source of folate with folic acid.
How much folic acid is too much?
The Recommended Dietary Allowance (RDA) for folate is listed in Dietary Folate Equivalents (DFEs). This unit of measure accounts for the differences in how your body absorbs folate from foods and folic acid from fortified foods and supplements.
Your body absorbs natural folate about half as well as folic acid from supplements. (2)
Adults need about 400 mcg DFE of folate each day. During pregnancy and breastfeeding, folate needs can increase. The RDA during pregnancy is 600 mcg DFE. (2, 7, 8, l0)
Your body stores 15–30 mg of folate. Most of that folate is in your liver, and the rest is in your blood and tissues. (2)
The RDA for folate for infants, children, and teens is:
- Birth to 6 months: 65 mcg DFE
- Ages 7–12 months: 80 mcg DFE
- Ages 1–3: 150 mcg DFE
- Ages 4–8: 200 mcg DFE
- Ages 9–13: 300 mcg DFE
- Ages 14–18: 400 mcg DFE
But always have in mind that you cannot consume too much folate by eating natural food rich in folate but you can consume too much folic acid by consuming a folic acid supplement.
Folic acid deficiency
Getting too little or too much folic acid can be detrimental to health.
A deficiency in folate can cause symptoms like:
- anemia(lack of red blood cells),
- weakness, headaches, fatigue.
- Heart palpitations
- Difficulty concentrating
- Weight loss
- Nausea
Women who are pregnant or of childbearing age, people with alcohol dependence, and those with malabsorptive disorders are at the greatest risk for folate deficiency.
Folic acid deficiency in the elderly is also a problem, especially in those with a poor diet or decreased appetite.
The only way to treat folate deficiency is to increase your folate intake levels through diet and sometimes take a folic acid supplement.
Risk & Side Effects
Take precautions
Eating folate-rich foods and taking natural forms of folate such as 5-MTHF are generally considered safe. But taking high doses of folic acid through supplements could potentially lead to a buildup of unmetabolized folic acid in your blood.
“Unmetabolized” means your body hasn’t broken down the folic acid or converted it into other forms of folate. No confirmed health risks due to unmetabolized folic acid have yet been found, but undiscovered risks may still exist. (2, 32, 33, 34, 35)
If you take folic acid dietary supplements (either capsule, tablet, powder or syrup), however, it’s vital to stick to the recommended dosage.
Adverse side effects of too much folic acid include:
- Cramps
- Diarrhea
- Confusion
- Skin reactions
- Epilepsy
- Changes in sex drive
- Difficulty sleeping
- Mood changes
Other possible risks of high folic acid intake
Taking high doses of folic acid may be associated with other health conditions, including the following:
Cancer
Folic acid might lower the risk of cancers affecting the head and neck, pancreas, esophagus, and bladder. But it may increase the risk of prostate cancer.
So far, research on the topic has not delivered conclusive results, and more studies are needed.
But research suggests that folate may suppress some types of cancer during its early stages, while high doses of folic acid taken after precancerous cells have developed may cause cancer to grow and progress. (2, 36, 37)
Impaired immune function
High-dose folic acid supplements may suppress the immune system by reducing the activity of protective immune cells such as natural killer (NK) cells. Whether these immune changes could put people at increased risk of infection is still unknown. (38)
Autism
What’s Autism?
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. (39)
Taking folic acid during pregnancy helps prevent neural tube irregularities. But having high levels of unmetabolized folic acid in your blood may increase the chance that your child will have ASD.
People who take less than 400 mcg of folic acid daily are unlikely to have high levels of unmetabolized folic acid in their blood. (30, 39)
High levels of unmetabolized folic acid during pregnancy may affect children’s mental development.
In a study of 1,682 mother-child pairs, children whose mothers supplemented with more than 1,000 mcg of folic acid per day during pregnancy scored lower on a test of mental abilities than children whose mothers took 400–999 mcg per day. (40)
Although these studies suggest there may be risks to taking high doses of folic acid during pregnancy, more research is needed to confirm these findings.
Research has suggested that high folic acid intake may be associated with certain health conditions, including cancer, autism, and immune system suppression.
Gene changes that affect folate levels.
When you take folic acid, your liver has to convert it into the active form, 5-methyltetrahydrofolate (5-MTHF).
If your liver doesn’t convert it quickly enough, folic acid can build up in your blood. Eating foods containing 5-MTHF instead of folic acid can prevent this from happening. (2)
Foods that contain 5-MTHF include. (2)
- Dark green vegetables
- beans and lentils
- Akidi (Fresh and dried black beans)
- asparagus
- avocado
- Ube oka (African bullet pears)
Certain gene changes affect how your body uses folate. Methylenetetrahydrofolate reductase (MTHFR) is an enzyme that breaks down homocysteine. Changes called mutations in the code for MTHFR can affect your health by changing folate levels in your body. (3)
One of the most common mutations of MTHFR is C677T. People with this variant have less activity of an enzyme that breaks down homocysteine. They may have high levels of homocysteine, which could increase their heart disease risk.
In a pregnant person, this variant can also increase the chance of neural tube irregularities in a developing fetus. (36)
There are genetic tests for MTHFR variants, but few people need them.
Having an MTHFR mutation alone doesn’t mean you’re at risk of health problems or that you need treatment. But if your homocysteine levels are high, a healthcare professional may recommend that you take a supplement. (36)
Conclusion
Folic acid is a type of B vitamin precisely B9 found especially in leafy green vegetables, the liver, and the kidney.
To be more specific, folate is the form that is found naturally in most food sources, while folic acid is a synthetic form of folate available in fortified foods and supplements.
What is folic acid used for? Within the body, folic acid uses include aiding in cell division, replicating and synthesizing DNA, and promoting fetal growth and development. It’s especially needed during early pregnancy.
Potential benefits of folic acid include a reduced risk of cancer, improved cognitive function, stronger bones, enhanced heart health, better pregnancy outcomes, and reduced symptoms of restless legs syndrome.
A deficiency can cause issues like anemia, stunted growth, heart problems, and neural tube defects. Conversely, consuming too much folic acid from fortified foods or supplements can lead to other adverse effects on health as well.
Therefore, you should get most of your folate through whole-food sources, such as fruits, vegetables, and legumes, to help meet your daily needs and reduce the risk of side effects.
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