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Folic acid vs. folate: What should you take before trying to conceive?

Folic acid vs. folate: What should you take before trying to conceive?

4 min read

Among the countless nutrition controversies in the Google-sphere, it's indisputable that folate is one of the most essential nutrients during pregnancy. Getting enough folate greatly improves fetal neural tube (brain, spine, and spinal cord) development.* Doing that requires planning ahead — and upping your folate intake prior to pregnancy.

Despite the broad acceptance of folate as an important nutrient for a healthy pregnancy, the controversy arises around which molecular form to include in prenatal vitamins. It’s a public health tug of war between the less costly, well-studied folic acid and the newer-on-the-scene methylfolate.

In this post, you’ll find the need-to-know details to make an informed decision about what’s best for you. To summarize what we'll dive into below:

First, a quick overview of the different types of folate

Folate, also known as vitamin B-9, is the umbrella term for all forms of the nutrient, including the lab-made (aka synthetic) versions used in supplements:

  • Folic acid is the form of folate commonly found in processed foods, prenatal vitamins, and other dietary supplements (more on this in a bit).
  • Methylfolate (aka L-methylfolate, 5-MTHF, 5-methyltetrahydrofolate) is a biologically active form of folate, meaning it's easy for your body to absorb.

Why is folate such a big deal?

Folate is needed for the synthesis of DNA and RNA, which in turn enables cell regeneration in your body and cell division for fetal development.* The Food and Drug Administration (FDA) says that women who consume healthful diets with adequate folate throughout their childbearing years may reduce their risk of having a child with a birth defect of the brain or spinal cord (read: neural tube) — and multiple randomized controlled trials (the gold standard for medical research) have demonstrated the efficacy of folic acid supplementation for supporting fetal neural tube development.* That's why, in 1998, the FDA mandated that all flour products — breads, breakfast cereals, pastas, etc. — be enriched with folic acid.

(Note that gluten-free products are not included in this mandate and are typically not enriched. If you eat a largely gluten-free or whole foods-based diet, you may not be getting enough folic acid intake from your food.)

Does folic acid fortification save the day? Not exactly

After folic acid enrichment of grains was mandated, the prevalence of infants born with neural tube defects (NTDs) decreased by 36%. But while this mandate was initially viewed as a huge public health victory, unfortunately, it hasn’t proven to be the panacea many had anticipated. National data in the US estimates that decades later, nearly 20% of people with ovaries in their reproductive years are still not getting enough folate — and around 3,000 births are affected by NTDs every year in the US. That's likely why leading medical bodies still recommend supplementation.

When should you begin taking a prenatal with folate?

The neural tube forms in the first four weeks after conception (before many people even realize they’re pregnant!). If you can plan ahead, it’s ideal to take a prenatal supplement with folate for at least one month before trying to conceive so you can build up the levels of the nutrient in your body before pregnancy.

How much folate do you need?

The American College of Obstetricians and Gynecologists (ACOG) recommends 600 micrograms (mcg) of folate per day during pregnancy — with at least 400 mcg DFE (dietary folate equivalent) of that coming from supplemental folate starting at least one month preconception through at least the first 12 weeks of pregnancy. Many providers (including myself as a nutritionist) also recommend continuing to supplement your folate levels through the rest of pregnancy and postpartum to meet the continued increase of nutritional needs.*

What about food-based folate?

As an advocate for a food-first approach, I can’t overlook the importance of eating food rich in folate, like green leafy vegetables (particularly spinach), brussels sprouts, asparagus, oranges, avocado, milk, yogurt, nuts, and beans.

But can you have too much folate in your system if you’re getting it from food sources as well as a supplement? There currently aren’t any guidelines that vary recommended amounts of folate supplementation based on food intake. But since folate is water-soluble, any excess nutrients will leave your body naturally. That said, in terms of the upper limit of folate supplementation, the National Institutes of Health (NIH) recommends no more than 1,000 mcg of folic acid per day. As for the amount you’re getting from what you eat? Overdosing on high levels of a food-based form of a nutrient isn’t a thing.

Why did we choose to put methylfolate in the Modern Fertility Prenatal Multivitamin?

While developing the Modern Fertility Prenatal Multivitamin, we dug into decades of research and consulted with our medical advisors to land on the strongest formulation we could offer. One of these decisions was opting for methylfolate over folic acid. There are two main reasons we did this:

How does methylfolate stack up against folic acid? While large-scale studies haven't yet been conducted with methylfolate to directly compare it to folic acid, the studies we do have show that methylfolate is as good as (or better than) folic acid in terms of increasing folate levels in red blood cells and serum— meaning a comparable amount of folate is available in the body after taking it.

All of this said, we definitely support anyone who's considering or using the Modern Fertility Prenatal Multivitamin to discuss what's best for them with their doctor. We landed on this formulation through research and guidance from our medical advisors, but we are continuing to evaluate it to make sure we have the strongest formulation possible.

The Modern Fertility Prenatal Multivitamin

The Modern Fertility Prenatal Multivitamin includes methylfolate, an easy-to-absorb form of folate, as well as 11 other essential nutrients recommended by OB-GYNs for before, during, and after pregnancy.

The Prenatal Multi easy to digest, vegetarian, gluten-free, and preservative-free. Plus, your subscription comes with a free (and beautifully blue!) reusable glass jar and your refills ship in just the pouch to reduce packaging waste and carbon footprint.

Start prepping your body now for pregnancy whenever with the Modern Fertility Prenatal Multivitamin.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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Anna Bohnengel, MS, RD, LD

Anna Bohnengel, MS, RDN, LD is a registered dietitian helping women take control of their fertility. Learn more at www.fertility-nutritionist.com/actionplan. Instagram: @MyFertilityNutritionist

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