Folate, or Vitamin B9, serves many important functions in the body. Not only does it play a critical role in the growth of healthy cells, it also supports the formation of DNA. The synthetic form of folate, called folic acid, is commonly added to food during manufacturing, and it’s also taken as a dietary supplement.
Interestingly enough, the human body absorbs folic acid much better than naturally-occurring folate. Folic acid provides slightly different biological effects than folate, but the two generally support a variety of essential metabolic processes and deficiency leads to several poor health outcomes ranging from increased risk of heart disease to birth defects.
Read on to learn more about folic acid and why it’s a vital nutrient to look out for—and to make sure you’re getting enough of in your everyday diet.
What is folic acid?
Essentially, folic acid is the synthetic form of folate, or Vitamin B9. It’s commonly added to foods like flour, prepared breakfast cereals and bread. In fact, in the United States, all grain products must be fortified with folic acid to protect the general population from folate deficiency.
In spite of these efforts, folate deficiency is common in older adults and pregnant women since it’s difficult to obtain the recommended daily value of the nutrient from food alone. Folic acid is also commonly taken as a dietary supplement. It’s a safe, convenient and effective way to make sure you’re getting your recommended daily intake of the nutrient.
Your body uses folic acid in a variety of ways, including:
- Promoting the synthesis, repair and myelination of DNA, as well as cellular division
- Converting homocysteine to methionine, a compound that’s essential for cellular actions
- Aiding in the maturation of red blood cells
The benefits of folic acid
Your body needs folate, whether in its natural form or its synthetic form of folic acid, to survive. It supports a variety of essential bodily processes, and low levels of the nutrient have been linked to increased risk of heart disease, stroke, cancer and birth defects. Supplementing with Vitamin B9, in its synthetic form of folic acid, is common, safe, and effective.
In Western countries, particularly the United States and Canada, folic acid is even added to food during manufacturing or processing to provide the general population with enhanced health benefits. People also take folic acid as a supplement for a number of reasons. Some of the primary benefits include:
- For pregnant women. Folic acid and folate supplements are commonly used by pregnant women to prevent birth defects, particularly neural tube defects like spina bifida and anencephaly. Doctors monitor maternal folate status to detect neural tube defect risks, and they recommend all women who are planning to become pregnant should supplement with 400 to 800mcg of folic acid daily. It’s best to start supplementing at least one month before pregnancy and throughout the first two to three months of pregnancy. Folic acid also prevents fetal birth defects and may reduce the risk of serious and potentially deadly pregnancy-related complications like preeclampsia.
- To promote brain health. Studies show that low blood folate levels accompany poor brain function. They’re also a marker for an increased risk of dementia. Even low folate levels put older adults at higher risk for cognitive difficulties. While research is ongoing, studies have shown that adults who consume folic acid supplements see improved brain function and may even help treat Alzheimer’s disease.
- For mental wellness. Research shows that people with depression typically have lower blood levels of folate, and that folic acid supplements may reduce depressive symptoms when used alongside antidepressants. Folate-based supplements like folic acid and methyl folate reduced depressive symptoms better than treatment with antidepressants alone.
- To reduce heart disease factors. Folate-based supplements play a key role in regulating homocysteine levels which have been shown to increase the risk of developing heart disease. They also may reduce high blood pressure, a major heart disease risk factor.
- For diabetes management. People with diabetes often benefit from folate-based supplements. They reduce insulin resistance, enhance cardiovascular function and may also reduce common diabetic complications like neuropathy.
- To combat inflammation. Inflammation is linked to a long list of health complications, including arthritis, asthma, cancer, diabetes and even mental illness. Dietary folic acid supplements have been shown to reduce inflammatory markers such as C-reactive protein (CRP).
- To promote fertility. Folate is associated with natal health, and higher intake of supplemental folate—above 800mcg each day—is linked to higher rates of live births in women while undergoing assisted reproductive technology. Maintaining appropriate folate levels is also associated with better oocyte (egg) quality, as well as implantation and maturation.
- To reduce medication side effects. Some medications, including immunosuppressant drugs like methotrexate, can have unpleasant side effects. Studies show that folate-based supplements may reduce instances of these side effects.
- To alleviate kidney disease. Chronic kidney disease is frequently associated with hyperhomocysteinemia. Folic acid supplements may play a role in reducing homocysteine levels, as well as heart disease risk, in people with impaired kidney function.
As you can see, it’s extremely important to maintain healthy levels of folate. And while that might be difficult through diet alone, Vitamin B9 supplements offer a convenient way to make sure your body is getting enough of this all-important nutrient.
When to take a Vitamin B9 supplement
Your body stores folate—generally between 10-30mg at any given point throughout the day. It’s mainly stored in the liver but is also found in blood and tissues. In the blood, the main form of folate is called 5-methyletrahydrofolate. Synthetic folic acid supplements can contain this form of folate, and it’s thought to have a higher bioavailability than natural folate, especially when consumed on an empty stomach.
While a balanced diet typically provides your body with all the folic acid you need to support your overall health, there are certain populations who benefit from supplementing. Women who are planning to become pregnant, may become pregnant, are pregnant or are breastfeeding should take a folic acid supplement. People with poor diets—and people who have medical conditions that interfere with the body’s ability to absorb folate from food—should also consider supplementing with B9.
Signs of Vitamin B9 deficiency
Certain populations are more at risk of becoming folate deficient. Older people, as well as pregnant women, commonly need to take a folic acid supplement since it’s challenging to receive the recommended daily value through diet alone. Since folate is found in such a wide variety of foods, clinical deficiencies are typically rare.
Here are some of the conditions that may put you at an increased risk for slight folate deficiency:
- Alcoholism. Regular consumption of alcohol interferes with the body’s ability to absorb folate, and it also speeds the rate at which folate breaks down and leaves the body. Alcoholism is also a risk factor for poor diets that are low in folate-rich foods. Supplementing is often an ideal solution.
- Pregnancy. As stated above, pregnant women need to supplement with folate since it plays such an important role in the development of the fetus.
- Intestinal surgeries or digestive disorders. Certain medical conditions, including celiac disease and inflammatory bowel disease, decrease the absorption of folate. In addition, surgeries involving digestive organs, or those that reduce normal stomach acid levels, also negatively affects absorption.
- Genetic variants. People who are born with the gene MTHFR are unable to convert folate to its active form where it can be used by the body to support essential processes.
Other common signs of deficiency include megaloblastic anemia, weakness, fatigue, irregular heartbeat, poor concentration, hair loss, pale skin, shortness of breath and other complications.
How much folic acid should you get daily?
Your body uses and loses folate throughout the day, and you need to replenish your stores through diet or supplementing each day. The recommended daily value of folic acid for healthy adults is 400 micrograms (mcg).
Usually, consuming plenty of folate-rich foods is sufficient to help you reach that number. Pregnant women should make it a point to take a folic acid supplement to ensure they’re receiving at least 400 to 800mcg every day. Here’s a brief breakdown of dosing information based on specific medical conditions:
- Folic acid deficiency: If your doctor has determined you’re deficient in folic acid, a 400 to 800mcg oral, intramuscular, subcutaneous or IV supplement should be taken once a day.
- Pediatric folic acid deficiency: Children who are deficient in folic acid should supplement. Infants generally need a .1mg supplement, while children need 1mg.
- Megaloblastic anemia: Adults living with megaloblastic anemia should take a 1mg folic acid supplement either orally, intramuscularly, subcutaneously or via IV once a day. Supplementing should continue until hematological profiles are normalized and symptoms of deficiency improve.
The best ways to get Vitamin B9
Consuming folate-rich foods from a varied diet is the best way to make sure you’re receiving the recommended daily value of B9 your body needs to support essential processes.
While many foods naturally contain folate, the body more readily absorbs the form of folate that is added to foods. In fact, the U.S. Food and Drug Administration has required food manufacturers to add folate to their products, particularly breads, cereals, pasta, rice and other grains.
Some of the foods that feature the best sources of folate include:
- Dark, leafy green vegetables
- Sunflower seeds
- Fresh fruits and fruit juices
- Whole grain foods
- Fortified foods and supplements
It’s often more efficient and convenient to take a folic acid supplement, but be sure to follow doctor’s recommendations as well as the directions on your prescription label. Supplements come in oral form or by injection. Oral supplements are taken by mouth, while injections are placed directly into a muscle, under the skin or into a vein.
Supplementing is very safe at appropriate doses, and excess folic acid is excreted in urine. One thing to keep in mind is that higher-than-normal folic acid intake can mask Vitamin B12 deficiency until the neurological damage becomes irreversible. This is yet another reason why you should consult with your doctor before supplementing. Your doctor may also recommend taking a supplement that contains 100% of your target daily value for both folic acid and Vitamin B12 to prevent any deficiencies from occurring.
Potential side effects of folic acid
While side effects of folic acid are generally rare, especially after you’ve received a doctor’s approval to supplement, you should still be aware of some of the symptoms of an adverse reaction to the nutrient.
Seek emergency help if you experience hives, itching, rash, skin redness, wheezing, difficulty breathing or swelling in your face. Other common side effects to look out for include:
- Nausea and loss of appetite
- Bitter, unpleasant taste in your mouth
- Confusion and cognitive problems
- Digestive concerns including bloating, gas and stomach pain
- Sleep disturbances
- Shifts in mood, including depression, excitement or irritability
Certain drugs and medications affect folic acid absorption. Talk to your doctor or pharmacist before taking folic acid with any medications. While this list is not complete, here are the drugs that interact negatively with folic acid:
- Barbiturates including phenobarbital or secobarbital
- Seizure medications like phenytoin or primidone
Talk with a healthcare professional about Vitamin B9
If you’re concerned about your Vitamin B9 levels and you’re wondering if a folic acid supplement could support your overall health, the first thing you should do is talk with your healthcare provider.
Whether you’re pregnant or planning to get pregnant, or you’re deficient in folic acid due to diet or a medical condition, folic acid supplements are generally safe and effective, but you need a doctor’s approval before taking one. Oversight by a doctor is also important since your dose may need to be adjusted to ensure you’re getting the best results from supplementing.
Keep in mind that folate supplements come in several forms and they each work a bit differently in the body. If you receive approval to take a folic acid supplement, follow your doctor’s and pharmacist’s instructions carefully and supplement safely.