You may have heard the buzz around the fertility nutrient- Folate. Arguably the most famous prenatal nutrient, supplementing with folate has been linked to preventing the development of hyperhomocysteinemia. Hyper- what?- a condition which can influence developmental abnormalities, particularly neural tube defects in the developing fetus. But navigating folate in all its forms can feel like a minefield. Folic acid, folate or the bioavailable folinic acid – where do I even start? moode unpacks the most common types of folate you’re likely to come across and how they differ, to help make sense of the options out there.
Why is folate necessary in preconception and pregnancy?
We all need folate for lots of important processes in the body, including red blood cell production, growth and repair of cells, and DNA replication – all processes that are front and centre when it comes to growing a fetus.
Raising folate levels during the preconception phase has been shown to reduce the risk of pre-term birth. A deficiency of folate has also long been associated with health issues for mothers, such as anaemia, and for the fetus, including congenital abnormalities such as neural tube defects. Because neural tube development is happening in the very early stages of pregnancy, preconception care with an appropriate form of folate supplementation is all the more crucial.
What’s the difference between folic acid and activated folate?
Did you know the supplemental form of a nutrient can exist in many iterations? So what we know as folate can look like a bunch of numbers and letters on your prenatal vitamin bottle. L-MTHF, 5-MTHF, levomefolic acid, calcium folinate, folinic acid, folic acid – yeah, they all mean the same thing, sort of. But if you’re getting the feeling that it’s complicated, you’d be right.
What is folate?
Folate is the nutrient itself, as it’s found in nature. It’s a naturally occurring, water-soluble vitamin, also known as vitamin B9. It’s found abundantly in the diet in foods such as green leafy vegetables, liver and animal organs and eggs.
What is folic acid?
Folic acid is the synthetic form of folate we’re most familiar with. In Australia, it’s often added (fortified) to wheat flour in an effort to increase consumption. It’s also the form of folate you’re most likely to be prescribed in a vitamin. Why? When the crucial role folate plays in reducing the risk of neural tube defects in pregnancy was first discovered, it was centred around clinical trials using folic acid. So most supplements chose to include this form. However, research and evidence exploring alternative forms and the impact these have on fetal development is continually updating. This is a space worth watching.
What is folinic acid?
The (relatively) new kid on the block, folinic acid is an activated form of folate. Activation is a conversion process which takes the burden off the body to process folic acid through the liver, providing an easily absorbed synthetic version of folate instead.
Why are folate forms contentious?
Where folate is absorbed in the gut, folic acid must first undergo a process of conversion in the liver to be broken down its ‘active’ form of 5-methyltetrahydrofolate (5-MTHF), which the body requires to allow the folate to be useable. This process is time consuming, and can put unnecessary strain on the liver.
And if you’re one of around 40% of the population with a genetic variant known as MTHFR, there’s some debate that the ability to metabolise (and therefore use) folic acid may be impaired. If the body doesn’t metabolise folic acid properly, there’s a risk that it can build up in your body and cause a number of issues, including increased homocysteine and reduced vitamin B12 levels.
Which folate to look for in your prenatal vitamins
Health practitioners recommend taking supplemental folate at least 3 months before trying to conceive, to ensure your maternal folate levels are adequate in time for pregnancy. This is because the neural tube closure occurs 4 weeks from conception, and the preventative effect this nutrient offers is ineffective after this period. Based on many years of research, the recommended daily intake of folate during pregnancy is 500 micrograms (and 600 micrograms for breastfeeding) (Gropper, et al, 2013). Now, to decide on the form of folate you’re after…
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