Folate Versus Folic Acid

By Dr. Leah Hollon ND, MPH

The American Industry has been pushing folic acid for years, but is there a better option?


Folate Pic (2)There are some significant ground rules that need to be established surrounding the discussion of folate. Folate is the naturally occurring form of folate.  It is not folic acid.  Folic acid is the synthetic or man-made form and thus not found in nature. What this means is that when you eat a salad you will never consume folic acid, but will instead consume folate.  It is important to recognize that folic acid has a higher attraction or what we call an affinity for our body than the natural form of folate.  What this means is in giving folic acid and folate simultaneously, the folic acid would have more attraction for our body.  In some cases, this can cause altered biology.

In 1998, the Food and Drug Administration (FDA) mandated fortification of all enriched grains, which meant adding in folic acid to these processed foods.  The reason this was identified as a public health concern was due to people eating low amounts of folate.  More specifically, with the addition of processed foods and fewer leafy green vegetables, there was an increase in birth defects or what we know as neural tube defects.  Nationally, individuals were making poor food choices, including low intake of fresh vegetables.  As many know, processed foods have little nutritional value unless enriched or fortified.   The FDA was adding folic acid to processed foods to increase the overall intake.  The problem with this fortification or enrichment process is that the added minerals and vitamins are usually not in a form that is very usable by the body.  Thus the body must expend energy to convert it into a usable form.

This conversion process is called methylation.  But here’s where it gets interesting, conversion can be difficult.  And what if you are one of those individuals that can’t convert folic acid easily?  Folic acid is not converted by all people at the same rate or ease.  When the FDA’s fortification of folic acid occurred at the national level, the goal was to address and prevent potential issues around fetal and maternal health.  Neural tube defects occur when there are issues in replicating DNA.  In order for proper DNA replication, folate and B12 are both required.  If they are not at an appropriate level then fetal development can be impacted.  Thus the national decision was to try to assist with DNA replication for maternal and fetal health by supplementing with folate.  The decision to add a cost saving and easily manufactured folate was recommended and that form has been folic acid since the initial fortification.

Folic acid is cost effective upfront. Currently though, we are unaware of the possible long-term costs in providing this synthetic form in nutrition or supplementation.   For those individuals that cannot metabolize folic acid, it remains as unmetabolized folic acid.  It is important to note that unmetabolized folic acid (UFA) is dangerous and can have negative health impacts including lowering immune function, infertility and cancer.  Research has found that UFA in plasma was associated with reduced natural killer (NK) cell function in postmenopausal women.  NK cells are invaluable to the immune system, allowing for protection against infection or illnesses.  Additionally, the Food and Safety Authority of Ireland conducted research that found elevated unmetabolized folic acid (UFA) in elderly populations.  Due to this link between UFA and cancer concerns in their general population, the fortification recommendations were altered.   More specifically, their research and subsequent publications stated “In light of these concerns, mandatory folic acid fortification previously recommended for Ireland and the United Kingdom is now suspended until more definitive scientific evidence becomes available.”

At this time, more research is being conducted to understand the concerns with UFA and those that have difficulty converting it, or essentially those with potential methylation issues. As an example, for those individuals with a genetic variation or mutation known as MTHFR677, giving methyltetrahydrofolate was superior to giving folic acid (Br J Pharmacol. 2009 Dec;158(8):2014-21).

 The take home is, eat your vegetables and explain to your community the importance of food as medicine.  Eat real food.  A pill is not going to solve the issue and, in fact, it may worsen it if it is in the wrong form.  If you feel comfortable enough in your skills to recommend support for epigenetic mutations such as MTHFR, the best option at this time is to avoid recommending folic acid.  In many cases, various forms of folate may be a better option.  Remember though that MTHFR enzymes interact with other enzymes and thus folate may or may not be the best option.  If you do not feel confident or comfortable in understanding the inter-dynamic communication among these enzymes and would like additional support, visit our upcoming CE events for more information.



Both Drs. Hollon and Lundberg found a passion in epigenetic expression due to the complexity of cases and patients they have had the opportunity to work with over the years.  Their interest in helping those with difficult illnesses and disease states has led them to a deeper level of understanding.  Over time they have investigated the frameworks of how nature and nurture coalesce into present and potential future health.  Years of research has assisted in their understanding of the interplay between nature and nurture, which has expanded their work where cases began to make more sense.  Various patterns emerged that have promoted additional quality of life and alleviation of symptoms in some of their most difficult cases. Due to this, many individuals and patients have sought their support.  In order to provide more access to this knowledge, Drs. Hollon and Lundberg currently serve as a resource to other practitioners in the region.  Their goal is to assist other practitioners on their most difficult cases in epigenetics.  They hope to share more insight not only with their local community but other practitioners and patients in the region through various courses they are offering.  They also provide consulting services for individual practitioners.



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