folic Acid Vs Folate . . . And why it matters

Team Naked Doula
May 19
3 min read

Folate is a B vitamin. It's essential in pregnancy, specifically in the weeks before and just after conception, when the neural tube forms. The neural tube becomes the brain and spine. It closes by week six. Most women don't even know they're pregnant at week six! That's the whole reason supplementing before conception matters.

The NHS recommends 400mcg of folic acid a day, ideally three months before you conceive. That advice is solid. But folic acid and folate are not the same thing, and knowing the difference helps you make a better choice about what you're actually taking.

Folate is the natural form. Folic acid is synthetic.

Found in food. Leafy greens, avocado, lentils, broccoli. Your body absorbs it and converts it into a usable form pretty efficiently.

The lab-made version used in most supplements and added to fortified foods like cereal and bread. Your liver has to convert it and that process is slower, and works better in some women than others.

Both need to be converted into the same active form before your body can use them. Folate gets there quickly. Folic acid depends on your liver keeping up.

When the liver can't keep up

If folic acid comes in faster than the liver can process it, the unconverted version builds up in the bloodstream. Research shows this can happen at the standard supplement dose - 400mcg a day. Add fortified cereal or bread on top, and it accumulates further.

Some studies have found links between high levels of unconverted folic acid and increased cancer risk. The research is still developing but there's no definitive proof of harm. But it's a reason not to assume more is better, and to think about the form you're taking, not just the dose.

Some women just don't convert folic acid well. If you've had recurrent miscarriages or a previous pregnancy affected by a neural tube defect, bring it up with your GP then a different form of folate supplement might suit you better. (If you want to go down a rabbit hole on why, look up MTHFR gene variants. It explains a lot.)

Why folic acid is still the recommendation

The evidence that folic acid reduces neural tube defects is decades old and solid. Those trials were done with folic acid specifically, there's no equivalent research yet for other forms. So the NHS recommendation stands, and it's not wrong. But there's a difference between "folic acid works" and "folic acid is your only option." For most women it's fine. For some, a methylfolate supplement/Natural folate (the active, ready-to-use form) may be more effective. That's a conversation to have with your midwife or GP, not a decision to make based on what looks good on a label.

What to actually do

Eat folate-rich food - greens, lentils, avocado. Take a supplement before you conceive. If you're on standard folic acid and have no reason to think it isn't working for you, carry on. If something in your history makes you wonder, ask your GP. That's what they're there for.

Don't wait for the positive test.

Her.9

If you're looking for a supplement that gets this right, Her.9 is what we recommend. It uses methylfolate, the active form your body can actually use, alongside 17 other nutrients formulated specifically for women. We all use it here at The Naked Doula. It's designed to support you from puberty through pregnancy and beyond, so it's not just a prenatal..... it's a long-term one!

Learn More about Her.9