When it comes to letter vitamins, it’s not always immediately clear which ones you should take—and sometimes terminology adds an extra layer of confusion. Such is the case with the question of folic acid versus folate. These two terms are often used interchangeably, but (surprise!) they’re not exactly the same thing. And even more critical: Different people may need one over the other for different health purposes.
Before you buy a bottle of either (or a supplement containing one of these nutrients), here’s what you need to know about the distinctions between folate and folic acid.
Folic Acid vs. Folate: How Are They Different?
Folate is a B vitamin (vitamin B9, to be precise) found in nature. And if its name reminds you of the foliage of autumn leaf-peeping, you’re onto something. In fact, the word “folate” is derived from the Latin folium, since this vitamin naturally occurs in leafy green vegetables like spinach, turnip greens, and Romaine lettuce. It’s also present in other foods, including beans, seafood, whole grains, lentils, oranges, and broccoli. There are actually several types of vitamin B9, including dihydrofolate (DHF), tetrahydrofolate (THF), 5, 10-methylenetetrahydrofolate (5, 10-MTHF), and 5-methyltetrahydrofolate (5-MTHF), but they all fall under the folate umbrella.
Folic acid, on the other hand, is a synthetic version of folate created for use in dietary supplements. (It also goes by the name pteroylmonoglutamic acid, but don’t worry, you won’t see that tongue-twister on labels.) Though it’s man-made, folic acid is actually better absorbed than folate. You can expect to absorb 85 percent of a folic acid supplement, compared with 50 percent of the folate found in food. Interestingly, the body converts folic acid to folate in the intestines.
Because of its superior absorption rate—and the connection between vitamin B9 and the prevention of neural tube defects when taken during pregnancy—in 1998, the Food and Drug Administration (FDA) began requiring cereal grains to be fortified with folic acid. (Research has primarily focused on folic acid and has yet to connect folate with the same level of efficacy for preventing these defects.) Thus, in a strange twist of fate, the synthetic version of vitamin B9 is also now readily available in foods, albeit in different ones than where it naturally occurs.
What Are They Good for?
Despite their unique origins, you’ll find both folate and folic acid in a variety of supplements these days, which can be a little confusing.
In general, folate and folic acid serve the same purposes in the body. Whether natural or synthetic, vitamin B9 is necessary for the development of DNA and RNA, the production of red blood cells, and breaking down homocysteine, an amino acid that, when too high, can increase the risk of heart disease.
Folate and folic acid are also involved in the process of metabolizing protein. Some research has even suggested that these vitamins might play a role in the treatment or prevention of autism spectrum disorder, cancer, dementia, and other conditions, though firm conclusions have yet to be drawn.
While these functions are all important to well-being, they tend to take a backseat to the most well-known benefits vitamin B9 has to offer: preventing neural tube defects in utero. The Centers for Disease Control and Prevention (CDC) recommends that all women of reproductive age (pregnant or not) consume 400 micrograms of supplemental folic acid daily to protect against defects of the brain and spine in possible future children. But you might wonder, can you take folate instead? “According to the CDC, ample research proves the effectiveness of folic acid supplements in preventing neural tube defects,” says Bianca Tamburello, R.D.N., of Fresh Communications “However, not much research has been done on the effectiveness of folate supplements.”
It’s a little confusing, yes, but for now, experts like Tamburello recommend following the scientific evidence available and opting specifically for a folic acid supplement when pregnant or planning for a pregnancy, per the CDC guidelines.
Read More: 7 Nutrients You Need More of When You’re Pregnant
Besides preventing neural tube defects, there’s no particular reason to choose folic acid over folate or vice versa, according to Tamburello.
What If You Have a MTHFR Gene Variant?
In recent years, there’s been a lot of discussion around a genetic variant with a name that sounds like an abbreviated curse word—MTHFR—and its relationship to these B vitamin forms. “Most Americans can process folic acid and folate well without issue,” says naturopathic doctor Alexa Neynaber, N.M.D., of Virasoap Natural Medicine. “However, about 40 percent of Americans have one of the clinically relevant MTHFR single nucleotide polymorphisms (SNPs) and cannot.”
Let’s break down what that means: “The MTHFR enzyme is the last step in folate metabolism,” Neynaber says. “A MTHFR gene variant, depending on the severity and type, can reduce this last step of conversion and lead to a buildup of homocysteine. In high levels, homocysteine can lead to cardiovascular inflammation, an increased risk of hypertension, and cardiovascular disease.” As such, some experts believe that people with these gene variants should be cautious with certain forms of vitamin B9.
Read More: Should You Start Taking Methylated B Vitamins?
Not everyone agrees. The CDC says that people with the most common MTHFR variant (known as C677T) can still process all types of folate, including folic acid, and stands by its recommendation that all women of reproductive age (regardless of gene variants) take 400 micrograms of folic acid each day.
Neynaber and many other alternative practitioners are in the opposite camp. “The real controversy arises if high homocysteine levels are clinically relevant,” she says. “I have personally seen patients who have had strokes, heart attacks, and death when their homocysteine is high.”
Because of this, Neynaber personally recommends people supplement with methylated folate, which some research shows is safe and effective during pregnancy. (This form of folate has already undergone a process called methylation that occurs in cells and makes the nutrient more bioavailable for absorption.)
What to Know Before Choosing a Folate or Folic Acid Supplement
Clearly, the discussion around folate and folic acid can be contentious, with varied opinions on which one is best for people with different health concerns. In future years, we may have ironclad answers, but for now, research is still teasing apart all the nuances around these forms of vitamin B9.
Ultimately, it’s always best to talk to your healthcare practitioner about the right folate or folic acid supplement for your individual health needs. And if you’re curious about whether you have a MTHFR variant, a genetic test (which typically involves a blood draw or cheek swab) is a simple way to find out. Interestingly, “MTHFR mutations are just one type of mutation that impacts folate metabolism,” according to Neynaber, so genetic testing might reveal other factors that could influence your choice of supplement. Once you’ve sorted out any genetic roadblocks, you can make your decision with confidence.