By Rachael Link, MS, RD
From supporting fetal development and growth to preventing cognitive decline and dementia, folate is absolutely essential throughout every stage of life. Getting enough folate and folic acid foods in your diet can keep your heart and bones healthy, prevent birth defects, and even reduce the risk of certain types of cancer.
Found in a variety of fruits, vegetables and legumes, it’s surprisingly simple to meet your needs by following a healthy diet rich in whole foods that can provide plenty of folate, plus other important nutrients that your body needs.
What Is Folic Acid? What Does It Do?
Folate, also known as vitamin B9, is an important water-soluble vitamin that plays a role in many aspects of health. It aids in cell division and helps make new cells by copying and creating DNA. (1) It also helps the body use vitamin B12 as well as certain amino acids.
Folic acid is the synthetic form of folate that is found in most prenatal vitamins, supplements and fortified foods. Folic acid for pregnancy is often recommended by many doctors to help ensure that folate needs are met and to protect against pregnancy-related complications.
In an effort to prevent dangerous birth defects caused by folate deficiency, many countries around the world have strict regulations in place requiring food manufacturers to fortify certain products with folic acid. In the United States, for example, fortification of enriched cereal grains with folic acid was fully authorized in 1996 and fully implemented just two years later, in 1998. (3)
Folate is also associated with improved cognitive function and protection against depression and Alzheimer’s disease. (4) It may also help support strong bones, decrease symptoms of restless legs syndrome and promote the health of the nervous system. (5, 6, 7)
Folic Acid vs. Folate
So what’s the difference between folate vs. folic acid? Although the terms are often used interchangeably, there are several differences between the two.
Folate is naturally found in food sources like fruits, vegetables and legumes. Folic acid, on the other hand, is the synthetic form of folate and can be taken in supplement form or found in fortified foods like enriched flour, pasta, cereal, bread and rice.
Interestingly enough, some studies have found that folic acid is actually more well-absorbed than folate from food sources. According to a study published in the American Journal of Clinical Nutrition, the folate found in food is about 78 percent as bioavailable as folic acid. (8)
However, other evidence shows that the enzyme needed to be able to use synthetic folic acid may not be very efficient, leading to a buildup of unmetabolized folic acid in the plasma and tissues. Some studies have even found that a higher intake of folic acid could be associated with a greater risk of certain types of cancer. (9) Keep in mind, though, that getting a small amount of folic acid each day from supplements isn’t likely to result in long-term “high intake” responsible for this problem.
If you eat many high folate foods, there’s no reason to supplement with 100 percent or more of your daily folic acid requirement, as provided by the FDA. I think that, for multivitamins and other supplements containing folic acid, around 15-20 percent of the daily recommended amount of folic acid is plenty. I also prefer to consume fermented folic acid, as fermentation is a process of pre-digestion that may be able to prevent unmetabolized folic acid buildup.
Filling your plate with foods rich in folate is the best option to meet your daily needs, as these foods are also high in other essential nutrients that are important to health. While folic acid supplementation may be a useful tool for preventing deficiency in some, incorporating plenty of nutrient-dense folate and folic acid foods can help most people meet their daily folate requirements while also supplying an array of other crucial vitamins and minerals.
Top Folate and Folic Acid Foods
If you’re looking to get more folate into your diet, upping your intake of a few folate and folic acid foods is key.
For reference, adults need about 400 micrograms of folate daily. For women who are pregnant or lactating, that number jumps up to 600 micrograms and 500 micrograms, respectively. Fortunately, by incorporating a few folate-rich foods into your meals, it’s easy to meet your daily needs.
Here are some of the top sources of folate and folic acid, according to the National Institutes of Health: (10)
- Beef Liver: 3 ounces contain 215 micrograms (54 percent DV)
- Spinach: 1/2 cup, cooked contains 131 micrograms (33 percent DV)
- Black-Eyed Peas: 1/2 cup contains 105 micrograms (26 percent DV)
- Fortified Rice: 1/2 cup contains 90 micrograms (23 percent DV)
- Asparagus: 4 spears contain 89 micrograms (22 percent DV)
- Enriched Spaghetti: 1/2 cup contains 83 micrograms (21 percent DV)
- Brussels Sprouts: 1/2 cup contains 78 micrograms (20 percent DV)
- Romaine Lettuce: 1 cup contains 64 micrograms (16 percent DV)
- Avocado: 1/2 cup contains 59 micrograms (15 percent DV)
- Broccoli: 1/2 cup, cooked contains 52 micrograms (13 percent DV)
Folate and Folic Acid Benefits
1. Promotes a Healthy Pregnancy
Because of its involvement in DNA synthesis and important enzymatic reactions, folate is a critical component of a pregnancy diet. During pregnancy, your folate requirements even increase to help support fetal growth and development. In fact, many health care professionals even recommend starting supplementation or eating more folic acid foods before pregnancy to prevent birth defects.
One of the most well-known benefits of folate is its ability to reduce the risk of neural tube defects that can affect the brain, spine or spinal cord. However, meeting your folate needs can also decrease the risk of anemia, preterm birth and pregnancy complications. (11)
2. May Decrease Cancer Risk
Emerging research shows that folate could aid in the prevention of certain types of cancer. According to a review published by the Department of Medicine at St. Michael’s Hospital, maintaining adequate folate levels or increasing folate intake from dietary sources and supplementation could reduce the risk of pancreatic cancer and breast cancer for certain populations. (12) Other studies have found that folate intake could be associated with a lower risk of colorectal, esophageal and ovarian cancers too. (13, 14, 15)
Keep in mind, however, that other studies have found that excess folic acid intake from supplementation and fortified foods may actually be associated with an increased risk of certain kinds of cancer. More research is needed to fully understand the role that folic acid and folate may play in cancer prevention and development.
3. Supports Heart Health
Heart disease affects an estimated 92.1 million Americans and accounts for nearly one-third of all deaths around the world. (16) Fortunately, studies show that folic acid benefits heart health and could help reduce the risk of heart disease.
Higher levels of folate are linked to lower levels of homocysteine, a type of amino acid that can contribute to the formation of blood clots and cause arteries to narrow and harden. (17) Increasing your intake of folate may help decrease homocysteine levels to prevent heart disease. In fact, a 2012 analysis out of China found that each 200-microgram increase in folate intake was associated with a 12 percent drop in the risk of developing coronary heart disease. (18)
4. Builds Strong Bones
In addition to being associated with a greater risk of heart disease, elevated homocysteine levels may also impact bone health as well. Studies show that folic acid can decrease homocysteine levels and impact the rate of bone metabolism to promote better bone health. (19)
In one 2014 study, increased plasma homocysteine was associated with decreased levels of folate as well as reduced bone mineral density. (20) Plus, another study published in the New England Journal of Medicine showed that higher levels of homocysteine were a risk factor for osteoporotic fractures in older adults. (21)
5. Improves Cognitive Function
Low levels of folate, along with other B vitamins like vitamin B12, have been associated with cognitive decline and dementia. (22) A study published in the American Journal of Clinical Nutrition even found that low folate status was associated with impaired cognitive function in the elderly. (23)
One 2016 study found that folic acid supplementation was able to effectively improve cognitive function in older adults with mild cognitive impairment. (24) Another study published in 2005 also found that a higher intake of folate was linked to a reduced risk of developing Alzheimer’s disease. (25)
6. Reduces Symptoms of Restless Legs Syndrome
Restless legs syndrome is a condition characterized by the urge to move the legs, especially at night. While anyone can be affected by restless legs syndrome, pregnant women are especially prone to developing the condition.
Studies show that low levels of folate may be associated with the development of restless legs syndrome, especially during pregnancy. Interestingly, according to a paper in Alternative Medicine Review, folic acid administration may help reduce the symptoms of restless legs syndrome. (26)
Signs of Folate/Folic Acid Deficiency
Folate deficiency on its own is uncommon. Since it typically stems from causes like a poor diet, alcoholism or issues with nutrient absorption, folate deficiency is often found coupled with other nutrient deficiencies.
Folic acid deficiency anemia, known as “megaloblastic anemia,” is the main clinical sign of low folic acid and B12. Megaloblastic anemia results in the production of red blood cells that are abnormal and large, causing symptoms like:
- Pale skin
- Premature hair graying
- Stunted growth
- Shortness of breath
- Heart palpitations
- Difficulty concentrating
- Weight loss
Women who are pregnant or of childbearing age, people with an alcohol dependence, and those with malabsorptive disorders are at the greatest risk for folate deficiency. Folic acid deficiency in the elderly is also a problem, especially in those with a poor diet or decreased appetite. (27)
Conventional folate deficiency treatment typically includes increasing folate levels by making dietary modifications and sometimes taking a folic acid supplement. It’s also important to diagnose and correct other nutrient deficiencies that may also be present, like vitamin B12 deficiency.
Can You Have Too Much Folic Acid? Signs of Excess Folic Acid
If you’re getting your folate from whole food sources, there’s no need to worry about overdoing it and getting too much folate from your diet. If you’re taking folic acid supplements, however, it’s vital to stick to the recommended dosage to avoid adverse side effects like cramps, diarrhea, confusion and skin reactions. Other possible folic acid side effects include epilepsy, changes in sex drive, difficulty sleeping and mood changes. (28) The upper limit of folic acid from fortified foods and supplements is set at 1,000 micrograms per day. (29)
Some studies suggest the enzyme needed to convert folic acid into a usable form is very slow, causing unmetabolized folic acid to build up in the plasma and tissues. Although more research is needed, a high intake of folic acid from supplementation may be associated with an increased risk of prostate cancer and colorectal tumors. (30, 31)
Another danger of excess folic acid intake is that it can mask a deficiency in vitamin B12, which can have detrimental effects on health if left untreated. Long-term vitamin B12 deficiency can lead to problems like anemia, fatigue, nerve damage and even neurological changes.
How to Use Folic Acid
Ideally, you should get the majority of your folate from natural, whole food sources like fruits and vegetables. Not only can these nutrient-dense foods provide folate, but they are also rich in other vitamins and minerals that your body needs.
However, if you’re unable to meet your folate needs through foods or have a condition that impairs absorption, your doctor may recommend using a folic acid supplement or eating more folic acid foods to help meet your needs.
Most adults need about 400 micrograms of folate, but the daily requirements increase for women who are pregnant or breastfeeding to 600 micrograms and 500 micrograms, respectively. Folic acid dosage can range anywhere from 100–800 micrograms, and most prenatal vitamins generally include between 600–800 micrograms of folic acid per serving.
If you do decide to use a supplement, opt for L-methylfolate instead of folic acid. This is the biologically active form of folate, and some research suggests that it may mitigate some of the risks associated with high folic acid intake. (32) Additionally, be sure to also include a range of folate-rich fruits and vegetables in your diet to ensure you’re meeting your micronutrient needs.
Folate and Folic Acid Foods Recipes
For most, you can easily meet your folate needs by including a few folate and folic acid foods in your diet. Need a few ideas? Here are some folate-rich recipes that you can try at home:
- Crustless Spinach Quiche
- Beef Liver and Onion Meatballs
- Asparagus Tapas with Red Pepper Sauce
- Broccoli, Kale and Brussels Sprouts Slaw
- Avocado Grilled Cheese
Folate is absolutely crucial for supporting growth and development, and folate deficiency is a big contributor to many birth defects, such as spina bifida and anencephaly. The role between folate deficiency and neural tube defects was first theorized back in 1965, but recommendations regarding folate intake during pregnancy didn’t start rolling out until decades later, after multiple trials showed that taking folic acid was able to completely cut the occurrence of neural tube defects.
In 1991, the Centers for Disease Control and Prevention recommended that women with a history of pregnancies affected by neural tube defects should begin taking 4,000 micrograms of folic acid daily from the time that they begin planning a pregnancy. A year later in 1992, the U.S. Public Health Service advised that women of childbearing age should start getting at least 400 micrograms of folic acid or folate daily through diet, supplementation or fortified folic acid foods.
However, the neural tube closes just 28 days after conception, and since 50 percent of pregnancies in the United States are unplanned, most women would need to begin supplementation before even getting pregnant.
In 1996, the United States authorized regulations that mandated fortification of enriched cereal grains with folic, acid and by 1998, the program was fully implemented. Today, 53 countries around the globe have regulations in place for mandatory fortification of wheat flour in an effort to reduce the risk of birth defects.
Precautions with Folic Acid Foods
Folate deficiency can contribute to many negative symptoms, such as weakness, fatigue, headaches and irritability. It can also sometimes indicate that there may be other underlying nutrient deficiencies as well, since it often occurs alongside other vitamin deficiencies. If you believe that you may have a folate deficiency, talk to your doctor about having your folate levels tested.
Getting your folate from whole foods like fruits, vegetables and legumes is the best way to meet your folate needs without the risk of adverse side effects. However, if you do decide to add folic acid from fortified folic acid foods or supplements into your diet, be mindful about how much you’re consuming. Keep your intake under 1,000 micrograms daily to avoid adverse side effects and potential negative effects on health.
Final Thoughts on Folic Acid Foods
- Folate is a water-soluble B vitamin found naturally in many different foods. Folic acid is the synthetic version of folate found in supplement form and added to fortified foods.
- Liver, green vegetables and legumes are good sources of folate. Folic acid is found in enriched cereal grains such as rice, pasta and bread.
- Folic acid benefits include promoting a healthy pregnancy, supporting heart health, improving cognitive function, potentially reducing the risk of cancer, building stronger bones and reducing symptoms of restless legs syndrome.
- Folate deficiency can cause symptoms like anemia, weakness, headaches, irritability and fatigue.
- While getting folate from natural food sources is perfectly safe, consuming too much folic acid from fortified foods or supplements may mask other nutrient deficiencies and could also be associated with a higher risk of cancer.
- Most people are able to meet their folate needs through whole food sources. Not only do these foods contain plenty of folate, but they are also rich in other nutrients that are important to health as well.
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