Mammas and soon-to-be mammas, I am sure you have heard ALOT about the importance of folic acid supplementation not only early in your pregnancy but preferably before you even fall pregnant. Folic acid supplementation has been shown to significantly decrease the risk of neural tube defects in newborns and even to reduce pregnancy complications like preeclampsia and preterm births.
Folate, also known as vitamin B9 and is one of the 13 essential vitamins. This means that pregnant or not, you cannot do without it. The body cannot make folate for itself so it waits for you either to eat a folate-rich diet or supplement with folic acid. Folate is used in the body for DNA replication and is involved in a bunch of very important enzymatic reactions. When a woman is pregnant, her folate requirements go up as she now needs more folate for the proper growth and development of the fetus.
There is a distinct difference between dietary folate and folic acid. Dietary Folate ( B9) occurs naturally in foods while folic acid is the synthetic form. When ingested, both folate and folic acid are metabolically inactive. The active form is a folate known as 5-methyltetrahydrofolate (5-MTHF). Dietary folate is converted into 5-MTHF in your digestive system before entering your bloodstream. On the other hand, the folic acid you consume in supplements tends to be converted into the active form 5-MTHF in your liver or other tissues. This process is much slower and generally less effective.
Eating a folate-rich diet
Mother nature in all her glory has provided us a variety of folate-rich foods that are high in dietary folate. These include:
Leafy green vegetables e.g spinach, kale
For a health-loving, green smoothie kind of mamma, you might manage to get all your folate requirements from food. That said, given folate’s importance for maternal and fetal health and the difficulty many women have meeting their needs through diet alone, it’s recommended that all women who are planning to become pregnant supplement daily with 400–800 mcg of folic acid. This should start at least 1 month before becoming pregnant and continue through the first 2–3 months of pregnancy. In some cases, doctors advise using folic acid supplements throughout your entire pregnancy and even into your postpartum period. In the Chinese Medicine world it is recommended to keep supporting your body throughout the whole pregnancy and after to ensure the mumma fully recovers especially whilst breast feeding.
The low down on the different types of folic acid supplements
Although many synthetic versions of folate are often grouped and referred to as folic acid, not all folic acid supplements were created equal. Below we will demystify the differences for you between the 3 most common forms of folic acid supplements:
Folic Acid - This is the most common supplement available and is the synthetic form of folate in its inactive state. It is metabolically inactive when ingested and it needs to first go through the process of digestion before getting synthesized in the liver. Synthesized folic acid differs structurally from natural folate and has slightly different biological effects in the body. It is also common for some of the folic acid to remain unmetabolized. Folic acid is commonly added to foods like flour, ready-to-eat breakfast cereals, and bread as way to boost the intake of the greater population. It is important to mention that incase you are on any other medications, be sure to first confirm with your health care provider before taking folic acid as it can have some negative interactions with other medications.
Folinic Acid - Folinic acid is a superior form of folic acid. In the digestive process, folic acid first get converted to folinic acid before finally being converted to 5 MFTH that can then be used in the body. Folinic acid is a naturally occurring folate that’s found in foods and commonly known as leucovorin in the clinical setting. Leucovorin is often used to prevent toxic side effects of the drug methotrexate (used to certain cancers) and to treat megaloblastic anemia caused by folate deficiency ( yes folate deficiency can cause anemia!). Folinic acid is more effective than folic acid at raising blood folate levels which means it is better metabolised than folic acid.
5-methyltetrahydrofolate ( 5-MFTH) - Now this right here is the king of folic acid supplementation. 5-MFTH is the already metabolized version of natural folate, this means you are consuming folate in its most ready-to-use state. Unsurprisingly a high intake of 5-methyltetrahydrofolate does not lead to unmetabolized folic acid in the blood. Plus, studies have shown that 5-methyltetrahydrofolate is more effective at increasing red blood cell folate concentrations. It should be noted that supplementing with 5-methyltetrahydrofolate rather than folic acid may reduce potential negative drug interactions. Conversely, 5-MFTH has better absorbability than all other forms of folic acid supplementation.
So if you are looking to supplement with folic acid, we strongly recommend you choose to use 5-MFTH. Research has proven that it is best for mamma, meaning it's best for bubba too!
Happy supplementing ladies :)