Why you should only take folate and never folic acid

The most important facts at a glance 

• It is extremely rare to consume too much folate from food, but it is possible to consume too much folic acid. Folic acid is the synthetic form of folate found in supplements and fortified foods.
• In pregnant mice, high folic acid levels impaired brain development in the offspring, and low vitamin B12 levels exacerbated the damage.
• The combination of a low vitamin B12 level, which often occurs in people who eat a vegan or vegetarian diet, and a high folic acid level could increase neurodevelopmental disorders in children.
• Many people have abnormally high folic acid levels due to prenatal supplements and fortified foods.
• Studies on the effect of folic acid on the development of autism are contradictory. Some point to a protective effect, but more and more evidence points to possible damage from excessive consumption.
• The terms folate and folic acid are often used interchangeably, but they are not the same thing. Folic acid is the synthetic version of folate or vitamin B9. Folic acid occurs naturally in foods such as leafy vegetables, but is also available in the form of food supplements and fortified foods such as muesli and bread.

Contents

• Folic acid supplements in food are not unproblematic
• Many people have unusually high folic acid levels
• Neurological developmental disorders have increased dramatically since the fortification of foods with folic acid
• Even a moderately high intake of folic acid can impair brain development
• The folate cycle is dependent on vitamin B12
• Where can you find natural folate?

Folic acid supplements in food are not unproblematic

In the 1990s, the U.S. Food and Drug Administration recommended that women who could become pregnant should take 400 micrograms (mcg) of folic acid daily to reduce the risk of having a child with a neural tube defect. However, because the neural tube closes very early in pregnancy - about 28 days after conception - some women may miss the critical period when folic acid is especially important.
"For folic acid to be effective, it must be taken in the first few weeks after conception, often before a woman knows she is pregnant," explains the Harvard School of Public Health. For this reason, the US Food and Drug Administration began fortifying foods with folic acid in 1998. Today, folic acid must be added to bread, flour, cornmeal, pasta, rice and other foods made from cereal grains. According to the Centers for Disease Control and Prevention (CDC), neural tube damage is the leading cause of death during pregnancy.

According to the CDC, neural tube defects have declined since folic acid fortification began, resulting in approximately 1,300 babies born each year without a neural tube defect who would otherwise have had a neural tube defect. While neural tube defects have decreased, other health conditions - particularly neurodevelopmental disorders - have increased.
"There is no doubt that the introduction of folic acid fortification in the diet has been beneficial and has significantly reduced the incidence of neural tube defects," said Ralph Green, professor in the Department of Pathology and Laboratory Medicine at the University of California at Davis, in a press release. "However, too much folic acid can affect brain development, and we need to study that more."
Davis and his colleagues conducted a study that showed that excess folic acid is associated with risks to neurological development, especially when combined with vitamin B12 deficiency - an important issue as folic acid intake has increased.

 

Many people have unusually high folic acid levels

"The food industry is adding folic acid to breakfast cereals, snacks and vitamins, which has most likely increased intake above the recommended limits," says Green. "The safe upper limit for folic acid is 1,000 micrograms per day. Data from the National Health and Nutrition Examination Survey show that a significant percentage of women are above this limit."
Many women consume folic acid not only through fortified foods, but also through prenatal vitamins. The study, published in the journal Communications Biology, states, "Total folate intake, particularly in the form of FA [folic acid], has increased substantially, as have folate concentrations in the blood of the population, with a substantial proportion of the population continuing to have extreme excess blood concentrations and supplement use leading to an increase in unmetabolized folic acid (UMFA).
Meanwhile, previous studies have shown that both too little and too much folic acid during pregnancy can affect the neuronal development of offspring by modulating prenatal neurogenesis. High levels of supplemental folic acid - 1,000 μg per day or more - during pregnancy have also been associated with impaired neurocognitive development in children aged 4 to 5 years.
Other studies showed that daily folic acid doses of more than 5,000 μg resulted in reduced psychomotor development in children compared to children whose mothers took lower doses of 400 to 1,000 μg.

 

Neurological developmental disorders have increased dramatically since the fortification of foods with folic acid

As folic acid levels in foods have increased, so have neurodevelopmental disorders. "Data collected by the Centers for Disease Control and Prevention (CDC) indicate that the incidence of several neurodevelopmental disorders has increased substantially in recent decades, most notably autism spectrum disorder (ASD), but also attention deficit hyperactivity disorder (ADHD) and epilepsy," the Communications Biology study states.

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➤ CDC data shows that one in 36 US children has autism - up from one in 10,000 in the 1970s!

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The rapid increase suggests that environmental factors play a role. "One exposure that has increased significantly in recent decades is the intake of the B vitamin folate in its synthesized, oxidized form as folic acid," the researchers write.
While studies on the effect of folic acid on the development of autism are conflicting, with some showing a protective effect, there is growing evidence of potential harm from excessive consumption. The scientists explain:
"Some of the more recent studies in this area, using data from the Boston Birth Cohort, have shown a positive association between maternal plasma folate levels and autism risk. The incidence of autism was highest in children born to mothers with the highest maternal plasma folate levels, which were above the WHO recommended limit (>45.3 nmol/L).
In addition, later work showed that children with cord blood levels of unmetabolized FA (UMFA) in the highest quartile had a higher risk of developing autism than children in the lowest quartile.
A Swedish study investigating the association between 62 maternal blood biomarkers in early pregnancy and a later autism diagnosis also showed that total folate had the highest risk ratio at 1.7. These findings are supported by epidemiologic studies conducted by the Rochester Epidemiological Project in Rochester, MN, and previous CDC data.

 

Even a moderately high intake of folic acid can impair brain development

For the study, the researchers investigated how folic acid intake in mice affects the development of their young animals' brains. The focus was on the cerebral cortex, which plays a role in cognitive and emotional functions as well as mental disorders. One group of mice was fed normal amounts of folic acid and B12, while four other groups were given food containing the following:

• High amounts of folic acid
• little vitamin B12
• High in folic acid and low in vitamin B12
• high folinic acid content, a natural folate

While the natural folate caused no changes in the developing brains of the mice, changes in neuronal development occurred at high folic acid concentrations. The most pronounced abnormalities occurred in the mice that received high folic acid and low vitamin B12. Study author Konstantinos Zarbalis, Professor of Pathology and Laboratory Medicine, explained:
"These different nutritional conditions appear to influence the formation of neurons in the developing brain. High folic acid concentrations or B12 deficiency led to a change in neuronal development.
The cortical neurons, which are normally formed at a later stage of brain development, were produced over a longer period of time and needed more time to settle down and take their proper position in the developing brain. In addition, both high folic acid and B12 deficiency appear to cause many neurons to develop fewer connections."
The team found that "even moderately excessive amounts" of folic acid have a negative effect on prenatal development of the cerebral cortex, which is exacerbated by a lack of vitamin B12.

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The folate cycle is dependent on vitamin B12

The research results illustrate the complex interaction of the various nutrients in the body and show why a balanced ratio is so important for optimal health. This is particularly true for folic acid and vitamin B12. The Communications Biology study states:
"The folic acid cycle only works properly when sufficient vitamin B12 is present. Vitamin B12 is so important because it supports a specific reaction in the body in which a substance called homocysteine is converted into another substance called methionine. This conversion is necessary for the body to properly utilize folic acid and convert one form of folic acid back into its active form.
If there is not enough B12, the folic acid cannot be properly utilized and remains in a form that the body cannot use. This is problematic because even an excess of folic acid (which sounds good in itself) can reduce the availability of usable folic acid if there is also a B12 deficiency. Studies have shown that a lack of B12 can negatively affect thinking ability, especially in older people, by impairing the utilization of folic acid in the body."
Vitamin B12, also known as cobalamin, is required by the body for the formation of red blood cells, nerve function and DNA synthesis. Insufficient vitamin B12 levels can lead to a range of physical symptoms, from numbness to fatigue. Mental health can also suffer significantly, as vitamin B12 plays an important role in neurological function.
For example, it has been shown that people with depression and high B12 levels respond better to treatment, while up to 30% of patients hospitalized for depression have a B12 deficiency.
The only reliable and absorbable source of vitamin B12 is animal products, which is why vegans or strict vegetarians who abstain from animal products and do not supplement their diet with vitamin B12 are often deficient, putting them at increased risk of neuropsychiatric and neurological problems.
Teicholz tweeted: "In many countries, pregnant women have been advised to take folic acid for decades to prevent neural tube defects in their babies. But folic acid is also added to refined grains, which drives up folic acid levels. Low B12 levels occur in vegan/vegetarian diets," which may be responsible for the increase in neurodevelopmental disorders in children in the US.

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Where can you find natural folate? 

While too much synthetic folic acid in fortified processed foods and supplements can be problematic, the body needs natural folate in the diet for optimal mitochondrial function, protein metabolism and for the breakdown of homocysteine, which can be harmful in high amounts. The best way to increase your intake of this important micronutrient is to eat foods rich in natural folate, such as asparagus, avocados, Brussels sprouts, broccoli and spinach. Foods rich in vitamin B12 also include beef liver, wild rainbow trout and wild sockeye salmon. If a deficiency is suspected, weekly B12 injections or a daily high-dose supplement may be necessary. Herbano offers high-quality folate and high-dose vitamin B12 capsules for anyone who wants to ensure an adequate supply of these important nutrients. These products are an excellent addition to a healthy diet, especially if you cannot or do not want to rely on natural sources alone.