The Supplement Series: Folic Acid: are you taking it? If so, please read...
A question I often get asked is: what supplements are best to take for conception, pregnancy and breastfeeding.
There are three tricky things about this question:
It is very person/situation specific
Depends what type/where you get them from
Too much can be as bad as too little: hypervitaminosis
What is hypervitaminosis?
As you may have guessed, this is where high storage levels of vitamins in the body can lead to negative and even toxic symptoms.
I’ll be honest, I hadn’t realised that such a condition existed until conversations with one of Better Babies’ expert advisors and leading Harley Street gynaecologist: Mahantesh Karoshi.
He tells me that this is a real problem.
The statistics back it up:
People have become much more health conscious, and as a result, the supplement and vitamin market is booming. In fact, in the US more than 50% of non pregnant women consume a micronutrient supplement (1) that climbs to 70-90% when it comes to pregnant women consuming multivitamins and/or single nutrient supplements containing Folic Acid. (1)
Often however, when we are taking micronutrients that we may not need (particularly those that are not water soluble/can be ejected easily by the body like A, D, E and K which instead get stored in fat) we can build up excess levels that can be harmful.
Now, when it comes to pregnancy there is one thing for sure. We do need folate which is ‘crucial to development. It is beyond dispute that supplementation of the diet of women during pregnancy with multivitamins that include folic acid in order to prevent neural tube defects has been a successful public health programme.’ (2)
What is Folate/Folic Acid?
Folic Acid is the synthetic version of a B vitamin (B9) called Folate: found naturally in dark leafy green vegetables, beans, eggs, asparagus, avocado, nuts/seeds and citrus fruits. It is also worth noting that Folate is relatively fragile and does degrade during processing so fresh fruit and veg is key. Ideally eaten raw or steamed. Boiling can in fact cause the folate to swap into the water so unless you’re having a soup its best to boil or steam.
It has also been added by government initiatives to certain foods/grains like breakfast cereals. Look out for labels saying they have been ‘fortified’ with Folic Acid.
The question is: how much and in what form?
Back to Goldilocks...
As above - ensuring you have adequate intake is crucial, however, there is research suggesting that too much isn't a good idea either….
So how much is ideal?
The official recommendation is 400 micrograms (mcg) before, during pregnancy and whilst breastfeeding (3) In fact, it is important to have it in your system BEFORE pregnancy as birth defects can occur at the earliest stages and by taking it ahead of time you are reducing your risks.
Some higher risk women (when there is a family history/diabetes) to take 500 mcg but above that level is not necessary.
The tricky part however is that if you look at prenatal supplements the amounts of Folic Acid contained within can vary dramatically from 400 mcg up to 2000 mcg! (2) That is also before any food intake (particularly fortified foods). So if you’re eating a healthy balanced diet the chances are you’ll be getting more.
In fact taking too much has been linked to negative metabolic effects in animal models for both mother and offspring and even epigenetic changes (this is where your environment impacts how your genes express themselves) based excess on maternal micronutrient consumption. (1)
‘Pregnant women under adequate medical care consume 2.5 - 7 fold the RDA of several micronutrients, including folic acid and vitamins B12 and B6, and even consume beyond the upper limit for folic acid (>1000 mcg).’ (1)
The tolerable safe upper limit for Folic Acid has been suggested to be 1000 mcg/day (2) so a 400 mcg supplement plus a good diet is absolutely fine.
Next important question: what type is best?
Folate is the form that we get from foods
Folic Acid: is the man made synthetic form
Of course eating a healthy balanced diet full of vegetables is a great starting point, that being said just as too much is bad, so is too little.
So, in order to make sure you’re getting enough it is a good idea to supplement during pregnancy.
Now, Folic Acid and Folate are not entirely identical and are in fact processed differently by the body. Folate (the form from food) is metabolised in the intestines and the man-made supplement form is instead metabolised by the liver.
Why does that matter?
The issue with this is that the enzymes that make it usable by the body are at lower levels in the liver and that can lead to higher levels of unmetabolized and non-useful folic acid in the blood which has been linked to side effects in animal models (2).
So, ideally you should go for methylfolate supplements (5MTHF). This is the body’s most active form of folate (4) My personal favourite is the one made by Cytoplan. However, the first port of call if you do have any questions on which supplement suits you best is of course your doctor.
On top of this, if you have any other concerns or feel unwell/like you could be deficient in certain nutrients (vegans and vegetarians can be vulnerable to this particularly during pregnancy) you should speak to your doctor about running tests to see exactly what you are deficient in before you go and take supplements. Knowledge is power and its much better to know what you’re short of rather than applying a blanket approach.
PANNIA E, CHO CE, ANDERSON HG: Role of maternal vitamins in programming healthy and chronic disease. Nutrition Reviews. 2016 Mar: 74(3): 166-180
WIENS D, DeSOTO CM: Is High Folic Acid Intake a Risk Factor for Autism? A Review: Brain Science: 2017 Nov: 7(11): 149
RCOG: Royal College of Gynaecology and Obstetricians: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-healthy-eating-and-vitamin-supplements-in-pregnancy.pdf
This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.