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Fertility Q&A – What You Need to Know About Getting Enough Folic Acid

Fertility Q&A – What You Need to Know About Getting Enough Folic Acid

Folic acid supplementation for a healthy pregnancy and babyConsuming folic acid is one of the most important things a woman can do when preparing for pregnancy. This is understood no matter what corner of the globe you stand in. Information about consuming the proper amounts of folic acid can be found in any preconception and pregnancy-health resource. But just knowing folic acid is important isn’t enough, you really should know why it is so important when preparing to get pregnant…

The Role of Folic Acid in Health

Folic acid is the common name used to refer to not only folic acid, but also to folate, folacin and vitamin B9, a critical nutrient in many metabolic processes of the body.

Folic acid/folate is required for the following:

  • the formation of DNA and the growth of new cells in all humans including a fetus
  • proper cell division
  • fetal nervous system development and preventing spina bifida
  • metabolism of amino acids
  • synthesis of SAM-e (S-adenosyl-methionine) known to support healthy emotions/moods
  • proper nervous system and brain function
  • maintenance of healthy homocysteine levels in the blood (elevated homocysteine levels may increase one’s risk of heart disease, stroke and miscarriage)
  • protection against lung, colon and cervical cancers

Folic acid is vital for preconception health and in pregnancy. “Pregnant women have an increased need for folic acid: it supports the growth of the placenta and fetus, and helps to prevent several types of birth defects, especially those of the brain and spine [neural tube],” shares Dr. Andrew Weil. According to the National Center for Complementary and Alternative Medicine at the National Institutes of Health (NCCAM), “Inadequate maternal folate status has also been associated with low infant birth weight, preterm delivery, and fetal growth retardation…”, as well as pregnancy loss, depression, and cervical dysplasia.

Women come to us regularly with questions regarding folic acid intake. We carefully chose a variety of those questions we have received and covered them below to help you understand this nutrient even more…

Fertility Q&A: Common Questions About Folic Acid

1. Q: Is folic acid the same as folate, or what is the difference?

A: Folic acid is the synthetic version of folate which naturally occurs in many whole foods. Folate is what the body uses for all of the metabolic processes within the body listed above. The body has to convert folic acid into folate before it can utilize it.

Folic acid = synthetic, added to foods and is available in supplement (pill) form
Folate = naturally occurs in food and may be available in some whole-food supplements (check label)

Processed foods are often fortified with folic acid because processing may lower the folate content and research has proven that supplementing with folic acid helps to prevent several birth defects in pregnancy.

2. Q: Which form of Folic Acid (folic acid or folate) is best when preparing for conception?

A: When it comes to preparing for conception and more importantly pregnancy, we find that, in order for a woman to meet the daily folate requirement, she should be eating a whole-food diet that includes a variety of folate rich foods in addition to taking a whole-food multivitamin that contains either folic acid or folate. Neither is better than the other, unless you have been diagnosed with the genetic defect MTHFR (see more about this in the next question) which alters the body’s ability to utilize folic acid properly.

Consuming nutrients, including folate, from whole foods is best, but there are certain times in a woman’s life that she should up her intake of folate – preconception, pregnancy and lactation. Because it can be challenging to get enough folate in the diet from food alone, we feel supplementation will help a woman ensure she is getting enough folate daily.

3. Q: What if I have MTHFR? I have been diagnosed with homozygous MTHFR gene mutation C667T. I heard that I should not supplement with folic acid, but rather folate. Is that true?

A: A MTHFR C667T (Methylenetetrahydrofolate reductase) gene defect alters the body’s ability to properly utilize and absorb folic acid and contributes to elevated homocysteine levels.

Women with MTHFR C667T should avoid consuming supplements and foods fortified with folic acid. To meet the daily folate requirement, women with MTHFR should instead eat folate rich whole foods and supplement with a whole food multivitamin that contains folate rather than folic acid.

Learn additional ways to support your body prior to pregnancy if you are a MTHFR carrier…

4. Q: How much folic acid should I be taking daily?

A: The American College of Obstetricians and Gynecologists states that the recommended dietary allowance (RDA) should be at least 400mcg (micrograms per day for non-pregnant women). Women trying to conceive, pregnant and/or lactating should take a minimum of 800mcg per day. This level of intake might be difficult for many women to achieve through diet alone, so it is suggested to take either a folic acid or folate supplement that is included in a whole food multivitamin, in addition to eating foods rich in folate.

The NCCAM suggests to start taking folic acid at least one month prior to pregnancy to build up stores within the body to meet the needs of a developing fetus when pregnancy occurs.

5. Q: I see you carry three products that contain folic acid or folate – Fertile Woman One Daily Whole food Multivitamin, Baby and Me Multivitamin (prenatal) and Fertilica Choice Antioxidants. I want to combine the Fertilica Choice Antioxidants with one of those multivitamins, but I am worried I will be taking too much folic acid. How much folic acid is too much? Also, I have MTHFR, are all of those supplements safe for me to take?

A: Great question! Research on therapeutic doses of folic acid for the treatment of cervical dysplasia and depression has shown that supplementation of folic acid at the upper limits of 5-10 milligrams daily is safe and well tolerated by the body. Though it is not recommended to take that much daily, as most people don’t need what is considered a therapeutic dose of folic acid. All of those supplements you asked about contain well below that upper limit, even when combined:

1000 micrograms (mcg) = 1 milligram (mg), so you can see that even when combining two of them, you are nowhere near that upper limit.

To answer your question about the safety of these particular supplements for women with MTHFR, Baby & Me 2TM Prenatal Multivitamin which contains folate rather than folic acid would be best. Women with MTHFR can’t utilize folic acid properly, so consuming folate is best.

Note: Folic Acid has been removed from Fertilica Choice Antioxidants since posting this Q&A.

6. Q: Why does a product contain folic acid if it is made from whole food?

A: In order for a whole-food multivitamin to meet the FDA requirements for each nutrient, individual nutrients like folic acid may start out as a USP pharmaceutical, food-grade nutrient isolate before it becomes the whole-food multivitamin you swallow. Nutrient isolates are then cultured in a base of fruits, vegetables and herbs with Lactobacillus bulgaricus, Streptococcus thermophilus and Saccharomyces cerevisiae; each is a catalyst to help the nutrient be easily identifiable and digested as a food source by the body.

7. Q: I have heard that certain substances can prevent the body from absorbing folic acid properly. What are they?

A: Excessive, or frequent consumption of the following substances lowers the body’s ability to absorb folic acid:

Talk to your healthcare provider about, or continue to research the implications of consuming any of the above while trying to conceive and in pregnancy.

8. Q: Should men also take folic acid?

A: Yes. Men wishing to increase sperm quality may want to consider eating a folate-rich diet and taking a whole-food multivitamin containing folate or folic acid. In 2008, a study was published in the peer-reviewed medical journal Human Reproduction that showed “a link between high levels of the nutrient [folic acid] in men’s diets and the genetic quality of their sperm.” While concrete conclusions were not made in this study, folic acid is a common nutrient in men’s multivitamins and may support sperm health.

Quick Recap

Folic acid and folate should be consumed by men and women preparing for pregnancy and continued by women during pregnancy and lactation for the health of her baby. You may already eat these foods, but click here to learn more about foods rich in folate. Careful though, the list will make you hungry!

Women with MTHFR should find an OB/Gyn or midwife to work with that is well educated in MTHFR gene mutation. They can help you understand how to get the right amount of folate based on your particular needs.


Dr. Christine Traxler M.D., OB/GYN
Dr. Christine Traxler M.D., OB/GYN

Dr. Traxler is a University-trained obstetrician/gynecologist, working with patients in Minnesota for over 20 years. She is a professional medical writer; having authored multiple books on pregnancy and childbirth; textbooks and coursework for medical students and other healthcare providers; and has written over 1000 articles on medical, health, and wellness topics.  Dr. Traxler attended the University of Minnesota College of Biological Sciences and University of Minnesota Medical School,  earning a degree in biochemistry with summa cum laude honors in 1981,  and receiving her Medical Doctorate degree (MD) in 1986.

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