Okay this is a little bit of a technical post, so scroll down to the ‘So what does this mean for you?’ part if you want to skip the first bit.
Folic acid is a B vitamin (B9) that is known to be necessary in early pregnancy. Folic acid is actually the synthetic form of folate, which in turn is naturally occurring and mainly found in green vegetables, beans, and lentils. Folic acid supplements are recommended to be taken when trying to conceive and during the first trimester of pregnancy, to prevent neural tube defects in the baby, such as spina bifida and anencephaly. Some research also suggests that folate plays a role in preventing congenital heart disease and oral clefts in the baby, as well as reducing the risk of preterm birth.
Folate has a much bigger role in our bodies that just preventing spina bifida though. It is responsible activating, making and repairing our DNA. It is also in charge of cell division, blood cell production and the conversion of homocysteine; a protein that if it begins to build up in our bodies is associated with cardiac disease, as well as Alzheimer’s.
So, to say the least, folate is crucial for our body and for a baby’s development. During pregnancy your body’s need for folate increases significantly, and therefore it is sometimes difficult to obtain sufficient amounts of it just through food.
To make things more difficult, there are some people that carry certain genetic variations that make it difficult to break down folic acid. There has been a lot of research lately on a process called methylation of folate, which is the active form of folate that our body can use. In basic terms this refers to the digestion or break down of folic acid and folate in our liver. Research has found that due to certain genetic variations (such as MTHFR), that are thought to affect up to 50% of the population, not everyone can digest folic acid, or sometimes even folate. Furthermore, these undigested folic acid molecules appear to overwhelm the liver’s detoxification capacity, which further blocks the absorption of folate and folic acid. This means that if you have a genetic variation (and there are many different ones) you may get little or no benefit from the folic acid supplement.
In certain countries (the UK not being one of them) women who have a history of multiple miscarriages are tested for variations of this gene, as these can have a direct effect on the development of spina bifida.
So what does this mean for you?
There is a type of folic acid that is pre-digested, called Methylfolate, or 5-MTHF. This is the most available, active forms of folate that is ready for immediate absorption and use in the body. Because most of us don’t know if we have a genetic variation that makes it difficult to digest folic acid or folate, it is worth supplementing with methylfolate just in case. The dosage would equal that recommended for folic acid, which is currently 400-800mcg (or 0.4 – 0.8mg) for women trying to conceive or in early pregnancy. In addition to this, remember to continue eating a diet high in folate (mainly in green veggies) to ensure you obtain enough of this important vitamin.
You may find it difficult to find this in some of the more popular pregnancy supplements, as not only is this relatively recent research and many of the supplements companies have not yet changed their formulations, it also is more expensive to add folate or methylfolate to multivitamins than folic acid. This is, however, a hot topic in the world of nutrition, and I expect in the coming years we will begin to see more and more pregnancy multivitamins stating that they use methylfolate instead of folic acid.
If you’d rather know whether you carry these genetic variations rather than just switching supplements, you can organise to have a blood test done privately, and then use an online program to interpret the results of your genes, and how this may affect your absorption of folate or folic acid. But I think the latter is much more complicated than just doing some research on supplements!
So in conclusion, look out for a supplement or pregnancy multivitamins that contains methylfolate, 5-MTHF, or 5-Methyltetrahydrofolate, instead of folic acid. It is important that even if you are just beginning to think about trying to conceive, you start taking this supplement straight away, as this nutrient is most important in the first weeks of pregnancy, often even before you know you are pregnant. It also takes a few weeks for the folate in your blood to reach optimum levels to prevent neural tube defects.
Below are some links to further research if you are interested in reading more into this topic.
Multivitamin Supplementation During Pregnancy: Emphasis on Folic Acid andl-Methylfolate
Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention
Prevention of Neural-Tube Defects with Periconceptional Folic Acid, Methylfolate, or Multivitamins?