As a medical professional in the 90s, folic acid supplementation was drilled into our heads for preventing spina bifida and midline defects.
But read this quote carefully:
Just about every pregnant woman is told to supplement with SYNTHETIC folic acid rather than the natural form folate. This is alarming and is impacting the health of the generation of children being born right now. ~Sarah Pope
Difficulty breaking down synthetic folic acid affects approximately 40% of women. They carry gene variants that can hinder the last step of the conversion needed to break down synthetic folic acid common in processed foods, boxed cereals, and supplements.
Its presence in the modern diet is likely contributing to many of our modern diseases.
Are We Folic Acid Blind?
Human exposure to folic acid was non-existent until its chemical synthesis in 1943, and was made a mandatory food fortification in 1998. (4) Reducing spina bifida (midline defects) was the good intention behind adding it to food.
While the incidence of neural tube defects (NTDs) in the United States been significantly reduced since folic acid fortification began, there has been concern about the safety of daily intake of high levels of folic acid from fortified foods.
Folic Acid: the Good, the Bad, and the Ugly
Why it was considered good:
- it’s highly stable added into cereal, juice, vitamins, flour, and other supplements
- it’s better at entering your intestinal cells than natural Folate, but this is where the folic acid’s benefits end
Why is the synthetic form of Folic Acid Bad?
Cara Comini (on the Healthy Home Economist) says it best:
“Many people are taught that taking an excess of water-soluble B vitamins isn’t a bad thing. This is because it will just be excreted in the urine if not needed. This is not the case with folic acid. If a person cannot process folic acid into usable folate, the folic acid ends up in the bloodstream where it hogs the receptor sites on cells where folate is needed (source).”
When unusable folic acid takes up the receptor sites where real folate is needed, a folate deficiency occurs and the following can happen:
- neural tube defects
- repeated miscarriages
- tongue tie and other midline defects
- growth problems
- thyroid problems
- nervousness and anxiety (when folate is started, these often go away)
- alarming associations between supplemental folic acid during pregnancy and asthma  and respiratory tract infections in children. 
And the Ugly
- women who take multivitamins containing folic acid increase their breast cancer  risk of death by 20-30%.
- folic acid supplementation was associated with an increased prevalence of colon cancer. (7, 8)
- daily supplementation with 1 mg of folic acid was associated with an increased risk of prostate cancer. (9)
- The presence of unmetabolized folic acid in the blood is associated with decreased natural killer cytotoxicity. (10) Natural killer cells play a role in tumor cell destruction.
- Taking too much folic acid while pregnant may put daughters at risk of diabetes and obesity .
- folic acid in excess of 400 mcgs/day among older adults caused significantly faster rate of cognitive decline. (12)
Why Correct Folate Supplementation Matters
Most common prenatal supplements have folic acid, but those with the common MTHFR gene variant need a high quality prenatal with the natural methylated form.
Even if you do NOT have the gene variant, you may simply be getting too much with all the other foods that are supplemented.
Dosage to Get Enough Natural Folate
Chris Kresser states, “If you’re pregnant or trying to get pregnant, I recommend a prenatal with 600-800 mcg of natural folate per day, depending on your dietary intake. All other people, such as men and older women, do not need to supplement and should be able to get plenty of folate in a diet with adequate vegetable consumption.”
Folate is found naturally in Spinach, Romaine lettuce, asparagus, turnip, collard and mustard greens, parsley, broccoli, cauliflower, beets, and lentils.
Protect Your Family
Cara Comini recommends these simple steps for your family:
- Toss any fortified food in your house. Now!
- Toss any supplement containing folic acid.
- If you feel that you need to supplement with folate, choose a supplement with real folate or methylfolate (I take this one and I give my kids this one – I see lowered anxiety in myself with it, as well as increase in focus and energy.
- Read labels of all supplements for folic acid and avoid.
- Consider getting tested for MTHFR gene mutation so that you know how toxic folic acid really is for you.
- Learn more about supplementing with bioavailable folate (you can learn more here). Some people who have been consuming folic acid need to replenish their stores.
“True healthcare reform starts in your own kitchen, not in Washington.” ~Anonymous