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Are you considering supplementing with folic acid? When choosing a dietary supplement, pay attention to what form of folate does the preparation contain – active or “traditional” folic acid? Find out what the scientific research says about it.
Folic acid – everything you need to know
Folic acid, also known as vitamin B9, B11, folate and folate, is one of the vitamins that has always aroused great interest among scientists. No wonder – it is an extremely important component that plays many important functions in our body.
The main source of folic acid and its derivatives in the diet for humans is undoubtedly food, although small amounts of vitamin B9 are also synthesized in the intestinal microflora. Natural plant and animal sources rich in folic acid include green leafy vegetables, broad beans, beets, nuts, cereals, liver, yeast, eggs. [1]
Unfortunately – as many studies show, the average Polish woman does not consume an adequate amount of folic acid. Folates, like other B vitamins, are very sensitive to high temperatures when baking, cooking or heating in a microwave oven. During the heat treatment, there is a significant loss of folate (they can even reach 70%), and consequently a decrease in the nutritional value of the meal. Moreover, improper storage of these products can also oxidize folate to less digestible form.
Functional disorders and inflammation of our digestive tract, taking anti-inflammatory drugs, antiepileptic drugs and contraceptives that may impair the absorption of folic acid are also important. In addition, the nutritional status of vitamins B9 and C, iron and zinc is of great importance for the absorption of vitamin B12. [2] [3]
Folic acid in pregnancy and reproductive age – why is acid supplementation so important?
Adequate supplementation in the peri-conception period and in the first weeks after conception is particularly important – especially since the woman is often unaware that she is pregnant. Already in the 80s it was shown that low maternal folate levels increased the risk of central nervous system defects in a child. It was these studies that initiated the creation of campaigns and preventive programs around the world that aimed to popularize the consumption of an adequate amount of folic acid by all women of reproductive age. [4]
Adequate intake of folic acid is crucial for the proper development of pregnancy, taking part in the proper development of the fetus by supporting cell growth and division, and repairing DNA. Folic acid and folate also reduce the risk of premature birth, low birth weight, and neural tube defects, cleft lip and palate.
It is these defects that can develop in the early stages of pregnancy, and when the neural tube does not form properly, it prevents the baby’s brain and spinal cord from developing properly. [5] Folic acid is also necessary for the formation of red blood cells and the proper metabolism of homocysteine - a metabolite which, if present in too large amounts, can have a detrimental effect on our body.
Why is not all folic acid the same? Traditional folic acid vs XNUMXth generation folic acid
Folic acid, which we take with food or some dietary supplements, is not an active form. Before folic acid or food folate can be used by our body, it must be converted into a bioactive form known as 5-methyltetrahydrofolate (5-MTHF). It is a multi-step process controlled by specific enzymes in our body, the most important of which is methylenetetrahydrofolate reductase – MTHFR. It is this enzyme that is responsible for the final stage of conversion of both forms of folate into reduced bioactive 5-MTHF.
Recent research from the last decade shows that not everyone can convert folate into active folate in the same way – meaning taking folate-containing supplements may be less effective for some people, even at very high doses.
Research conducted in Poland has shown that even every second woman may improperly absorb folic acid, and the cause is a mutation of the gene responsible for the synthesis of MTHFR. This defect leads to a reduced activity of the MTHFR enzyme, which reduces the efficiency of converting folic acid into an active, ready-to-use form. [6]
This is where the active folates come into play, bypassing the action of this enzyme. Generation IV folic acid does not undergo the same conversion process as folic acid, effectively bypassing this genetic variation. Generation IV folic acid is considered a kind of “ready” folate – the body can use it immediately, without any changes. What’s more, the 7th generation folic acid has one more advantage – it is very well absorbed even when the pH of the gastrointestinal tract is changed. [XNUMX]
What to consider when choosing folic acid?
If you are not sure if you are properly assimilating folic acid, you should consider taking dietary supplements containing not only “classic” folic acid, but also ready-to-use, highly absorbable, active folic acid of the newest generation (the so-called 5-MTHF folate). Give yourself and your child a “double” protection.
Folic acid supplementation – the latest recommendations of Polish experts
According to the recommendations of experts, every expectant mother, as well as all women of childbearing age who can potentially become pregnant, should additionally take folate. As you can read in the 2020 recommendations of the Polish Society of Gynecologists and Obstetricians on supplementation in pregnant women:
“According to the current knowledge, it is recommended for all women of reproductive age to use folic acid at a dose of 0,4 mg / d in the form of supplements, as a supplement to the natural diet rich in folates” [8]
In women in the first trimester of pregnancy, up to week 12, it is recommended to use folic acid in a dose of 0,4-0,8 mg per day, and after 12 weeks and during breastfeeding – 0,6-0,8 mg per day. However, there are groups of women who should supplement folic acid in higher doses.
Higher doses of folic acid are used in women who have had a baby with a neural tube defect or who are at increased risk of folate deficiency and neural tube defects. These are, among others, patients:
- suffering from type I or II diabetes before pregnancy,
- taking antiepileptic drugs, methotrexate, cholestyramine, metformin, sulfasalazine during pregnancy or before pregnancy,
- using stimulants,
- with renal or hepatic insufficiency,
- with a BMI over 30,
- after bariatric surgeries or with gastrointestinal diseases resulting in malabsorption. [9]
However, we should remember that the doctor should always decide about the dose of folic acid.