Heart Health High Blood Pressure Treatment The Health Benefits of Folate How Naturally Occurring Vitamin B9 Differs From Folic Acid By Craig O. Weber, MD Craig O. Weber, MD, is a board-certified occupational specialist who has practiced for over 36 years. Learn about our editorial process Craig O. Weber, MD Medically reviewed by Medically reviewed by Richard N. Fogoros, MD on July 12, 2019 facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. Learn about our Medical Review Board Richard N. Fogoros, MD Updated on November 25, 2020 Print Table of Contents View All Table of Contents Health Benefits Possible Side Effects Recommended Intake Other Questions Folate is a form of vitamin B9 that the body needs to maintain red and white blood cells (hematogenesis), convert carbohydrates into energy (metabolism), synthesize and maintain the genetic building blocks of the body (DNA and RNA). A daily intake of folate is also needed to maintain a healthy pregnancy, ensure normal fetal development, and prevent certain serious birth defects. Folate is naturally present in many foods, particularly dark green vegetables, beans, and legumes. There are also vitamin supplements made with a synthetic form of folate known as folic acid. In the United States and around 80 other countries, breakfast cereals, flour, bread, and other foods are fortified with folic acid to prevent folate deficiency within the general population. Verywell / Alexandra Gordon Folate vs. Folic Acid Although many people use the terms folate and folic acid interchangeably, there are key differences. Folate is immediately converted in the digestive tract into the active form of vitamin B9, called 5-methyl-THF (5-MTHF). By contrast, folic acid needs to enter the bloodstream and be delivered to the liver and other tissues to be converted. Although it was once thought that folic acid was better absorbed than folate, it is metabolized very slowly. Moreover, a lot of the folic acid you consume will remain unmetabolized and linger in the system. In recent years, there have been concerns that excessive accumulation of unmetabolized folic acid may promote tumor growth, although this has yet to be definitively proven. Generally speaking, if you consume enough folate in your diet, you won't need to take a folic acid supplement. Since the majority of folate will be quickly metabolized by the body, the likelihood of accumulation is low. Health Benefits Folate is essential to good health. If you don't get enough from your diet or folic acid supplements, you may develop a folate deficiency. Although this is rare in the United States, there are certain groups that are vulnerable, including pregnant women, infants, and younger children (whose intake may fall short due to their rapid growth). Folate deficiency can also be caused by certain medications (such as metformin, birth control pills, and methotrexate) and in people with severe bleeding, liver disease, malabsorption disorders (like celiac disease), and alcoholism. Consuming enough folate in your diet may help prevent a number of health conditions, including some cases stroke, neural tube defects, aging-related macular degeneration, and even some types of cancer. Cardiovascular Disease Folate is used by the body to maintain and repair blood vessels. It also helps lower the level of an amino acid called homocysteine that contributes to cardiovascular disease. Homocysteine is created when proteins, mainly from meat, begin to break down. High concentrations of homocysteine can cause the hardening the arteries (atherosclerosis), increasing the risk of heart attacks and stroke. A 2010 study from Japan, which followed 23,119 men and 35,611 women for 14 years, found that a higher dietary intake of folate and vitamin B12 corresponded to a lower risk of death from stroke, coronary heart disease, and heart failure. A similar study from the University of North Carolina found that young adults with the highest dietary intake of folate generally had a lower risk of high blood pressure—a key contributor to heart disease—later in life. Neural Tube Defects Neural tube defects (NDTs) are birth defects of the brain or spinal cord that typically occur during the first month of pregnancy. The two most common NDTs are spina bifida and anencephaly. Inadequate levels of folate and vitamin B12 during pregnancy are known to increase the risk of NDTs. Of the two, folate deficiency is much more common and therefore more of a concern. Because an NDT can occur before you even know that you are pregnant, it is essential that you maintain good dietary habits at all times, including the ample intake of folate. This is especially true if you in your reproductive years and are vulnerable to folate deficiency. To further reduce the risk of NDT, doctors will routinely recommend folate supplements along with a daily multivitamin during pregnancy. Other health experts will advise women of childbearing age take a daily 0.4-milligram (400-microgram) folic acid supplement. A 2016 study in the American Journal of Public Health concluded that an adequate intake of folate, either through diet, supplementation, or fortification, reduced the risk of spina bifida worldwide. According to a 2015 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, the introduction of fortified foods led to a 28 percent decrease in spina bifida cases between 1995 and 2011. Macular Degeneration Aging-related macular degeneration (AMD) is an eye disorder characterized by the progressive loss of the center of the field of vision. The underlying cause of macular AMD is not well understood, although some scientists believe that it is the result of inflammation and oxidative stresses placed on the eyes over a lifetime. Chronically elevated homocysteine may also play a part, putting into focus the role of folate in preventing AMD A 2013 study from Australia, evaluating the medical files of 1,760 adults with AMD over 10 years, concluded that folate deficiency increased the risk of early AMD by 75 percent. Moreover, an elevation in homocysteine levels correlates to a 30 percent increased risk of developing AMD. By contrast, taking 2,500 micrograms (mcg) of folic acid per day reduced the risk of AMD by 35-40 percent, according to research from Women's Antioxidant and Folic Acid Cardiovascular Study (WAFACS). Cancer Folate has a contradictory relationship with cancer. On the one hand, the chronically insufficient intake of folate may increase the risk of brain, breast, cervical, colorectal, lung, ovarian, pancreas, and prostate cancers. On the other, the excessive intake of folic acid may increase the risk of certain cancers, mainly prostate cancer. There is some evidence that the high intake of dietary folate may significantly reduce the risk of certain cancers, particularly those in women. A 2014 review of studies, including 16 clinical trials and 744,068 women, reported that the daily intake of between 153 mcg and 400 mcg of dietary folate significantly decreased the risk of breast cancer. Interestingly, a daily intake of over 400 mcg was not associated with a decreased risk when compared to women who took less than 153 mcg. Other studies have seen similar benefits with ovarian and cervical cancers. Possible Side Effects As an essential nutrient sourced from food, folate is not associated with side effects or risks. In the end, you cannot get too much folate from the foods you eat. The same cannot be said of folic acid, which may cause abdominal cramps, insomnia, nausea, diarrhea, and permanent nerve damage if overconsumed. Although dietary folate cannot interact with pharmaceutical or over-the-counter medications, certain drugs can interfere with how folate is metabolized. These include: Anticonvulsants like Dilantin (phenytoin), Tegretol (carbamazepine), or valproic acidAzulfidine (sulfasalazine), used treat ulcerative colitis and rheumatoid arthritisBirth control pillsDyrenium (triamterene), a diuretic used to treat fluid retention and high blood pressureMetformin, used control blood sugarMethotrexate, used to treat certain cancers and autoimmune diseases Recommended Intake The recommended daily allowance (RDA) of folate can vary by age and pregnancy status as follows: 0 to 6 months: 65 mcg per day7 to 12 months: 80 mcg per day1 to 3 years: 150 mcg per day4 to 8 years: 200 mcg per day9 to 13 years: 300 mcg per day14 years and over: 400 mcg per dayDuring pregnancy: 600 mcg per dayDuring lactation: 500 mcg per day Folate is naturally present in a wide variety of foods, including vegetables (especially dark green leafy vegetables), fruits, nuts, beans, peas, seafood, eggs, dairy, meat, poultry, and grains. Among the foods especially rich in folate are: Beef liver: 215 mcg per 3-ounce servingSpinach (cooked): 131 mcg per 1/2-cup servingBlack-eyed peas: 101 mcg per 1/2-cup servingBreakfast cereals (fortified): 100 mcg per 1-cup servingAsparagus: 89 mcg per 4 spearsBrussel sprouts: 78 mcg per 1/2-cup servingRomaine lettuce (shredded): 64 mcg per 1-cup servingAvocado: 59 mcg per 1/2-cup servingWhite rice (cooked): 54 mcg per 1/2-cup servingBroccoli: 52 mcg per 1/2-cup servingMustard greens (cooked): 52 mcg per 1/2 cup serving Other Questions How do you know if you have folate deficiency? Signs of folate deficiency are often subtle. Unexplained fatigue and weakness are often the first signs. It is usually only after symptoms are severe that folate deficiency anemia is diagnosed. It differentiated from other types of anemia in that the reduced red blood cell count will be accompanied by the appearance of large, misshapen, immature red blood cells called megaloblasts. Also known as megaloblastic anemia, the condition may cause a cascade of specific and non-specific symptoms, including: Shortness of breathMuscle weaknessAbnormally pale skinSwollen tongue (glossitis)Smooth and tender tongueLoss of appetiteLoss of weightNauseaDiarrheaRapid heartbeat (tachycardia)Tingling or numbness in hands and feet (peripheral neuropathy) The Health Benefits of Folic Acid Was this page helpful? Thanks for your feedback! Looking to start a diet to better manage your high blood pressure? Our nutrition guide can help. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Feng Y, Wang S, Chen R, Tong X, Wu Z, Mo X. Maternal folic acid supplementation and the risk of congenital heart defects in offspring: a meta-analysis of epidemiological observational studies. Sci Rep. 2015;5:8506. doi:10.1038/srep08506 Khan KM, Jialal I. Folic acid (folate) deficiency. In: StatPearls. Updated December 3, 2019. Obeid R, Herrmann W. The emerging role of unmetabolized folic acid in human diseases: myth or reality?. Curr Drug Metab. 2012;13(8):1184-95. doi:10.2174/138920012802850137 Xun P, Liu K, Loria CM, et al. Folate intake and incidence of hypertension among American young adults: a 20-y follow-up study. The American Journal of Clinical Nutrition. 2012;95(5):1023-1030. doi:10.3945/ajcn.111.027250 Williams J, Mai CT, Mulinare J, et al. Updated estimates of neural tube defects prevented by mandatory folic Acid fortification - United States, 1995-2011. MMWR Morb Mortal Wkly Rep. 2015;64(1):1–5. Huang P, Wang F, Sah BK, et al. Homocysteine and the risk of age-related macular degeneration: a systematic review and meta-analysis. Sci Rep. 2015;5:10585. doi:10.1038/srep10585 Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. 2009;169(4):335-41. doi:10.1001/archinternmed.2008.574 Pieroth R, Paver S, Day S, Lammersfeld C. Folate and its impact on cancer risk. Curr Nutr Rep. 2018;7(3):70–84. doi:10.1007/s13668-018-0237-y Additional Reading Atta, C.; Fiest, K.; Frolkis, A. et al. Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis. Am J Public Health. 2016 Jan;106(1):e24-34. DOI: 10.2105/AJPH.2015.302902. Chen, P.; Li, C.; Li, X. et al. Higher dietary folate intake reduces the breast cancer risk: a systematic review and meta-analysis. Br J Cancer. 2014 Apr 29;110(9):2327-38. DOI: 10.1038/bjc.2014.155. Cui, R.; Iso, H.; Date, C. et al. Dietary folate and vitamin b6 and B12 intake in relation to mortality from cardiovascular diseases: Japan collaborative cohort study. Stroke. 2010 Jun;41(6):1285-9. DOI: 10.1161/STROKEAHA.110.578906. Gopinath, B.; Flood, V.; Rochtchina, E. et al. Homocysteine, folate, vitamin B-12, and 10-y incidence of age-related macular degeneration. Am J Clin Nutr. 2013 Jul;98(1):129-35. DOI: 10.3945/ajcn.112.057091.