Drugs & treatments

Folic acid or folates: do you know the differences?

May 30, 2019

Both are included in the list of group B vitamins, also known as vitamin B9. However, while folates are bioavailable elements and are found in food, folic acid is a synthetic molecule found in vitamin supplements. We talked about the difference between folic acid and folates with Dr. Maria Rosaria Parisen Toldin, fertility gynecologist at Humanitas.

 

What is folic acid?

Folic acid is the most stable and biologically active form of vitamin B9, of which the body needs more during the earliest stage of pregnancy, from conception. The intake of folic acid before the conception reduces by up to 70% the risk that the fetus develops a defect in the neural tube. Scientific evidence has shown that folic acid deficiency is one of the main risk factors for the development of congenital malformations and, in particular, neural tube defects, such as lack of brain development or extroversion of the spinal cord, also known as spina bifida. Pregnant women therefore have a greater need for folic acid, which is usually prescribed in the form of supplements.

 

How and where to find folates?

Folates are contained in abundance of some foods. Especially in vegetables such as artichokes, broccoli, asparagus, spinach, lettuce and legumes, such as beans and chickpeas, but also and in some fruits including oranges, strawberries and dried fruits. Folates, however, have a reduced bioavailability.

If consumed at room temperature, fresh vegetables can lose up to 70% of their folate content in three days. In the cooking process you can also lose up to 95%. Also for this reason it is essential to use supplements of folic acid that, almost completely absorbed in the intestine, ensure the correct need.

 

Preparing for conception with folic acid

Many embryonic structures, in particular the neural tube, conclude their development in the first month of gestation. For effective prevention, it is essential that the woman starts taking 0.4 mg of folic acid per day from the moment she plans to become pregnant. According to the “Official Recommendation for the Prevention of Congenital Defects”, it is necessary to intervene at least 1 month before conception and for the entire period in which the pregnancy is being sought up to the 3rd month of gestation. For women at risk (who have had previous abortions or suffer from celiac disease or malabsorption), a higher dose of 4-5 mg per day is recommended. The maximum tolerable intake level of 1 mg per day of total folates (natural folates and folic acid) was defined in 2000 by the Scientific Committee on Food of the European Commission, on the basis of the risk of progression of neurological symptoms caused by the masking of hematological signs of vitamin B12 deficiency.

 

What to know about Folic acid supplements,

Dr. Parisen gives some guidance on taking folic acid supplements by answering some questions.

How much?

“Many studies have confirmed that a dose between 400 and 800 mcg/day prevents neural tube defects. No study has shown that a dose higher than 1 mg/day leads to a further reduction – said the specialist -. Taking a higher dose of up to 4-5 mg/day is recommended only in women at risk (with previous pregnancies with neural tube defects or repeated miscarriages, suffering from diabetes, celiac disease or other pathologies from malabsorption or taking antiepileptic drugs or antagonists of folic acid)”.

When?

“In theory, it is ideal to take folic acid for all fertile women or, in any case, when they decide to look for a pregnancy, because the closure of the neural tube takes place approximately 6 weeks after implantation (between the 17th and 29th day of conception) – added the doctor -. The ideal is 2-3 months before conception”.

Costs?

“Folic acid is prescribed free of charge”.

Are there any risks associated with excessive doses?

“Women of childbearing age should be cautious and should not exceed the recommended daily dosage, as there is much clinical evidence to confirm that excessive intake of folic acid can lead to changes in the neurological development of the fetus – concluded Parien -. The actual damage is not known. Further studies are needed to determine the most effective dose of folic acid, the daily threshold limit of intake of folic acid and the ideal period of preventive supplementation for optimal neurological development”.

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