Do I Need a Folic Acid Supplement? (2023)

Folic acid is a synthetic form of folate, also known as vitamin B9. Dietary supplements containing 5-MTHF, the form that's used by the body, are also available. Folate is a component of many foods, and supplementation is recommended as a treatment for health conditions that are linked to a folate deficiency. Its most common use is to promote the healthy development of the nervous system during pregnancy.

Do I Need a Folic Acid Supplement? (1)

Health Benefits

Folate was first identified in 1931 by scientist Lucy Wills who discovered that brewer's yeast, an extract high in folate, could reverse anemia during pregnancy. It was only in 1943 that scientists were able to isolate folate in its pure form, eventually synthesizing it in the lab as folic acid.

The synthesized vitamin served as the basis of the first cancer drug, aminopterin. Later, folic acid was found to prevent or treat other health conditions.

Neural Tube Defects

Folic acid is typically prescribed as a supplement during pregnancy to reduce the risk of neural tube defects. Neural tube defectsare birthdefectsof the brain, spine, or spinal cord. They develop during the first month of pregnancy, often before a woman even knows she is pregnant.

The two most commonneural tube defects are spina bifida (characterized by an undeveloped spine) and anencephaly (the absence of a major part of the brain, skull, and scalp).

Low levels of folate during pregnancy are associated with at least half of all neural tube defects. Taking 400 micrograms (mcg) of folic acid daily can reduce the risk of these defects by 50%, says the American Academy of Pediatrics.

Folic acid supplementation is considered the first-line defense against genetic birth defects like spina bifida and anencephaly.

(Video) Ask a doctor: folic acid supplements

Since 1998, folic acid has been added to cereals, baked goods, and other foods to further reduce the risk of neural tube defects. At least 80 countries have taken similar steps.

Folate Deficiency

In addition to the prevention of neural tube defects, folic acid can be used to treat folate deficiency, often caused by ulcerative colitis, liver disease,alcoholism, andkidney dialysis.

  • Folate deficiency can lead to a type of anemia known as megaloblastic anemia in which the bone marrow produces abnormal, immature red blood cells of unusually large size. Symptoms include extreme fatigue, heart palpitations, shortness of breath, open sores on the tongue, and changes in the color of the skin or hair.
  • A deficiency of folate and other B vitamins can trigger a condition known as hyperhomocysteinemiain which there is too much of the amino acid homocysteine in the blood. This can occur in people with kidney disease or genetic disorders affecting the production of 5-MTHF. Chronic hyperhomocysteinemia is linked to an increased risk of cardiovascular disease, Alzheimer's disease, recurrent miscarriage, and bone fractures in the elderly.

Taking 250 mcg to 1,000 mcg of folic acid daily can usually help reverse folate deficiency.

Folic Acid and Inflammatory Bowel Disease (IBD)

Skin and Eye Disorders

Folic acid appears to be beneficial in the treatment of vitiligo, a chronic condition characterized by the loss of skin pigmentation. According to a two-year study from Sweden, the combination of folic acid and vitamin B12 appeared to completely stop the spread of vitiligo in 64% of the study participants.

The combination of folic acid and vitamin B12 also appears to slow the progression of macular degeneration, an aging-related eye disorder characterized by progressive vision loss, according to a 2016 study from Harvard University.

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Compared to other supplements commonly used to treat macular degeneration, including thiamine (vitamin B1) and riboflavin (vitamin B2), high-dose folic acid proved most effective in slowing disease progression.

Other Benefits

Folic acid is also believed by some to be effective in preventing stroke, treating high blood pressure, and alleviating symptoms of depression.

Limited benefits may include:

  • While it is true that folic acid supplementation was shown to decrease the risk of stroke by 10-20% in poor developing countries, the same benefit was not seen in the developed world where fortification of food with folic acid is commonplace.
  • The same applies to the relationship between hypertension (high blood pressure) and folic acid. While folic acid appears to reduce blood pressure slightly with ongoing use, it has no additive effect when used with traditional (and more effective) high blood pressure medications.
  • Similarly, while depression is associated with low folate levels, the increased intake of folic acid has proven beneficial in some studies but not others, according to research from the Centers of Disease Control and Prevention.

There is no definitive evidence that it can treat Alzheimer's disease, bipolar depression, or chronic fatigue syndrome.

Potential Side Effects

Folic acid supplements are generally safe and well-toleratedwhen taken as prescribed. Doses over 1,000 mcg may cause side effects, including abdominal cramps, stomach upset, diarrhea, flatulence, taste disturbances, irritability, jitteriness, insomnia, nausea, and skin color changes.

Although rare, animal studies have shown that folic acid may cause behavior changes and seizures at very high doses.

Certain people may experience symptoms of a hypersensitive reaction, including rash, itchiness, and swelling. While rare, potentially life-threatening, whole-body reactions, called anaphylaxis, have been known to occur.

Call 911 or go to your nearest emergency room if you develop rash or hives, shortness of breath, wheezing, rapid heartbeat, dizziness, or the swelling of the face, throat, or tongue after taking a folic acid supplement.

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Prostate Cancer Risk

Because they are nearly identical in molecular structure, folic acid and folate are considered by many to be the same thing. But they aren't.

What differentiates the two is how they are used by the body.

  • Folate is converted in the digestive tract into the active form of vitamin B9, called 5-methyl-THF (5-MTHF).
  • Folic acid needs to enter the bloodstream and be delivered to the liver and other tissues to be converted into 5-MTHF. It is a slow and inefficient process and one that can leave much of folic acid unmetabolized and freely circulating in the body.

About 30-40% of the population may have an MTHFR genetic defect impairing the conversion of folic acid to active folate.

While high levels of circulating folic acid won't cause harm to most people, there have been suggestions that high concentrations may increase the risk of prostate cancer.

In terms of prostate cancer risk, men who consistently take 1,000 mcg or more of folic acid appear to be at the greatest potential risk. On the flip side, men who get enough folate in their diet are at less risk.

Despite these shortcomings, folic acid is inexpensive, non-toxic, and unlikely to cause side effects unless taken in excess.

Drug Interactions

Folic acid can reduce the effectiveness of certain drugs, including:

  • Anticonvulsants like Cerebryx (fosphenytoin), Dilantin (phenytoin), and Mysoline (primidone)
  • Barbituates like Amytal (amobarbital), Butisol (butabarbital), and Luminal (phenobarbital)
  • Methotrexate used to treat certain autoimmune disorders and cancer
  • Daraprim (pyrimethamine) used to prevent malaria

Certain drugs can interfere with the absorption of folic acid, undermining its efficacy.

(Video) How and When to Take Folic Acid

These include:

  • Acid blockers, including antacids, H2 blockers, and proton pump inhibitors
  • Aspirin
  • Azulfidine (sulfasalazine) use to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease

Separating drug and folic acid doses by two to four hours can often help prevent interactions, but it's best to talk with your healthcare provider and pharmacist for more specific advice.

Dosage and Preparation

Folic acid supplements are available over the counter in most drugstores, nutritional supplements stores, health food shops, and larger grocery stores. They can be found in capsule, tablet, soft gel cap, chewable tablet, and gummy forms.

Common doses range from 400 to 800 mcg in supplements for adults and 200 to 400 mcg in children’s multivitamins. Folic acid can be taken with food but is better absorbed on an empty stomach.

According to the Office of Dietary Supplements, only around 85% of folic acid will become available in the bloodstream if taken with food. When taken without food, nearly 100% of the folic acid will become bioavailable.

It is often recommended that you take a B-complex supplement rather than individual B vitamins. Doing so can lead to imbalances and/or mask symptoms of deficiency. Folic acid supplements, for example, can sometimes mask a potentially dangerous B12 deficiency.

5-MTHF Preparations

5-MTHF is found in many high-quality supplements. Sold under the brand names MetafolinandDeplin, a 5-MTHF supplement may be appropriate for people with liver disease or genetic disorders that impede the conversion of folic acid.

Metafolin is available OTC and there are other 5-MTHF preparations in other supplements. Deplin is a prescription drug, that contains 15mg of 5-MTHF and is approved for the treatment of depression.

(Video) Why Do You Take Folic Acid?

It is possible that taking 5-MTHF might not increase the risk of prostate cancer.

What to Look For

Vitamin supplements are not stringently regulated in the United States and can vary in quality from one brand to the next. To ensure quality and safety, choose supplements that have been tested and certified by an independent certifying body like the U.S. Pharmacopeia, ConsumerLab, or NSF International.

Other Questions

Which foods are highest in folic acid?

Generally speaking, you can get all of the folic acid you need from food, particularly now that cereals and other foods are fortified with the B vitamin. Even if you take a folic acid supplement, you can bolster your intake with the following real food options:

  • Beef liver: 215 mcg per 3-ounce serving
  • Spinach (cooked): 131 mcg per ½-cup serving
  • Black-eyed peas: 105 mcg per ½-cup serving
  • Asparagus: 89 mcg per four spears
  • Brussel sprouts: 78 mcg per ½-cup serving
  • Romaine lettuce: 64 mcg per one-cup serving
  • Avocado: 58 mcg per ½-cup serving
  • White rice (cooked): 54 mcg per ½-cup serving
  • Broccoli: 52 mcg per ½-cup serving
  • Mustard greens (cooked): 52 mcg per ½-cup serving


How do you know if you need to take folic acid? ›

It is recommended to take folic acid while you're trying for a baby (ideally for 3 months before) and during the first 12 weeks of pregnancy. The usual dose if you're trying to get pregnant and during the first 12 weeks of pregnancy is 400 micrograms, taken once a day.

How do you feel if you don't have enough folic acid? ›

Folate deficiency occurs when your body doesn't get enough folate. Symptoms include fatigue, weakness, mouth sores and neurological issues. Folate deficiency can be prevented by eating a diet rich in foods that contain folate.

Do you need to take a folic acid supplement? ›

Everyone needs folic acid. But for women who can get pregnant, it is really important! If a woman has enough folic acid in her body before she is pregnant, it can help prevent major birth defects of her baby's brain and spine. These birth defects are neural tube defects or NTDs.

Why would a doctor put you on folic acid? ›

Folic acid is used to: treat or prevent folate deficiency anaemia. help your baby's brain, skull and spinal cord develop properly in pregnancy, to avoid development problems (called neural tube defects) such as spina bifida.

What happen if you dont take folic acid? ›

If you do not have enough folic acid, your body can make abnormally large red blood cells that do not work properly. This causes folate deficiency anaemia, which can cause tiredness and other symptoms. Folic acid will help you make healthy red blood cells and improve or prevent the symptoms of anaemia.

Is folic acid and vitamin B12 the same thing? ›

Your body needs vitamin B-12, also called cobalamin, and folate, also called folic acid, to function normally. Both nutrients play important roles in creating red blood cells and making DNA and RNA to help build cells.

What happens if a woman doesn't get enough folic acid? ›

What can happen if I do not get enough folic acid during pregnancy? If you do not get enough folic acid before and during pregnancy, your baby is at higher risk for neural tube defects. Neural tube defects are serious birth defects that affect the spine, spinal cord, or brain and may cause death.

Why do you replace B12 before folate? ›

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.

Why would my folic acid be low? ›

A diet low in fresh fruits, vegetables, and fortified cereals is the main cause of folate deficiency. In addition, overcooking your food can sometimes destroy the vitamins. Folate levels in your body can become low in just a few weeks if you don't eat enough folate-rich foods.

Can I take folic acid without doctor? ›

Folic acid might also be prescribed to people with folate deficiency anaemia or to people who are taking the medication methotrexate, as it helps to reduce side effects. If you think you might not be getting enough folate in your diet, you can take over-the-counter folic acid supplements.

What happens when you start taking folic acid? ›

If you have the right level of folic acid in your body before you get pregnant, it reduces the risk of the baby developing neural tube defects by up to 70%. Neural tube defects are problems with the brain or spinal cord, including spina bifida.

How long do you need to take folic acid for? ›

It's best to take folic acid for at least 14 weeks before you become pregnant, when you're trying for a baby. You should continue taking it for at least the first 12 weeks of pregnancy. Folic acid can also be taken with: ferrous fumarate and ferrous sulphate (to treat iron deficiency anaemia)

What is side effect of folic acid? ›

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin. you're wheezing. you get tightness in the chest or throat. you have trouble breathing or talking.

What should you not take with folic acid? ›

Do not take your folic acid within 2 hours before or after taking indigestion remedies (antacids containing aluminium or magnesium), as they may stop the folic acid being properly absorbed.

What are 3 benefits of folic acid? ›

Folic acid supplements are used for:
  • Preventing neural tube defects in babies.
  • Preventing and treating anemia.
  • Preventing side effects from taking methotrexate.
  • Treating a folate deficiency.
22 Mar 2022

What fruit is good for folic acid? ›

Besides being delicious and full of flavor, citrus fruits like oranges, grapefruit, lemons, and limes are rich in folate. Just one large orange contains 55 mcg of folate, or about 14% of the DV ( 17 ).

When should I take folic acid morning or night? ›

5. When should I take Folic acid, morning or night? It is advised to consume Folic acid during the day, as it digests better. Metabolism and digestion slow down at night, making it difficult for the supplement to digest.

Is folic acid good for seniors? ›

It has been suggested and studied that folic acid is closely-linked to memory. With the majority of seniors over the age of 80 displaying some symptoms or signs of dementia, eating a balanced diet that includes the recommended daily allowance of folic acid may help prevent memory-loss, forgetfulness, and even aphasia.

What cancers cause folic acid deficiency? ›

Folic acid deficiency in humans has been linked with megaloblastic anaemia, neural tube defects in the neonate, and heart disease. Folate has also been implicated in the development of cancer, especially cancer of the colorectum.

What are the symptoms of low B12? ›

Symptoms of vitamin B12 deficiency
  • a pale yellow tinge to your skin.
  • a sore and red tongue (glossitis)
  • mouth ulcers.
  • pins and needles (paraesthesia)
  • changes in the way that you walk and move around.
  • disturbed vision.
  • irritability.
  • depression.

Is low folic acid serious? ›

Most cases of this type of anemia are easily treated. Severe effects are rare. But if you've been without folate for a long time, your risk of having some types of cancer and heart disease goes up. You might also find it harder to get pregnant.

How long does it take to recover from folic acid deficiency? ›

Folate-deficiency anemia most often responds well to treatment within 3 to 6 months. It will likely get better when the underlying cause of the deficiency is treated.

How big of a problem is folic acid deficiency? ›

Untreated folic acid deficiency can lead to megaloblastic anemia and pancytopenia. In addition, it can cause glossitis, angular stomatitis, and oral ulcers [2].

How can you tell the difference between B12 and folate deficiency? ›

Additional testing with homocysteine and MMA determinations may help distinguish between B12 and folate deficiency states. In folate deficiency, homocysteine levels are elevated and MMA levels are normal. In vitamin B12 deficiency, both homocysteine levels and MMA levels are elevated.

Can I take B12 and folic acid together? ›

Taking folic acid at high doses can hide a vitamin B12 deficiency. So these vitamins are often taken together.

Does folate help with anxiety? ›

Vitamin B9 (folic acid) and B12 (cobalamin)

Vitamins B9 and B12 are both thought to treat symptoms of anxiety. Folic acid has many uses in the body, and B9 deficiency has been linked to higher levels of anxiety and depression.

What is the difference between folate and folic acid? ›

The terms “folic acid” and “folate” often are used interchangeably. However, folate is a general term used to describe the many different forms of vitamin B9: folic acid, dihydrofolate (DHF), tetrahydrofolate (THF), 5, 10-methylenetetrahydrofolate (5, 10-MTHF), and 5-methyltetrahydrofolate (5-MTHF) 1.

Does low folic acid cause headaches? ›

Folate-deficiency anemia may develop in individuals who lack folic acid, a synthesized version of folate, in the blood. In this instance, an individual may experience migraines, along with a lack of energy, decreased appetite, pale skin and other physical symptoms.

Is there a difference between prescription folic acid and over the counter folic acid? ›

Do You Need a Prescription to Buy Folic Acid? You can buy folic acid over-the-counter (OTC) or with a prescription from your healthcare provider. Most OTC formulations contain 400 mcg to 800 mcg of folic acid per pill. Prescription folic acid is available in 1 mg tablets.

Why has my doctor prescribed me 5mg folic acid? ›

Folic acid is indicated for the treatment of megaloblastic anaemia due to folic acid deficiency. It is also used for prophylaxis in chronic haemolytic states, in renal dialysis, and in drug induced folate deficiency. Folic acid is used for the prevention of recurrence of neural tube defects.

Why would a doctor prescribe folic acid for a woman? ›

Women need extra folic acid during early pregnancy to reduce the risk of having a baby with a neural tube defect like spina bifida. Before conception and during pregnancy, a woman needs 0.4mg of folic acid daily.

Is folic acid good for hair? ›

Just as getting the right nutrients helps keep your skin and internal organs healthy, nutrients can affect your hair growth too. Folic acid (vitamin B-9), when taken regularly as recommended, is just one of the nutrients that can promote overall healthy hair.

Can you take folic acid continuously? ›

There is no upper limit (UL) established for naturally occurring folate from foods. Keep in mind that most people don't consume more than 1,000 mcg of folic acid per day unless they're taking supplements in high doses.

Does folic acid give you energy? ›

Vitamin B9, also called folate or folic acid, is one of 8 B vitamins. All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy.

Does folic acid lead to weight gain? ›

Excess folic acid intake increases weight gain and fat mass on a high fat diet. (A) Growth curves; (B) food intake; (C) fat mass; (D) lean mass; and (E) tissue weights. Values are means ± SEM, * p < 0.05. Excess folic acid intake impairs glucose tolerance on a high fat diet.

Does folic acid affect your bowels? ›

You may experience nausea, black stool, constipation, loss of appetite, bloating or flatulence (gas) in some cases. Most of these side effects of FOLIC ACID do not require medical attention and gradually resolve over time. However, if the side effects persist or worsen, please consult your doctor.

Can I drink coffee while taking folic acid? ›

What should I avoid while taking ferrous fumarate and folic acid? Certain foods can make it harder for your body to absorb this medicine. For at least 2 hours before or 2 hours after you take this medicine: Avoid drinking coffee or tea.

Does vitamin D interact with folic acid? ›

No interactions were found between folic acid and Vitamin D3.

What symptoms does folic acid help? ›

Research on use of folate and oral folic acid supplements for specific conditions shows:
  • Birth defects. Research has shown that folic acid supplements can prevent birth defects of the neural tube. ...
  • Folic acid deficiency. ...
  • Heart and blood vessel disease and stroke. ...
  • Cancer. ...
  • Depression. ...
  • Dementia.

Do eggs have folic acid? ›

According to this study, one egg (60 g) may provide 40–86 µg of folates, which corresponds to 10–22% of the recommended daily intake for adults, 400 µg according to the Nutrition Standards for the Polish Population.

Is folic acid good for skin? ›

Folic acid (folic acid vitamin), otherwise known as vitamin B9, plays a vital role in helping to maintain the skin's natural beauty. It possesses concentrations of antioxidants that work to reduce levels of oxidative stress in the skin as well as neutralize harmful free-radicals that are present in the environment.

Who should be taking folic acid? ›

CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby's brain (anencephaly) and spine (spina bifida).

What happens if you take folic acid when not pregnant? ›

Therefore, taking folic acid if you're a woman and not pregnant helps ensure you have adequate levels of folate for a developing fetus before you find out you're pregnant. Additionally, research indicates folic acid may play a preventive role in autism, type 2 diabetes and rheumatoid arthritis.

Is it OK to take folic acid when not pregnant? ›

Most women should be getting 400mg of folic acid every day, even when not pregnant. While much of the conversation focuses on ensuring a woman's body can provide essential nutrients for a fetus during pregnancy, research suggests that folic acid benefits aren't limited to fetal development.

What fruit has folic acid? ›

Many fruits contain folic acid, but citrus fruits rank highest — oranges are especially high in the vitamin. Other folate-rich fruits include grapefruit, papayas, grapes, bananas, strawberries, raspberries and cantaloupe.

Do bananas have folic acid? ›

Rich in a wide variety of vitamins and minerals, bananas are a nutritional powerhouse. They're especially high in folate and can easily help you meet your daily needs when paired with a few other folate-rich foods. A medium banana can supply 23.6 mcg of folate, or 6% of the DV ( 36 ).

How long does it take for folic acid to build up? ›

If you're planning to have a baby, it's important that you take folic acid tablets for two to three months before you conceive. This allows it to build up in your body to a level that gives the most protection to your future baby against neural tube defects, such as spina bifida.

What supplements should not be taken with folic acid? ›

Do not take your folic acid within 2 hours before or after taking indigestion remedies (antacids containing aluminium or magnesium), as they may stop the folic acid being properly absorbed.

What month Should I stop taking folic acid? ›

Folic acid before and during pregnancy

It's important to take a 400 micrograms folic acid tablet every day before you're pregnant and until you're 12 weeks pregnant. Folic acid can help prevent birth defects known as neural tube defects, including spina bifida.

What happens if you take too much folic acid? ›

But even though folic acid is important, taking too much could be problematic. Research is pointing to some possible negative effects of consuming too much folic acid, such as impaired fetal growth, increased risks of childhood diseases like asthma and autism, and promoting the growth of some cancer cells.


1. Pregnant women advised to continue taking folic acid supplements
(CBS Mornings)
2. Do I need FOLIC ACID supplements???
(AYA mama)
3. Why You Should Take Folic Acid BEFORE Pregnancy
(Nucleus Medical Media)
4. Folic Acid Is Vital To Getting Pregnant | Good Morning Britain
(Good Morning Britain)
5. Benefits of having folic acid supplements before conceiving- Dr. Nupur Sood
(Doctors' Circle World's Largest Health Platform)
6. About Folic Acid Side Effects
(ExpertVillage Leaf Group)
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