Finicky Folate for Pregnancy

You may already have heard that you need to look for a prenatal vitamin with folate, or is it folic acid? The two terms are often used interchangeably, but there is a difference. While both are different forms of vitamin B9, folate is the naturally occurring form found in some foods. Folic Acid is the synthetic form of folate.

Converting Folate

When you consume either folate or folic acid, it undergoes changes in the digestive system, converting it into an active form of vitamin B9 before entering your bloodstream. The active form is known as 5-methyltetrahydrofolate (5-MTHF), also called methyfolate.

However, a significant portion of the population is unable to convert folic acid into B9 folate in the way that is expected. Methylfolate, on the other hand, is the biologically active form of folate. It is highly absorbable and can be used immediately, by everyone, without requiring any conversions, which is why you should look for a prenatal vitamin with methyfolate rather than folic acid. If you have a genetic mutation, particularly in the MTHFR gene, take only the natural folate and not the folic acid. Additionally, people with the MTHFR gene should avoid foods fortified with folic acid, such as cereals, commercially baked goods, processed grain foods, supermarket breads, and energy drinks with synthetic B vitamins.

Why is Folic Acid so Prevalent?

Folate plays a crucial role in fetal development, particularly in the formation of the neural tube, which eventually develops into the brain and spinal cord. Ensuring adequate folate intake before and during pregnancy can significantly reduce the risk of neural tube defects, serious birth defects of the spinal cord and the brain, most common being spina bifida.

Because folate intake before pregnancy is crucial for preventing neural tube defects, national programs worldwide began mandating the fortification of foods such as flour, rice, and cereals with chemically synthesized folic acid. Folic acid works well for this purpose because it is highly stable and significantly more cost-effective for large-scale food processing and long-term food storage compared with methyfolate under these conditions.

However, excessive folic acid intake from fortified foods and supplements, linked to a range of health issues and compounded by the presence of the MTHFR gene, have led to personalized approaches to supplementation. Methylfolate, is increasingly used in nutrition and prenatal vitamins. Many mothers prefer methyfolate, as it is a more efficient and bioavailable source of the vitamin.

Reading the Labels

DFE (dietary folate equivalent) = mcg naturally occurring folate.

If a label lists "folic acid" in parentheses after the total folate amount, it confirms that folic acid, the synthetic form of vitamin B9, has been added.

If a product’s label lists a percentage of the daily level (DV) for folate but does not show mcg of folic acid in parentheses, that means that folic acid has not been added to the product.

Foods High in Folate

The highest sources of naturally occurring folate include liver, legumes, dark leafy greens, and vegetables such as asparagus and brussels sprouts. Folate can also be found in fruits, nuts, seeds, and eggs. The RDA for folate is 600 mcg/d, though it is safe to obtain between 800-900 mcg/d from food and supplements.

Power Packed Folate

If you love liver, rejoice! Just about any liver lover will obtain significant portions of their daily needs by eating just one beef, chicken, or pork liver. The muscle meat of these animals, however, provides very little folate, which also applies to seafood.

Folate and Vegetables

If eating liver isn't your thing, vegetables are excellent sources of folate and rich in fiber, vitamins, and minerals. But overcooking vegetables can significantly reduce folate content. Steaming, microwaving, or stir-frying are the best ways to retain folate, as they use less water and involve shorter cooking times than boiling. For soups and stews, throw greens in at the end to keep the nutrients in the broth. Raw vegetables are also an excellent option, and they release folate more when chopped than when left whole. Fermentation may also increase the folate content of foods.

The following vegetables are listed from the highest content of folate per one cup serving to the lowest.

• Edamame

• Lentils

• Chickpeas

• Spinach

• Kidney Beans

• Broad Beans (Fava)

• Broccoli

• Raw Beets

• Brussels Sprouts  

• Kale

  
  

Nuts and Seeds

Nuts and seeds are good sources of folate, but not nearly as high as many leafy green vegetables, like spinach and turnip greens. They do, however, add flavor and extra folate to your diet, particularly peanuts, flax seeds, walnuts, and sunflower seeds. Throw a few on a salad or eat a small handful for a snack.

Eggs - a Folate Super-Food

Not only do eggs contain high quality proteins and vitamins, they are rich in naturally occurring methyfolate. The yolk is the main source of folate found in cooked eggs, much more than raw.

Folate and Fruits

Tropical fruits such as guava, mango, melon, or pineapple have higher folate content than most fruits, whereas peaches or apples contain lower levels.  The following list of fruits is arranged from the highest folate content per one-cup serving to the lowest. Eat what you love, aiming for higher-folate foods. Who can go wrong with a cup of mangos!

• Avocados

• Guavas

• Mangos

• Oranges

• Strawberries

• Cantaloupe Melon

• Passion fruit

• Pineapple

• Bananas

• Raspberries

• Clementines

• Apple

• Peach

For a complete list of foods rich in folate published by the USDA, click here.

Boost Your Folate With Food Combinations

Food is more enjoyable when you mix different ingredients, and folate-rich foods are easy to incorporate into breakfast, lunch, or dinner recipes. By mixing and matching these folate-rich ingredients, you can create delicious meals that are both satisfying and beneficial for your health.

• Poached eggs and avocado on toast 

• Add spinach and avocado to an omelet

• Chickpea salad with spinach and lentils 

• Bean, pea and green lentil salad 

• Hummus wrap with leafy greens

• Avocado, pumpkin/sunflower seeds and spinach salad 

• Roasted asparagus with scrambled eggs 

• Cauliflower and chickpea curry 

• Quinoa bowls topped with broccoli and asparagus

• Mango avocado salsa 

• Green smoothie: mix of avocado, mango and spinach 

• Pasta primavera loaded with vegetables

Sources

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Carboni L. (2022). Active Folate Versus Folic Acid: The Role of 5-MTHF (Methylfolate) in Human Health. Integrative medicine (Encinitas, Calif.), 21(3), 36–41.

Crider, K. S., Bailey, L. B., & Berry, R. J. (2011). Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients, 3(3), 370–384. https://doi.org/10.3390/nu3030370

Hecker, J., Layton, R., & Parker, R. W. (2025). Adverse Effects of Excessive Folic Acid Consumption and Its Implications for Individuals With the Methylenetetrahydrofolate Reductase C677T Genotype. Cureus, 17(2), e79374. https://doi.org/10.7759/cureus.79374

Jin J. (2017). Folic Acid Supplementation for Prevention of Neural Tube Defects. JAMA.;317(2):222. doi:10.1001/jama.2016.19767

March of Dimes: Neural Tube Defects. Accessed July 20, 2020.

National Institutes of Health. (2018 October 4 Published). Folate. Retrieved from Folate Fact Sheet for Health Professionals

Nierenberg, Cari. Autism Risk Linked to High Folate Levels in Pregnancy. Live Science, May 11, 2016.

Seyoum, E., and J. Selhub. 1998. Properties of food folates determined by stability and susceptibility to intestinal pteroylpolyglutamate hydrolase action. J. Nutr. 128:1956–60 

United States Department of Agriculture: National Nutrient Database for Standard ReferenceRelease 28 Nutrients: Folate, January 2016.

Wiens, D., & DeSoto, M. C. (2017). Is High Folic Acid Intake a Risk Factor for Autism?-A Review. Brain sciences, 7(11), 149. https://doi.org/10.3390/brainsci7110149