Folate vs Folic Acid vs 5-MTHF: What You Need in Your Prenatal Vitamins

Folate vs Folic Acid vs 5-MTHF: What You Need in Your Prenatal Vitamins

6 min read

For many, Folate and Folic Acid are the first supplements you’ll hear about when you start trying to conceive, but the two terms can get confusing. These nutrients play a huge role in pregnancy and the prep for it, so here, we break down the differences and why you’ll find a combination of Folic Acid and 5-MTHF in Bird&Be’s prenatal vitamins.

What is Folate?

Folate is a water-soluble B vitamin that’s used by our bodies to make new cells (think about our body parts that make lots of new cells each day, like hair, skin and nails). Folate is the building block of DNA, the blueprint inside all our cells. It’s found in foods like eggs, dark green leafy vegetables, beans, avocados, peas, fruits like oranges and strawberries, seafood, beef liver and poultry.

Why do we need Folate?

After several large-scale studies were done in the 1980s, it was determined that adequate Folic Acid (a form of Folate—more on that in a sec) intake for women and people with eggs helps to decrease the risk of Neural Tube Defects (NTDs) in their babies. NTDs are severe defects of the brain and spinal cord, and they occur when the neural tube does not properly close in the baby’s early development. Getting enough Folate before and during early pregnancy has been found to effectively decrease the risk of NTDs. 

It’s so important, in fact, that our foods (grains) are now fortified with Folate to ensure anyone of reproductive age has more Folate in their diet; this is considered one of the most successful public health initiatives of our time. Many countries have reported significant declines in NTDs since food-fortification programs began in the late 1990s.

In other good news, Folate has also been shown to reduce the risk of preterm birth. It’s critical for DNA replication and repair, and even lowers the risk of blood clots, cardiovascular disease and dementia. 

Why is Folate important BEFORE Pregnancy?

In the United States, up to 35 percent of all pregnancies are not planned. Given that the neural tube closes early in the embryo’s development (within a month of conception), it’s recommended that people with eggs should be  supplementing with Folate/Folic Acid before becoming pregnant, hence the common recommendation of taking prenatals (emphasis on the “pre”) at least two to three months before you start trying to conceive.

What’s the difference between Folate vs Folic Acid?

Often the words Folate and Folic Acid are interchanged, but they’re not actually the same. Folate is a banner term that includes naturally present Folate in whole foods as well as Folate (synthetic or otherwise) found in supplements and fortified foods. Folic Acid is a synthetic form of Folate, found to be more stable for adding to food and some supplements and generally easier to absorb. But, Folic Acid isn’t an active form—your body needs to convert it in a multi-step process.

What is 5-methyltetrahydrofolate (5-MTHF)?

5-MTHF is a naturally occurring form of Folate and is super well-absorbed by the body. When we ingest Folate (either from whole foods or via supplements/fortified foods with Folic Acid), our body needs to do some work to metabolize it into a usable form, which is called L-methyltetrahydrofolate or 5-MTHF. So by taking Folate in a highly bioavailable form (5-MTHF), your body has to do less work converting it. Think of it like skipping ahead on the assembly line right to the final stage. 5-MTHF is already converted and ready for use, so we’ve made sure to include it in our prenatal vitamins, too.

What is the MTHFR gene mutation?

The MTHFR gene instructs your body to make the MTHFR enzyme, which is what your body uses to process Folate to its final form of 5-MTHF. By the way, MTHFR stands for Methylenetetrahydrofolate Reductase. There are many types of MTHFR gene variants, and they’re actually very common (most people in the U.S. likely have a variant). Some variants (sometimes called mutations) decrease the ability of the enzyme to process Folate. 

We all have two sets of genes: one inherited from the sperm and the other from the egg. As you might expect, having two MTHFR mutations (referred to as homozygous) impacts the ability to create that essential enzyme. To overcome this potential enzyme deficiency, and knowing how critical Folate is for a healthy pregnancy, Bird&Be prenatals have 1 mg (1,000 mcg) DFE (Dietary Folate Equivalent—see below for more details) of 5-MTHF, the biologically active final form.

What is DFE?

To further break down the complicated world of Folate, as of January 2021, health authorities are now measuring Folate requirements in DFE (Dietary Folate Equivalent) to reflect the higher bioavailability of supplemental Folate, meaning that the Folate in supplements/fortified foods is more potent than the natural Folate found in whole foods. The body actually has an easier time absorbing Folate from Folic Acid or 5-MTHF than the Folate in whole foods, so Folic Acid and Folate supplements are measured as having a higher amount of DFE than actual micrograms.

  • 1,000 mcg food Folate = 1,000 mcg DFE (Dietary Folate Equivalent)
  • 667 mcg of Folic Acid or 5-MTHF in fortified foods or supplements consumed with food = 1,000 mcg DFE
  • 1,000 mcg of Folic Acid or 5-MTHF in fortified foods or supplements consumed with food = 1,670 mcg DFE
  • 1,000 mcg Folic Acid/5-MTHF from dietary supplements taken on an empty stomach = 1,500 mcg DFE (though we do not recommend taking supplements without having first consumed a meal)

It’s important to note that the amount of DFE in the Folate is reduced if you don’t eat your supplements with food. Plus, prenatals on an empty stomach are a recipe for nausea, so make sure you take your vitamins after a meal.

Why do we need Folic Acid in prenatal vitamins?

Governing health authorities in Canada and the United States recommend that all reproductive-aged women and people with eggs take at least 0.4 mg (400 mcg) of DFE via Folic Acid daily for at least two to three months prior to conception, and then increase to 0.6 mg (600 mcg DFE) during pregnancy to  ensure the body has adequate folate stores. All studies done to support this recommendation and the food-fortification movement were done with Folic Acid. Because of this, many doctors support the use of Folic Acid specifically before and during pregnancy. Our prenatals have 400 mcg of Folic Acid (equivalent to 668) mcg of DFE—see the conversion above), meeting the base requirement of Folic Acid set out by the CDC and Health Canada. 

Given that the complementary medicine community also throws a lot of weight and support behind 5-MTHF, we’ve ensured Bird&Be supplements have enough of both forms of Folate, while still remaining under the daily upper limit. That means you get the best of both worlds. Combining medical and naturopathic approaches is a pillar of our values at Bird&Be.

Why do Bird&Be prenatals include Folic Acid AND 5-MTHF?

Only Folic Acid has been proven to prevent NTDs (Neural Tube Defects) in large scale clinical studies, so everyone should be on the minimum amount set out by the  CDC and Health Canada, and many OBGYNs will agree. However, for those that may not process Folic Acid effectively, and given that many people do not know their gene status, we’ve ensured that we provide more than enough of the active form 5-MTHF as well, so you’re covered from both sources, and are still within the standard dose of 1,000 mcg of Folate per day total (or 1,670 mcg DFE).

Do those with MTHFR mutations risk having too much unmetabolized Folate in their systems?

Even with MTHFR variations or mutations, you’re still able to process some Folic Acid into 5-MTHF. However, that conversion is reduced if you can’t process it super effectively, which is why we still have 600 mcg (or 1,000 mcg DFE) of 5-MTHF in our formulas. So even if your body doesn’t process the Folic Acid as effectively as others, you won’t get too much from our formulas to cause any health concerns, and we’ve made sure there is more than enough to support your body and baby during pregnancy.