What We Do Differently About Vitamin B9: Folic Acid and Folate Explained

There are two different main types of vitamin B9: Folic acid and folate. Folic acid (chemically known as pteroylmonoglutamic acid) is the form that is only found in supplements, it is not found in foods in significant amounts. Folate (also known as levomefolic acid, L-5-MTHF, L-methylfolate and L-5-methyltetrahydrofolate) is the form that is found in foods but it can occasionally be found in certain supplements, although this is not common practice.

Folate is the main active form of vitamin B9 that can be used directly in the body, whereas folic acid needs to be converted to the active form through several processes in the body. The body doesn’t always manage to convert all the folic acid.

Studies have shown that patients taking 400micrograms of synthetic folic acid (from fortified bread) had detectable levels of unconverted folic acid in the blood (1) (2). Taking 200micrograms didn’t have this effect. 400micrograms is commonly used in multivitamins.

Higher levels of unconverted folic acid are related to lower activities of natural killer cells (3). In fact, supplementing high doses of folic acid caused a reduction in the number of and the efficacy of natural killer cells (4). The same was found in mice (5). Natural killer cells help our body get rid of cancer cells (6). This may explain why giving high doses of synthetic folic acid was related to a higher risk of cancer over a 5 year period when compared to placebo (7). The opposite association has been found between levels of the natural form of vitamin B9 (folate) and cancer whereby low levels of folate are associated with higher risk of many cancers (8).

Natural killer cells are also key in our body’s defence against viral infection (9). So, it may be the case that taking synthetic folic acid can lead to a worsened resilience towards viral infection.

The conversion of synthetic folic acid partly depends on one’s genetics (8), so some people may have worse outcomes than others from taking the same dose. Whereas it is currently understood that folate has the same activity in the body regardless of one’s genes. This is why we use the natural form of folate in the ThinkPharm Formula.

So how much do we need? Depends on who you’re asking. The UK government says 200micrograms (10), the European food safety authority says 250micrograms (11) and the US says 400micrograms (12). This is where it gets interesting. These recommendations for vitamin B9 apply to the dietary folate equivalent (DFE). Basically only 50% of folate in food is absorbed, whereas 85% or more is absorbed from a supplement (12). A dietary folate equivalent was made to account for this, meaning you only need 60% the amount you would need from food if you are taking a supplement. It’s absorbed even better on an empty stomach such that only 50% of the requirement is needed if taking the supplement without food. Other ingredients of the ThinkPharm Formula are best taken with food and most people will take vitamins with food, so we will use the 60% figure. This basically means all the multivitamins out there which state a certain content of vitamin B9, will in practice contain two-thirds extra (if taken with food) or double (if taken on an empty stomach) of the dietary folate equivalent.

Why do the supplement companies do this? Probably because they want their vitamin product labels to look good and they don’t truly care about the health of their customers. They care about making a profit and customer perception is a big part of that. They can’t be bothered to explain this difference to their customers.

Some researchers argue that the data is too conflicting to definitively conclude that unconverted folic acid causes problems (8). We would agree that more data is needed for 100% certainty. In the absence of further information, we believe that there is no harm in avoiding synthetic folic acid when we can simply use the active form which has not been shown to have the same relationship and may have a positive impact on one’s cancer risk (8) (13).

After looking at the nutritional data tables, we agree with the SACN (Scientific Advisory Committee on Nutrition) that it is difficult to get enough folate from foods alone (10). The SACN advises the UK government on nutrition and related health matters. This is why we’ve placed folate into the ThinkPharm Formula.

The form we are using is thought to be safest, because blood levels of this form are inversely correlated with cancer. It must be stated that they haven’t done trials that prove supplementing it is better than using synthetic folic acid (14). Putting only 200micrograms of folate in our supplement should eliminate any potential risk, because even when using synthetic folic acid at this dose, there is no unconverted folic acid left over and no effect on natural killer cells. This will provide 333micrograms of dietary folate equivalent, so even if we assume the US recommended amounts are correct, we only need another 67 micrograms from the diet. We think this is a very achievable intake, even without carefully selecting one’s foods. By taking the ThinkPharm Formula you should be safeguarding yourself from low vitamin B9 intake, whilst avoiding any potential problems and obtaining the benefits associated with the vitamin.

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Disclaimer: Food supplements are intended to correct nutritional deficiencies, maintain an adequate intake of certain nutrients, or to support specific physiological functions. The ThinkPharm Formula (or any other food supplement) is not a medicine and therefore cannot and does not claim to treat or prevent disease. All content on this website is for educational purposes only and does not constitute medical advice. None of the scientific studies quoted on this website qualify as proof or implication that ThinkPharm Health's supplements treat or prevent disease. Findings of scientific studies do not always represent reality. It is always difficult for scientific studies to reach accurate conclusions regarding nutrition and its relationship to diseases. Please consult your healthcare professional before making any significant changes to your diet and lifestyle. ThinkPharm Health is not liable for risks or issues associated with using or acting on information from this website.