When Did Folic Acid Become Controversial?

Another day, another safe substance deemed dangerous. If you haven't heard, wellness influencers and natural supplement companies have been questioning the safety and efficacy of folic acid.

Folic acid has been recommended by public health authorities for more than three decades because it has been proven to reduce the risk of neural tube defects, which are serious congenital malformations of the brain and spinal cord. It's a key part of most prenatal vitamins and if prenatals make you queasy, doctors will sometimes recommend taking folic acid on its own to ensure the health of your baby.

To find out what's really going on, we turned to Dr. Prati Sharma, a reproductive endocrinologist, fertility specialist and a medical advisor at Bird&Be, a prenatal and fertility supplement company.

Why the sudden fear around folic acid?

The rhetoric in wellness circles online is that folic acid is synthetic and therefore bad. Dr. Sharma says that it's "painted as inferior to methylated folate–often marketed as the bioavailable, body-ready form of folate. This conversation is mainly taking place among wellness influencers and prenatal brands marketing themselves as ‘clean’ alternatives to supplements that include folic acid."

Synthetic or not, most research points to the fact that folic acid is still the only clinically proven form of folate to prevent neural tube defects, says Dr. Sharma.

The questions about folic acid aren't totally unwarranted, though. While not dangerous, there are some instances where the nutrient may not do its job. "Up to 60 percent of women have a genetic variant (MTHFR) that can sometimes reduce the efficacy of the body’s conversion of folic acid into the active form of folate (5-MTHF), which is required to build DNA and RNA, produce red blood cells, and support neural tube development," says Dr. Sharma. "Because of this, there have been concerns that women are not getting the full protection folic acid is supposed to provide."

In these cases, pregnant people are encouraged to take a hybrid approach and take both folic acid and methylated folate. "It is important to note that MTHFR gene variants are very common and they do not prevent folic acid from being absorbed," reinforces Dr. Sharma. Bird&Be's Complete Prenatal Pack includes both ingredients.

How do you know if you have the genetic variant? Most people don't and most of the time, it doesn't cause any issues, so taking folic acid and methylated folate can help cover your bases. But be sure to speak with your doctor before taking any supplements for your pregnancy.

Why is it dangerous to skip folic acid when pregnant?

"Folic acid is the one ingredient that’s proven to be critical in prenatal vitamins to prevent birth defects and support healthy fetal development—with decades of research to back this up. Removing folic acid altogether could cause dangerous complications for pregnancies like neural tube defects, Spina bifida, Anencephaly, or Encephalocele," says Dr. Sharma.

Does every pregnant person need to take folic acid?

While we can get lots of nutrients from food alone, Dr. Sharma says that it's not recommended to rely on diet for folic acid. "Even a folate-rich diet may not provide enough to fully prevent neural tube defects." It's suggested that pregnant women take 400 mcg of folic acid daily to support neural tube development.

How does folic acid prevent neural tube defects?

"Folic acid prevents neural tube defects by providing the developing embryo with the nutrients it needs for rapid cell division, DNA and RNA synthesis, and proper tissue formation," says Dr. Sharma. These processes happen very early, often before a pregnancy test is taken, so it can make sense to start taking a supplement when you're trying to conceive.

"Folic acid also supports methylation, a key process for gene regulation and neural development, and helps form red blood cells that supply oxygen to the developing embryo. These functions ensure the neural tube closes properly, reducing the risk of serious birth defects like spina bifida and anencephaly," says Dr. Sharma.

The bottom line

It's important to take notice when a well-known, highly-recommended substance is being questioned, but don't automatically write it off. Check product recalls, look at official health reports from Health Canada and the U.S. Food & Drug Administration and talk to your doctor.