Why Your Prenatal Folic Acid Might Not Be Enough…

by Jess Sherman, Registered Holistic Nutritionist

Every woman of child bearing age is generally told to take 400mcg of folic acid daily.  Current government recommendations still hold that a deficiency of folic acid during pregnancy can lead to neural tube defects such as spina bifida in babies.

While research still does support the need for adequate folic acid levels during pregnancy, new research is revealing that folic acid supplements might not be sufficient for 20-50% of us, and that there might be a better way to protect the health of your baby. 

What Folic Acid Is and Why You Need It…

Folate, also known as B9, is involved in just about every process in the body; it’s very important that we get enough of it.  “Folic acid” and “folate” are blanket terms, often used interchangeably, to refer to various forms of B9, though they are not identical.  The folic acid and folate found in many prenatal vitamins is typically a synthetic version of the type of B9 we get from food.  B9 deficiency in utero and in early childhood has been linked to many health issues including neural tube defects, poor growth, neurological problems and anemia.

Why Your Prenatal Folic Acid Might Not Be Enough…

As mentioned above, there are various forms of B9, each slightly unique in make-up.  For B9 to actually be used by the body, it needs to be in a form called MethyleneTetraHydroFolate (or MTHF).  The body goes through several processes to convert raw material into MTHF and requires several enzymes to do so. 

A particular genetic mutation has been discovered that leads to a reduced ability to complete this conversion; it is called the MTHFR genetic mutation.  People who have this mutation lack a particular enzyme, called methylenetetrahydrofolate reducatse, which is a key player in the conversion process. 

Depending on the particular polymorphism, people with MTHFR mutation seem to convert at about 30%-70% efficiency.  So basically, this means if you are taking folic acid and eating a folate-rich diet and have an MTHFR mutation, you are only able to convert about 30-70% of what you are ingesting into a form that is usable by your body. This can quickly lead to a folate deficiency.

It is estimated that about 20-50% of us have some form of this genetic mutation.  It can be detected by a simple test.

There are 3 issues here of concern for pregnant women. 

First of all, you might not be taking enough folic acid if you are converting poorly.  The recognized amount to avoid birth defects is 400mcg a day, which is what you will find in a typical prenatal vitamin.  If you are absorbing 50% of of that because you have an undiagnosed MTHFR mutation, you are not getting enough.

Second, a person who is not converting folic acid well will have a lot of it circulating in the blood because it is not getting into the cells where it can be used.  There is some concern about what happens to this circulating folic acid.  Some people think it gets excreted along with other water soluble vitamins, some are raising questions about its possible connection to cancer.  We still need to know more about this.

Third, circulating folic acid can block folate receptor sites blocking your ability to absorb the folate you are getting from your food.  So this means that if you have an MTHFR variant and are unaware of it, and you take synthetic folic acid, you might actually be blocking your ability to absorb folate from your food.


So what’s a pregnant mom to do?  Here’s what I recommend:

  • If you have a family history of miscarriage, neural tube defects, depression, chronic fatigue, autism, infertility, anxiety, thyroid problems or anemia, consider getting an MTHFR test. These issues can indicate a reduced ability to properly metabolize folate.  You can ask your doctor for a simple test.
  • Check your prenatal vitamin. Look for one that contains a more usable, methylated form of folic acid like L-methlyfolate, or L-methyltetrahydrofolate. There is a nice write-up about the different supplemental forms of folate here.  Be aware, however, that some people can experience side effects from methylated folate because it stimulates the methylation process so effectively.  If you feel effects such as irritability, insomnia, sore muscles, anxiety, heart palpitations, nausea, headaches or dry mouth, taking electrolytes has been shown to counter the effects, though I would recommend you talk to your doctor about this approach first.  You’ll need to find a doctor who understands MTHFR.   
  • Make sure your diet is full of green vegetables, sunflower seeds, liver, leeks and peppers, which are good sources of natural folate. Also understand that there are many cofactors needed for the metabolism of B9.  A diverse, whole food diet will supply these in ample amounts.








Gilbody S, Lewis S, Lightfoot T. Methylenetetrahydrofolate reductase (MTHFR) genetic polymorphisms and psychiatric disorders: a HuGE review. Am J Epidemiol. 2007 Jan;165(1:1-13/Epub 2006 Oct 30


Wu K et al. A randomized trial on folic acid supplementation and risk of recurrent colorectal adenoma. Am J Clin Nutr. 2009 Dec;90(6):1623-31.


Lee JE et al. Folate intake and risk of colorectal cancer and adenoma: modification by time. Am J Clin Nutr. 2011 Apr;93(4):817-25.


Vollset SE et al. Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50,000 individuals. Lancet. 2013 Mar 23;381(19871):1029-36.











About the Author

Jess Sherman is a Board Certified Registered Holistic Nutritionist and mother of three.  She teaches parents how to feed their kids… without losing their minds in the process. 

She is a Registered Holistic Nutritionist, Board Certified in Practical Holistic Nutrition (CAHN-pro).  She teaches parents what they need to know about how food impacts behaviour, learning and development, and helps them feed their kids and themselves real food without losing their minds in the process. You can learn more about Jess and her work by visiting http://jesssherman.com/. You can also connect with Jess onFacebook:https://www.facebook.com/jessshermanRHN  and Twitter:https://twitter.com/jessshermanRHN


Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of  the International Maternity and Parenting Institute.


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