Folate and Folic Acid
Folate is needed to make healthy blood cells and DNA. It matters most before and in early pregnancy, when enough folic acid prevents many spina bifida cases.
Pregnancy: the key facts
- Take a folic acid supplement (at least 400 micrograms a day) from at least 1 month before conception until 3 months into pregnancy.
- A higher dose (usually 5 mg) is advised for some people, such as those with a previous pregnancy affected by a neural tube defect, diabetes, obesity or some epilepsy medicines. Ask your GP.
- Since September 2009, flour for bread in Australia has had folic acid added. Neural tube defects fell 14% overall, almost 55% in babies of teenage mothers, and 74% in babies of Aboriginal and Torres Strait Islander mothers.
Who’s at risk of deficiency
- Poor diet, especially low in vegetables and legumes
- Heavy alcohol use
- Coeliac disease and other absorption problems
- Pregnancy and breastfeeding
- Some medicines: methotrexate, some epilepsy medicines (phenytoin, carbamazepine, valproate) and sulfasalazine
Symptoms
- Tiredness, weakness and breathlessness from anaemia (large red blood cells)
- Mouth ulcers, a sore tongue, poor concentration, palpitations
Tests and treatment
- A full blood count and folate level. Vitamin B12 should be checked at the same time.
- Treatment is folic acid tablets, usually for about 4 months, plus fixing the cause.
- Taking folic acid alone when B12 is also low can fix the anaemia while B12 nerve damage gets worse. Check both.
Food sources
- Leafy greens, legumes (chickpeas, lentils, beans), asparagus, Brussels sprouts, oranges, eggs and fortified bread and cereals.
- Adults need about 400 micrograms a day (600 in pregnancy).
See your GP if
- You’re planning a pregnancy: ask whether you need the standard or higher dose
- You’re tired, pale and breathless
- You take methotrexate or epilepsy medicines and are planning a pregnancy
Weird history
- In the late 1920s and early 1930s, British doctor Lucy Wills studied anaemia in pregnant textile workers in Bombay (now Mumbai). She found Marmite cured it. The active ingredient was later identified as folate.
- Western Australian researchers Carol Bower and Fiona Stanley published key evidence in 1989 linking folate in early pregnancy to fewer neural tube defects.
Common questions
How much folic acid should I take before pregnancy?
At least 400 micrograms a day, starting at least a month before conception and continuing for the first three months. Some people need a higher dose (usually 5 mg); ask your GP.
What is the difference between folate and folic acid?
Folate is the form found naturally in food. Folic acid is the synthetic form used in supplements and fortified foods. Both do the same job.
What are the symptoms of folate deficiency?
Tiredness, weakness and breathlessness from anaemia, along with mouth ulcers, a sore tongue and poor concentration.
Why is folic acid added to bread in Australia?
Since 2009, bread flour has been fortified to reduce neural tube defects such as spina bifida. Rates fell by 14% overall and much more in some groups.
Can you take too much folic acid?
The upper limit for adults is 1,000 micrograms a day from supplements and fortified foods, unless prescribed a higher dose. High doses can hide vitamin B12 deficiency.
Helpful resources
- Pregnancy, Birth and BabyAustralian Government pregnancy and parenting advice, including folic acid. Free.
- Healthdirect: Vitamins and mineralsPlain-English Australian Government guide. Free.
Evidence and more information
- NHMRC: Folate for healthy babies (impact case study)
- NIH Office of Dietary Supplements: Folate
- Nutrient Reference Values for Australia and New Zealand (Eat for Health)
maladywise.com/folate/