Folic acid is a big deal when you're pregnant or trying to get pregnant. As a woman of childbearing age, I have yet to have a doctor that did not suggest that I take folic acid supplements.
Doctors do this for a reason: most Americans are not getting enough folate (the natural form of folic acid) from whole foods. Without enough folate, you run the risk of having children with severe birth defects like Spina Bifida.
I understand the seriousness of the situation. However, I wish my doctors would ask me about my diet before pushing the pills. Why am I so against them?
Well, as it turns out, folic acid is not the same as folate and at high doses it has been proven to be dangerous. The difference between folate and folic acid is that the synthetic form needs to be metabolized into folate and a large subset of the population with a certain gene type are unable to do that. When you can't metabolize it, it stays around in the body and may do damage. Specifically, it has been correlated in many studies with several types of cancer.
In 2013, a study assessing breat cancer risk and folic acid found that:
"caution needs to be used when introducing folic acid supplementation since it may lead to cancer progression" (view the study here)
Here is another concrete example – Retinoblastoma is an eye cancer found in children under the age of 5. A study determined that mothers who took folic acid supplements while pregnant and had the genetic variation that could not turn folic acid into folate, were 4 times more likely to have a child with Retinoblastoma than the control (read the full study here).
It turns out that while too little folate can cause terrible birth defects, it is also really bad for you if you have too much of the synthetic form.
“Both insufficient folate intake and increased folic acid intake have been associated with the development of carcinomas in adults and with the promotion of neoplastic lesions and genetic damage in rodent models."
"Vitamin supplementation with folic acid has been associated with an increased risk of breast cancer. Prospective studies have demonstrated that the ingestion of folic acid at the tolerated upper limit of 1000ug may contribute to tumor progression in colonic adenomas and to increased incidence of breast, prostate, and lung cancers.”
What’s disturbing is that doctors don’t seem to know any of this! From my own encounters, most of them don’t even know the difference between folate and folic acid! After explaining to one doctor the reasons why I would not take the pills, he responded that he needs to learn more about nutrition.
It's not just a matter of saying no to supplements and eating the right foods. If you eat any enriched breads, pastas, rice, cereals, or flours, they all are fortified with folic acid. The FDA has been fortifying with folic acid since 1998 with the goal of reducing birth defects. I've recently seen tv commercials using "folic acid" as a health promoting marketing tactic.
In summary, many of us are likely getting too much folic acid and some of us could get seriously ill from it.
So what’s a person to do?
– Get as much Folate from foods as you can (the Wholesome app shows you the top sources of Folate and will even tell you if you’ve had enough) this is especially important if you are planning to get pregnant as you will need to get much more. Warning: it is incredibly important to get enough folate while you are pregnant so that the baby does not develop birth defects. In the app settings, you can update your profile to 'pregnant' and the app will set your goal to the USDA's daily recommended amount.
– Have a blood test performed by your doctor to measure your actual levels of folate. I had this done recently and found out mine were way above the recommended amount (finally some validation that I don’t need those pills!).
– If your levels for folate are low and you must resort to a supplement look for ones that say “folate” and are from whole food sources – not folic acid. I don’t know of any specifically – but I know they exist. Ask your doctor or do your own research.
– Assuming you are getting enough folate, avoid packaged goods with folic acid listed on the label – that probably means less cereal and energy bars. Sometimes the labels are confusing, for example, cliff energy bars list “folate” under vitamins but then in the ingredients it says “folic acid”.
At a minimum, be aware and try to get natural folate from whole foods rather than folic acid supplementation.
Wholesome can help. It has a list of high in folate foods and allows you to track toward the your recommended goal.