Do You Need to Take a Folate Supplement? If You’re Tired, Read This

When was the last time you thought about getting enough folate in your diet? Probably never, unless, that is, you’re pregnant or trying to get pregnant, in which case doctors bring it up as an important vitamin to take since it is critical to the healthy formation of the fetal brain stem and chord, which develop early, even before many women know they are pregnant

But most women have learned about folate since a lack of it, also called vitamin B9, or being deficient in vitamin B12, or both could cause anemia. Folate is an important vitamin in helping your red blood cells carry oxygen to the body, and when these blood cells are too large or unable to do their jobs, you can get Vitamin B deficient anemia, which is different from not having enough iron, which also can cause anemia.

Many RDs are finding that their clients don't eat enough foods that contain folate, like dark leafy greens. So while it’s true that this nutrient is critical for women of childbearing age, it’s actually important for everybody, no matter their gender or life status. Here’s a primer on what folate does for your body and whether you need to supplement.

Folate is a water-soluble B vitamin, B9, that plays several key roles in the body. For starters, you need this vitamin to make DNA and red blood cells. It’s also essential for nervous system function and works with the body function involved in methylation, a biochemical process that helps repair your cell's DNA, protects against cancer, supports detoxification, and keeps your immune system healthy. It also impacts brain chemistry, energy production, and supports the protective coating along your nerves, along with many other vital body functions, according to Lee Cotton, R.D.N., L.D.N., a dietitian in Stuart, Florida.

While folate is a critical nutrient for everybody, it plays a key role for women trying to become pregnant for the important role it plays in the development of the fetus. “Folate is important for reducing the risk of birth effects of the brain and spine,” Cotton says. These are called neural tube defects, and the two most common are anencephaly and spina bifida. According to the Centers for Disease Control and Prevention, these defects can happen in the first few weeks of pregnancy, perhaps even before women know they’re pregnant, which is why anyone of child-bearing age is encouraged to take folate.

Given folate’s numerous roles in the body, it’s not surprising that studies have found benefits in lowering the risk of diseases. The National Institutes of Health, for instance, suggest that folate may lower stroke risk and reduce the risk of some forms of cancer, like breast cancer. In fact, according to the Nurses’ Health Study, women with the highest folate levels appeared to be 27 percent less likely to develop breast cancer compared to women with the lowest levels.

Numerous plants contain folate, including leafy greens, nuts, black-eyed peas, lentils, asparagus, Brussels sprouts, broccoli, oranges, cabbage, soybeans, bananas, and avocados. Many foods are now fortified with folic acid, a synthetic version of folate, that’s added to bread, pasta, rice, and breakfast cereals. It's also used in supplements.

So should you take a supplement to get the folate you need if you’re following a plant-based diet? Unless you’re a woman of childbearing age, probably not. “Most people on a vegan [or plant-based] diet can get enough folate from whole plant foods,” says Lee Crosby, R.D., nutrition education program manager with the Physicians Committee for Responsible Medicine.

The Recommended Dietary Allowance of folate for anyone over 19 is 400 micrograms (mcg) per day, while pregnant women need 600 mcg. How easy is it to get that amount? Just one cup of boiled spinach, which contains 262 mcg, and a cup of black-eyed peas, which contains 210 mcg, will hit that target, Cotton says.

There is one caveat, though, and this applies to women who are thinking about becoming pregnant or are already pregnant. For these women, the CDC recommends getting folic acid from a supplement. It recommends taking 400 mcg of folic acid supplements daily in the months prior to becoming pregnant, and then 4,000 mcg every day for the month before getting pregnant and during your first three months of pregnancy. You can also eat foods with naturally occurring folate as well as foods fortified with folic acid. To make sure you’re getting enough, your doctor will monitor your folate levels during your pregnancy, Cotton says. 

One thing you should know, Crosby cautions. There is a "Jekyll and Hyde" concern that while folic acid can work to prevent some cancers from ever starting, once cancer is established, it can increase its growth. Specifically, a review of the studies published in The American Journal of  Clinical Nutrition, specifically noted that folate appears to lower the risk of colorectal cancer, pancreatic cancer, breast cancer, and prostate cancer, the authors also reported: "Folic acid supplementation may prevent initiation and early promotion of cancer development but it may promote the progression of established precancerous and cancer cells."

Because this is a controversial area, talk with your doctor to determine what your best course of action is.

When taking folate, especially if pregnancy is the near-term goal, alcohol can impact the absorption of folate in the liver, Cotton says. This is why people with severe alcoholism are often at risk of folic deficiency.

Bottom line? Focus on eating foods with vitamin B9 and you will have no problem getting the daily folate your body needs. Those include Leafy greens such as kale, cabbage, and spinach, as well as beans, peas, and chickpeas and broccoli and Brussels sprouts.