Folate vs Folic Acid: Causes, symptoms and supplements


Folate vs Folic Acid

Folate and folic acid are terms often used interchangeably in discussions about vitamin B9, yet they differ significantly in their biological effects and uses. Dr. Christos Zavos, a renowned gastroenterologist and hepatologist from Thessaloniki, Greece, provides expert insights into these vital nutrients, their sources, recommended dosages, and the best forms to consume for optimal health.

Folate: Natural vs Synthetic Vitamin B9

Folate is the natural form of vitamin B9, found in a variety of foods, particularly leafy greens, legumes, nuts, and seeds. This nutrient is crucial for DNA synthesis, repair, and the production of red blood cells. In contrast, folic acid is the synthetic form used in supplements and fortified foods. While both forms aim to prevent folate deficiency, their absorption and utilization in the body can differ.

Dr. Zavos recommends incorporating folate-rich foods into one’s diet as the first step to ensuring adequate intake. Foods high in folate include spinach, asparagus, and Brussels sprouts, which not only provide folate but also deliver a complex of additional nutrients beneficial for overall health.

Causes of Low Folic Acid

Several factors can contribute to folate deficiency, including:

  1. Inadequate Dietary Intake: Not consuming enough folate-rich foods (like leafy greens, fruits, nuts, and beans) is the most straightforward cause of deficiency.
  2. Increased Requirements: Pregnancy, breastfeeding, and certain diseases such as cancer require more folate, which can lead to deficiency if the intake does not meet the increased demands.
  3. Malabsorption Syndromes: Conditions such as celiac disease or Crohn’s disease can interfere with the absorption of folate in the intestine.
  4. Medications: Some medications, including anticonvulsants and methotrexate, can interfere with folate absorption or break down.
  5. Alcoholism: Excessive alcohol intake can impair folate absorption and increase folate excretion through the urine.

Symptoms of Folate Deficiency

Folate plays a crucial role in cell division and the synthesis of DNA and RNA, impacting overall health and well-being. Deficiency in this essential nutrient can manifest in several ways:

  1. Fatigue and Weakness: Insufficient folate often results in a general feeling of fatigue, which is not relieved by rest.
  2. Pale Skin: Those with folate deficiency may exhibit a pale complexion due to the reduced production of red blood cells.
  3. Shortness of Breath: Difficulty in breathing, especially during exertion, can be a symptom of reduced oxygen transport in the body.
  4. Mouth Ulcers and Swollen Tongue: Folate deficiency can lead to the development of soreness in the mouth and a swollen, red tongue, often referred to as glossitis.
  5. Changes in Mood: Irritability and other mood disturbances are commonly associated with low folate levels.
  6. Growth Problems: In children, a lack of adequate folate can result in stunted growth.
  7. Elevated Levels of Homocysteine: Low levels of folate can result in elevated homocysteine levels in the blood, which is a risk factor for heart diseases and stroke.

The Role of Methylfolate and Folic Acid Supplements

Methylfolate is the bioactive form of folate that is readily usable by the body. It is particularly important for individuals with genetic mutations that affect folate metabolism, such as the MTHFR mutation. For those unable to convert folic acid effectively, Dr. Zavos suggests considering supplements that contain L-methylfolate, the most active form of folate.

Folic acid supplements remain a vital public health tool to prevent neural tube defects in newborns. However, Dr. Zavos advises that the daily dosage of folic acid should be carefully managed. The recommended daily allowance for most adults is 400 micrograms, increasing to 600 micrograms for pregnant women.

Choosing the Right Supplement: Folate Options

For those looking to supplement their dietary intake, Dr. Zavos endorses choosing a supplement that offers a dose of bioactive folate that is easy for the body to utilize without the conversion steps required by folic acid. Such supplements are an excellent choice for ensuring adequate folate levels, supporting overall wellness, and promoting metabolic functions.


Adequate folate intake is essential for health, particularly in key stages such as pregnancy. While folic acid supplements are effective, natural sources and methylfolate formulations might be better suited for those with specific genetic profiles or higher metabolic needs. Dr. Christos Zavos emphasizes the importance of personalized health advice and recommends consulting with a healthcare specialist to determine the best strategy for folate supplementation.

For more personalized advice or to discuss folate supplementation further, interested parties are encouraged to contact Dr. Christos Zavos through the contact form on his website,, or by calling at (+30)-6976596988 or (+30)-2311283833. One can also send an email to for a detailed consultation or to arrange an appointment at his private office in Thessaloniki, Greece.

Last update: 15 April 2024, 16:37


Gastroenterologist - Hepatologist, Thessaloniki

PhD at Medical School, Aristotle University of Thessaloniki, Greece

PGDip at Universitair Medisch Centrum Utrecht, The Netherlands

Ex President, Hellenic H. pylori & Microbiota Study Group