Folic Acid or Methylfolate. What Do You Need to Know?

Let me clear this up. Properly, simply, once and for all.

Folate (vitamin B9) is a nutrient your body needs for DNA production, cell division and making red blood cells. During the preconception period and early pregnancy it’s absolutely critical it’s responsible for the proper closure of your baby’s neural tube, which happens in the first 28 days after conception.

Folate deficiency increases the risk of neural tube defects such as spina bifida.

Folate is the natural form found in food. Folic acid is the synthetic form found in supplements and fortified foods. Methylfolate (5-MTHF) is the active form the one your body actually uses.

When you eat spinach, broccoli or lentils you’re getting folate. When you take a folic acid supplement your body needs to convert it into the active form (methylfolate) through several enzymatic steps.

Most people do this without any issues. But there’s a catch.

MTHFR is the enzyme responsible for the final step of converting folic acid into methylfolate. Some people have a genetic variant (mutation) of this enzyme, which makes the process less efficient.

It’s estimated that:

• approximately 10–15% of the European population has the homozygous variant (TT) of the MTHFR C677T gene, which reduces enzyme activity by around 70%
• approximately 40–50% has the heterozygous variant (CT), which reduces activity by around 30–35%

This sounds alarming, but in practice? For most women, standard folic acid works perfectly well.

Source: Crider KS, et al. “MTHFR 677C→T genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation.” Am J Clin Nutr. 2011;93(6):1365–1372.

Here’s a simple guide:

Take standard folic acid (400 mcg/day) if:

• You don’t have a diagnosed MTHFR mutation
• You haven’t had a previous pregnancy affected by a neural tube defect
• You don’t have absorption issues (e.g. coeliac disease, IBD)
• It’s cheaper and readily available pick it up in any pharmacy

Consider methylfolate (400–800 mcg/day) if:

• You have a confirmed MTHFR mutation (homozygous TT)
• You’ve had a previous pregnancy affected by a neural tube defect
• You have gut issues that affect absorption
• You’d simply prefer the “just in case” option methylfolate won’t do any harm

Important: The NHS officially recommends 400 mcg of folic acid daily for all women planning a pregnancy. Methylfolate isn’t currently the standard NHS recommendation, but it is safe and effective.

Source: NHS UK, “Vitamins, supplements and nutrition in pregnancy”; NICE CG156 “Fertility problems: assessment and treatment.”

Honestly? You don’t have to. If you’d like peace of mind, there’s no harm in testing, but it’s not essential. Why?

Because even if you have the MTHFR mutation, the solution is straightforward: take methylfolate instead of folic acid. The test won’t dramatically change what you do.

However, if you have a history of miscarriages, neural tube defects in the family, or raised homocysteine levels speak to your GP about MTHFR testing.

Regardless of which supplement you choose, eat foods rich in natural folate:

• Spinach — approx. 194 mcg / 100g
• Lentils — approx. 181 mcg / 100g (cooked)
• Broccoli — approx. 108 mcg / 100g
• Asparagus — approx. 149 mcg / 100g
• Avocado — approx. 81 mcg / 100g
• Brussels sprouts — approx. 60 mcg / 100g

The supplement is your safety net, but food is the foundation.

Source: USDA FoodData Central.

• Folic acid works for most women — it’s affordable, safe and widely available
• Methylfolate is a good alternative — particularly if you have an MTHFR mutation or want extra reassurance
• 400 mcg daily minimum — start at least 3 months before you plan to conceive
• Eat your greens — natural folate from food is always welcome
• Don’t panic — the fact that you’re reading this article means you’re already doing more than most

If you’re not yet taking folic acid or methylfolate buy some today and start taking it daily. Set a reminder on your phone. It takes 10 seconds a day and could make an enormous difference.

“Health is the greatest human value”

AnaskoMed, Your Dietitian & Nutritionist

Remember that the information in this article is not a diet or education tailored individually, so if you have any health problems or your diet is more demanding, use the option of individual dietary cooperation or contact your doctor before using it.

References:

1. Crider KS, et al. MTHFR 677C→T genotype is associated with folate and homocysteine concentrations. Am J Clin Nutr. 2011;93(6):1365–1372.
2. NHS UK. Vitamins, supplements and nutrition in pregnancy. 2024.
3. NICE CG156. Fertility problems: assessment and treatment. 2013 (updated 2017).
4. USDA FoodData Central. U.S. Department of Agriculture.
5. De-Regil LM, et al. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015;(12):CD007950.