If you are experiencing a hard time remembering to take your prenatal vitamins, then this Q & A may help.  January is folic acid awareness & birth defects prevention month. Here are a few interesting facts about folic acid and why all women of child bearing age should be taking folic acid daily.  

Folic Acid & Fertility – a Necessary Nutrient Before, During, and After Pregnancy

So check your prenatal vitamin.  RMACT recommends a minimum intake of 800 mcg. folic acid (not folate) be in your prenatal care and sells a quality prenatal in every RMACT office.  Here is why: 

Folic-Acid-to-Increase-Fertility

What is folic acid?

Folic acid is an essential B vitamin.  Folic acid is the synthetic form of naturally occurring folate found in foods.  This synthetic version is found in multi-vitamins, prenatal vitamins, and fortified foods such as breakfast cereals, pasta, and breads.  Folic acid is necessary for DNA synthesis of red blood cells, nervous system, and proteins; and cellular growth and reproduction. 

Why is folic acid so important for a pregnancy?

Folic acid is a nutrient that is known to have a direct affect on preventing a type of birth defect called a neural tube birth defect.  If folic acid/folate intake is deficient, neural tube birth defects are serious and can affect the fetal spine and brain, at the time of conception and within the first 28 days of fetal development during which time the spine is forming.  Spina bifida and anencephaly are examples of two more common neural tube defects.  

Folic acid is also an important nutrient for healthy sperm.  All men who are actively trying to conceive will benefit from a basic mens multi-vitamin containing 100% of the RDA, not a mega dose formula. 

Folic Acid and Preconception Health

When is the best time to start taking folic acid?

All women of child bearing ago should be taking folic acid daily.  It is best to start three months or more before conception.  Best to take vitamins with food at a larger meal, such as lunch or dinner.  RMACT does not recommend breakfast time.

If a woman has already had a child with a neural tube defect, her risk for having another is very high.  She should speak with her RMACT physician or OB/gyn to get a high dose prescription folic acid. 

Could taking too much folic acid be a problem?

Yes.  Do not take more folic acid than recommended by your physician or nutritionist.  A mega dose of folic acid, without a medical reason, can mask a B12 deficiency--causing pernicious anemia and irreversible nerve damage. 

Why not just eat food sources rich in folate instead of taking synthetic folic acid?

The naturally occurring folate in food sources is important too, but it is not wise to rely on food based folate intake alone for the following reasons:

  1. Food based “folate” has a forty percent lower absorption rate compared to folic acid.  If folate, not folic acid, is listed on your supplement bottle then it is advised to switch to a supplement that lists folic acid instead of folate. 

    Many prescription prenatal vitamins list methyl folate as the source of folic acid.  1000mcg. (or 1 mg.) methyl folate is a bioactive form of folate and is equivalent to 600mcg. Folic acid—an acceptable minimum dose for a singleton pregnancy.  Multiple pregnancies may require more folic acid in the first trimester and women should consult with their MD supervising their pregnancy. 

  2. Folate in foods is easily destroyed when foods are cooked or canned.  Fifty percent of food folate is lost in the canning process and up to ninety percent can be destroyed in cooking.  Lightly steaming in place of boiling in water is recommended. 

Why is a Folic Acid Supplement Important?

If foods are fortified with folic acid, why do we still need a supplement?

Folic acid fortification is helping.  Since folic acid fortification of US grains started in 1998, neural tube birth defects have decreased by thirty five percent however even with this fortification not all women are getting enough of this B vitamin.  Here are a few reasons why a woman’s food intake may not be enough and why a folic acid supplement is so important:

  1. Grains are the main food group that receives folic acid fortification.  The lower carbohydrate meal plans restrict grains and thus lowering folic acid intake. 
  2. Ethnic foods found in the US are often not fortified with folic acid.  This is especially true for corn masa flour—which is more popular among Hispanics—is not fortified.  In fact, Hispanic women are twenty percent more likely to have a child with a neural tube birth defect than a non-Hispanic white woman.
  3. Manufacturers of organic grains are not required to fortify the grain with folic acid.  Some do, but many do not. Check the labels of your favorite organic grain products.  
  4. Manufacturers of whole grain products are not required to fortify with folic acid.  Eating whole grains is recommended for life long health. 
  5. Folic acid /folate is a water soluable nutrient, which means that our bodies do not store this B vitamin.  Availability is dependant upon an individual’s daily nutrient intake.
  6. Some medications and regular intake of alcohol can interfere with folate metabolism and other medications can reduce the serum and tissue concentration of folate.

Should we still eat foods rich in folate?

Yes.  Folate is found naturally in foods.  Excellent sources of folate include foods such as leafy, dark green vegetables, citrus fruits, lentils and beans, asparagus, peanuts and wheat germ.  Incorporating these foods into a daily meal plan, in addition to taking supplemental folic acid from a prenatal vitamin is essential and beneficial for conception, healthy baby and healthy pregnancy. 

 

Carolyn Gundell, RMACT Nutritionist, is available to RMACT patients for all nutrition and lifestyle support during preconception and pregnancy as part of the RMACT Nutrition Program.  If you are interested in an appointment with her, please contact your RMACT Navigator.

Topics: Nutrition Program

Carolyn Gundell, M.S.
Carolyn Gundell, M.S., leads RMACT’s Fertility Nutrition Program, a service available to all patients. Carolyn has a great passion for nutrition and its link to fertility, which she shares with her patients to empower them with food and lifestyle behaviors that optimize their health for conception, successful fertility treatment, and healthy pregnancy.
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