Folic Acid vs. Folate

Written by Dr. Steve Chaney on . Posted in current health articles, folic acid vs. folate, Health Current Events

Are Supplement Manufacturers Trying to Mislead You?

Author: Dr. Stephen Chaney

folic acid vs. folate questionThere has been much confusion on folic acid vs. folate.  For example, I recently received this question from a reader:

“I have gotten so much clarification about folic acid from your video – thank you!
But I have another question I was hoping you could answer.

When a supplement label states there is “folate” rather than “folic acid”, is there really a difference between the two? I hear women telling each other to only use the one that says folate because it’s made from food. And folic acid isn’t. These women are also paying more money for these products because of this. Is this true? (And I’m not talking about tetrahydrafolate, either)
I’ve been told by one manufacturer that they label it as folic acid, but they know other companies who use the exact same source of folic acid.  Still,  they put folate on their label, possibly to avoid controversy.
Are these women being duped? Should they be asking the manufacturer certain questions for clarification?”

The video, this reader is referring to is my “The Truth About Methyl Folate” video in which I debunk the many myths about methyl folate circulating on the internet, and, unfortunately, repeated by some doctors.

However, the reader is correct. I did not address the folic acid vs. folate nomenclature in that video. I will attempt to clarify it in this article.

Folic Acid vs. Folate

A Rose By Any Other Name

roseI call this section “A Rose By Any Other Name” from the famous Shakespeare quote from Romeo and Juliet “A rose by any other names would smell as sweet”.

Biochemists and nutritionists use the terms folic acid and folate interchangeably. There is a sound chemical rationale for that.

Folic acid has a glutamic acid residue on one end. Thus, folic acid is what chemists refer to as an organic acid, specifically a carboxylic acid. Under acidic conditions the appropriate suffix for an organic acid is “ic”. However, under neutral or alkaline conditions, organic acids lose their protons. Once that happens, the appropriate suffix is “ate”.

The exact pH of vitamin pills may vary from brand to brand. In our body our stomach is acidic, our intestines are alkaline, and our blood and cells are normally near neutral. Thus, vitamin B9 could correctly be labeled either folic acid or folate in supplements. It will be folic acid in our stomach and will be folate in our intestines, bloodstream, and cells.  Beginning to see the difference between folic acid vs. folate?

The bottom line is that nobody is trying to trick you by using the term folate for the vitamin B9 on their supplement label. Furthermore, whether the label says folic acid or folate, the actual vitamin B9 will be in both the folic acid and folate form as it travels through your body.

In answer to your other question, since folic acid and folate are two names for the same molecule, folate is not more natural than folic acid. If someone is charging you extra because they use the term folate on their label, they are ripping you off.

 

What About Tetrahydrofolate?

uderstanding folic acid vs. folateThe person who sent me the question also asked about tetrahydrofolates.  Here the story gets a bit murkier.  As folic acid or folate enters our cells, three things immediately happen:

  • It is reduced to tetrahydrofolate. That terminology simply means that 4 hydrogens have been added to the molecule.
  • A string of glutamic acid residues is added. That traps it inside the cells.
  • It is converted to a half dozen different derivatives that play important metabolic roles in the cell. N5-methyltetrahydrofolate (commonly referred to as methyl folate) is one of these metabolically active compounds.

This is where it gets confusing. Nutritionists also refer to all of these tetrahydrofolate derivatives as folates. My guess is that years ago some genius must have decided that the term tetrahydrofolate was too long and complicated for the general public.

In my view lumping everything together under the term folate has turned out to be more confusing in the long run. However, I do have the advantage of hindsight.  It’s easy to point out mistakes after they are made.

However, this is where all of the confusion arises.  It’s because the term folate can mean so many different things.  Here are a few fast facts to help clarify the confusion.

  • Folates in food are in the tetrahydrofolate form. Tetrahydrofolate in foods is, in fact, more natural than folic acid or folate in supplements. However, tetrahydrofolates in foods are utilized only about half as well as folic acid or folate in supplements. In addition, most of us don’t eat enough high-folate foods.
  • In contrast, tetrahydrofolate in a supplement is not more natural than folic acid. That’s because:
  • It would require one cup of lentils or two cups of spinach to provide the RDA level of tetrahydrofolate in a single vitamin tablet. That’s just one tablet.  You do the math!  If someone tells you that the folate in their supplement came from foods, they will lie to you about other things as well.
  • In fact, the tetrahydrofolate found in supplements is chemically synthesized from folic acid. It can never be more natural than folic acid.
  • Supplements containing tetrahydrofolate are no better utilized than supplements containing folic acid when you measure their ability to increase cellular tetrahydrofolate levels (the only measure that really matters).

The bottom line is that even if folate on the label were to refer to tetrahydrofolate, it is not from food.  It is not more natural than folic acid.  It is not better utilized than folic acid.  If someone is charging you a higher price for that supplement, they are ripping you off.

 

Debunking The Methyl Folate Myths

mythsMethyl folate has become an internet sensation.  If you believe all the hype, everyone should be using supplements containing methyl folate rather than folic acid.  In fact, some of the claims made by manufacturers who sell methyl folate supplements are downright deceptive.

Unfortunately, there are even medical doctors touting the wonders of methyl folate and offering all sorts of plausible sounding biochemical explanations about why it is superior to folic acid.  My take on that is that I try not to practice medicine when I write my articles.  I have neither the training nor the degree to do that.  In turn, I would ask medical doctors to stop trying to practice biochemistry.

As I said at the beginning of this article, I have produced a video, “The Truth About Methyl Folate,” in which I debunk all the many methyl folate myths circulating on the internet. If you would like the “Cliff Notes” version, here it is:

  • Supplements containing methyl folate do not get their methyl folate from foods.
  • Methyl folate in supplements is chemically synthesized and is not more natural than folic acid.
  • Folic acid and methyl folate in supplements are equally well utilized by the body, even in individuals with a MTHFR deficiency.
  • Excess folic acid does not cause cancer.

If you would like the science and the references behind those statements, I invite you to view my video.
metho folate
I hope you now understand folic acid vs. folates.  If not, please feel free to reach out to me.

 

The Bottom Line

  • A reader recently asked me to clear up the confusion about why the terms folic acid vs. folate are used interchangeably on supplement labels to describe vitamin B9.
  • That terminology is based on simple chemistry.  Folic acid and folate are two names for the same molecule. Under acidic conditions, it is called folic acid. Under neutral or alkaline conditions, it is called folate.
  • Since folic acid and folate are two names for the same molecule, folate is not more natural than folic acid.  If someone is charging you extra because they use the term folate on their label, they are ripping you off.
  • In the cell folate is reduced to tetrahydrofolate and a number of metabolically active derivatives of tetrahydrofolate are formed. Unfortunately, these compounds are also referred to as folates. This terminology has a historical basis rather than a chemical basis and is confusing.
  • If you see the term tetrahydrofolate on your supplement label,  you need to know that it is not from food.  It is not more natural than folic acid.  It is not better utilized than folic acid.  If someone is charging you a higher price for that supplement, they are also ripping you off.
  • I have produced a video called “The Truth About Methyl Folate” to debunk the many methyl folate myths on the internet. In the article above, you will find the “Cliff Notes” version of the video.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (2)

  • Peggy Turcott

    |

    Dear Mr Chaney,
    I am new 2 ur Health Tips emails. They r very educational. Thank you 4 the benefit of ur time consuming reports. I do have a suggestion, if u dont mind. It would take less sheets of paper & look more professional if u created them in Word using full width of sheets. Then send as attachments so when we open & print it won’t have email appearance if senders name, date, receivers email address & subject line. When printing sometimes there is a 3.5″ white space boarder on R side & a 1″ white space boarder on L side there pushing the words to the middle page using more sheets of paper because the words don’t spread out 2 both the sides leaving only a 1/2 boarder. Thank u 4 reading & possibly considering my suggestion 4 a more professional look but also 2 save us pages. I print & have handy 2 show 2 clients.

    Reply

    • Dr. Steve Chaney

      |

      Dear Peggy,
      If you click on the link included with each email, it will take you directly to that article on my website. You can share the link with anyone and print out the article full size if you would like to.
      Dr. Chaney

      Reply

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Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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