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

Do Omega-3s Lower Blood Pressure in Young, Healthy Adults?

Posted August 14, 2018 by Dr. Steve Chaney

What Is The Omega-3 Index And Why Is It Important?

Author: Dr. Stephen Chaney

 

Do omega-3s lower blood pressure in healthy adults?

omega-3s lower blood pressure young adultsThe literature on the potential health benefits of omega-3s is very confusing. That’s because a lot of bad studies have been published. Many of them never determined the omega-3 status of their subjects prior to omega-3 supplementation. Others relied on dietary recalls of fish consumption, which can be inaccurate.

Fortunately, a much more accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes. Using modern technology, it can be determined from a single finger prick blood sample. It is a very accurate reflection of omega-3 intake relative to other fats in the diet over the past few months. More importantly, it is a measure of the omega-3 content of your cell membranes, which is a direct measure of your omega-3 nutritional status.

A recent extension of the Framingham Heart Study reported that participants with an Omega-3 Index >6.8% had a 39% lower risk of cardiovascular disease than those with an Omega-3 Index <4.2% (WS Harris et al, Journal of Clinical Lipidology, 12: 718-724, 2018 ). Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk, while 8% or better is considered indicative of low cardiovascular risk. For reference, the average American has an Omega-3 Index in the 4-5% range. In Japan, where fish consumption is much higher and cardiovascular risk much lower, the Omega-3 Index is in the 9-11% range.

Previous studies have suggested that omega-3 fatty acids lower blood pressure to a modest extent. Thus, it is not surprising that more recent studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, those studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Unfortunately, there were no studies looking at that population. The current study was designed to fill that gap.

 

How Was The Study Done?

omega-3s lower blood pressure young healthy adultsThe current study (M.G. Filipovic et al, Journal of Hypertension, 36: 1548-1554, 2018 ) was based on data collected from 2036 healthy adults, aged 25-41, from Liechtenstein. They were participants in the GAPP (Genetic and Phenotypic Determinants of Blood Pressure) study. Participants were excluded from the study if they had been diagnosed with high blood pressure and were taking medication to lower their blood pressure. They were also excluded if they had heart disease, chronic kidney disease, other severe illnesses, obesity, sleep apnea, or daily use of non-steroidal anti-inflammatory medications.

Blood samples were collected at the time of their enrollment in the study and frozen for subsequent determination of Omega-3 Index. Blood pressure was also measured at their time of enrollment in two different ways. The first was a standard blood pressure measurement in a doctor’s office.

For the second measurement they were given a wearable blood pressure monitor that recorded their blood pressure over 24 hours every 15 minutes during the day and every 30 minutes while they were sleeping. This is considered more accurate than a resting blood pressure measurement in a doctor’s office because it records the variation in blood pressure, while you are sleeping, while you are exercising, and while you go about your everyday activities.

 

Do Omega-3s Lower Blood Pressure In Young, Healthy Adults?

omega-3s lower blood pressure young adults equipmentNone of the participants in the study had significantly elevated blood pressure. The mean systolic and diastolic office blood pressures were 120±13 and 78±9 respectively. The average Omega-3 Index in this population was 4.6%, which is similar to the average Omega-3 Index in the United States.

When they compared the group with the highest Omega-3 Index (average = 5.8%) with the group with the lowest Omega-3 Index (average = 4.6%):

  • The office measurement of systolic and diastolic blood pressure was decreased by 3.3% and 2.6% respectively
  • While those numbers appear small, the differences were highly significant.
  • The 24-hour blood pressure measurements showed a similar decrease.
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index. [In studies of this kind, a linear dose-response is considered an internal validation of the differences observed between the group with the highest Omega-3 Index and the group with the lowest Omega-3 Index.]

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

 

What Does This Mean For You?

omega-3s lower blood pressure young adults questionPerhaps I should first comment on the significance of the relatively small decrease in blood pressure observed in this study.

  • These were young adults, all of whom had normal or near normal blood pressure.
  • The difference in Omega-3 Index was rather small (5.8% to 4.6%). None of the participants in the study were at the 8% or above that is considered optimal.
  • Liechtenstein is a small country located between Switzerland and Spain. Fish consumption is low and omega-3 supplement consumption is rare.

Under these conditions, even a small, but statistically significant, decrease in blood pressure is remarkable.

We should think of this study as the start of the investigation of the relationship between omega-3 status and blood pressure. Its weakness is that it only shows an association between high Omega-3 Index and low blood pressure. It does not prove cause and effect.

Its strength is that it is consistent with many other studies showing omega-3 fatty acids lower blood pressure. Furthermore, it suggests that the effect of omega-3s on blood pressure may also be seen in young, healthy adults who have not yet developed high blood pressure.

Finally, the authors suggested that a diet rich in omega-3s might reduce the incidence of high blood pressure by slowing the age-related increase in blood pressure that most Americans experience. This idea is logical, but speculative at present.

However, the GAPP study is designed to provide the answer to that question. It is a long-term study with follow-up examinations scheduled every 3-5 years. It will be interesting to see whether the author’s prediction holds true, and a higher Omega-3 Index is associated with a slower increase in blood pressure as the participants age.

 

Why Is The Omega-3 Index Important?

 

The authors of this study said: “The Omega-3 Index is very robust to short-term intake of omega-3 fatty acids and reliably reflects an individual’s long-term omega-3 status and tissue omega-3 content. Therefore, the Omega-3 Index has the potential to become a cardiovascular risk factor as much as the HbA1c is for people with diabetes…” That is a bit of an overstatement. HbA1c is a measure of disease progression for diabetes because it is a direct measure of blood sugar control.

In contrast, Omega-3 Index is merely a risk factor for cardiovascular disease. However, if it is further validated by future studies, it is likely to be as important for predicting cardiovascular risk as are cholesterol levels and markers of inflammation.

However, to me the most important role of Omega-3 Index is in the design of future clinical studies. If anyone really wants to determine whether omega-3 supplementation reduces cardiovascular risk, high blood pressure, diabetes or any other health outcome they should:

  • Start with a population group with an Omega-3 Index in the deficient (4-5%) range.
  • Supplement with omega-3 fatty acids in a double blind, placebo-controlled manner.
  • Show that supplementation brought participants up to an optimal Omega-3 Index of 8% or greater.
  • Look at health outcomes such as heart attacks, cardiovascular deaths, hypertension, stroke, or depression.
  • Continue the study long enough for the beneficial effects of omega-3 supplementation to be measurable. For cardiovascular outcomes the American Heart Association has stated that at least two years are required to obtain meaningful results.

These are the kind of experiments that will be required to give definitive, reproducible results and resolve the confusion about the health effects of omega-3 fatty acids.

 

The Bottom Line

 

An accurate measure of omega-3 status has been developed and validated in recent years. It’s called the Omega-3 Index. Simply put, the Omega-3 Index is the percentage of EPA and DHA compared to 26 other fatty acids found in cellular membranes.

Although more work needs to be done, an Omega-3 Index of 4% or less is generally considered indicative of high cardiovascular risk while 8% or better is considered indicative of low cardiovascular risk.

Previous studies have shown an inverse correlation between Omega-3 Index and blood pressure. However, these studies have been done with older populations, many of whom had already developed high blood pressure.

From a public health point of view, it is much more interesting to investigate whether it might be possible to prevent high blood pressure in older adults by optimizing omega-3 intake in a young, healthy population, most of whom had not yet developed high blood pressure. Until now, there have been no studies looking at that population.

The study described in this article was designed to fill that gap. The participants in this study were ages 25-41, were healthy, and none of them had elevated blood pressure.

When the group with the highest Omega-3 Index (average = 5.8%) was compared with the group with the lowest Omega-3 Index (average = 4.6%):

  • Both systolic and diastolic blood pressure were decreased
  • Blood pressure measurements decreased linearly with increasing Omega-3 Index.

The authors concluded: “A higher Omega-3 Index is associated with statistically significant, clinically relevant, lower systolic and diastolic blood pressure in normotensive, young and healthy individuals. Diets rich omega-3 fatty acids may be a strategy for primary prevention of hypertension.”

Let me translate that last sentence into plain English for you. The authors were saying that optimizing omega-3 intake in young adults may slow the age-related increase in blood pressure and reduce the risk of them developing high blood pressure as they age. This may begin to answer the question “Do omega-3s lower blood pressure in young, healthy adults?”

Or even more simply put: Aging is inevitable. Becoming unhealthy is not.

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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