Dietary Supplement Fact Sheet:

Folate

What is folate and what does it do?

Folate is a B-vitamin that is naturally present in many foods. A form of folate, called folic acid, is used in dietary supplements and fortified foods.

Our bodies need folate to make DNA and other genetic material. Folate is also needed for the body's cells to divide.

How much folate do I need?

The amount of folate you need depends on your age. Average daily recommended amounts are listed below in micrograms (mcg) of dietary folate equivalents (DFEs).

All women and teen girls who could become pregnant should consume 400 mcg of folic acid daily from supplements, fortified foods, or both in addition to the folate they get naturally from foods.

Life Stage	Recommended Amount
Birth to 6 months	65 mcg DFE
Infants 7–12 months	80 mcg DFE
Children 1–3 years	150 mcg DFE
Children 4–8 years	200 mcg DFE
Children 9–13 years	300 mcg DFE
Teens 14–18 years	400 mcg DFE
Adults 19–50 years	400 mcg DFE
Adults 51–70 years	400 mcg DFE
Adults 71+ years	400 mcg DFE
Pregnant teens and women	600 mcg DFE
Breastfeeding teens and women	500 mcg DFE

What foods provide folate?

Folate is naturally present in many foods and food companies add folic acid to other foods, including bread, cereal, and pasta. You can get recommended amounts by eating a variety of foods, including the following:

Vegetables (especially asparagus, Brussels sprouts, and dark green leafy vegetables such as spinach and mustard greens).
Fruits and fruit juices (especially oranges and orange juice).
Nuts, beans, and peas (such as peanuts, black-eyed peas, and kidney beans).
Grains (including whole grains; fortified cold cereals; enriched flour products such as bread, bagels, cornmeal, and pasta; and rice).
Folic acid is added to many grain-based products. To find out whether folic acid has been added to a food, check the product label.

Beef liver is high in folate but is also high in cholesterol, so limit the amount you eat. Only small amounts of folate are found in other animal foods like meats, poultry, seafood, eggs, and dairy products.

What kinds of folic acid dietary supplements are available?

Folic acid is available in multivitamins and prenatal vitamins. It is also available in B-complex dietary supplements and supplements containing only folic acid.

Am I getting enough folate?

Most people in the United States get enough folate. However, certain groups of people are more likely than others to have trouble getting enough folate:

Teen girls and women aged 14–30 years (especially before and during pregnancy).
Non-Hispanic black women.
People with disorders that lower nutrient absorption (such as celiac disease and inflammatory bowel disease).
People with alcoholism.

What happens if I don't get enough folate?

Folate deficiency is rare in the United States, but some people get barely enough. Getting too little folate can result in megaloblastic anemia, which causes weakness, fatigue, trouble concentrating, irritability, headache, heart palpitations, and shortness of breath. Folate deficiency can also cause open sores on the tongue and inside the mouth as well as changes in the color of the skin, hair, or fingernails.

Women who don't get enough folate are at risk of having babies with neural tube defects, such as spina bifida. Folate deficiency can also increase the likelihood of having a premature or low-birth-weight baby.

What are some effects of folate on health?

Scientists are studying folate to understand how it affects health. Here are several examples of what this research has shown.

Neural tube defects
Taking folic acid regularly before becoming pregnant and during early pregnancy helps prevent neural tube defects in babies. But about half of all pregnancies are unplanned. Therefore, all women and teen girls who could become pregnant should consume 400 mcg of folic acid daily from supplements, fortified foods, or both in addition to the folate they get naturally from foods.

Since 1998, the U.S. Food and Drug Administration has required food companies to add folic acid to enriched bread, cereal, flour, cornmeal, pasta, rice, and other grain products sold in the United States. Because most people in the United States eat these foods on a regular basis, folic acid intakes have increased and the number of babies born with neural tube defects has decreased since 1998.

Preterm birth, congenital heart defects, and other birth defects
Taking folic acid might reduce the risk of having a premature baby and prevent birth defects, such as congenital heart problems. But more research is needed to understand how folic acid affects the risk of these conditions.

Cancer
Folate that is found naturally in food may decrease the risk of several forms of cancer. But folate might have different effects depending on how much is taken and when. Modest amounts of folic acid taken before cancer develops might decrease cancer risk, but high doses taken after cancer (especially colorectal cancer) begins might speed up its progression. For this reason, high doses of folic acid supplements (more than the safe upper limit of 1,000 mcg) should be taken with caution, especially by people who have a history of colorectal adenomas (which sometimes turn into cancer). More research is needed to understand the roles of dietary folate and folic acid supplements in cancer risk.

Heart disease and stroke
Some scientists used to think that folic acid and other B-vitamins might reduce heart disease risk by lowering levels of homocysteine, an amino acid in the blood. But although folic acid supplements do lower blood homocysteine levels, they don't decrease the risk of heart disease. Some studies have shown that a combination of folic acid with other B-vitamins, however, helps prevent stroke.

Dementia, cognitive function, and Alzheimer's disease
Folic acid supplements with or without other B-vitamins do not seem to improve cognitive function, but more research on this topic is needed.

Depression
People with low blood levels of folate might be more likely to suffer from depression and might not respond as well to treatment with antidepressants as people with normal folate levels.

Folic acid supplements might make antidepressant medications more effective. But it is not clear whether these supplements help people with both normal folate levels and those with folate deficiency. More research is needed to learn about the role of folate in depression and whether folic acid supplements are helpful when used in combination with standard treatment.

Can folate be harmful?

Folate that is naturally present in food is not harmful. Folic acid in supplements and fortified foods, however, should not be consumed in amounts above the safe upper limit, unless recommended by a health care provider.

Taking large amounts of folic acid might hide a vitamin B12 deficiency. Folic acid can correct the anemia but not the nerve damage caused by vitamin B12 deficiency. This can lead to permanent damage of the brain, spinal cord, and nerves. High doses of folic acid might also increase the risk of colorectal cancer and possibly other cancers in some people.

The safe upper limits for folic acid are listed below.

Ages	Safe Upper Limit
Birth to 6 months	Not established
Infants 7–12 months	Not established
Children 1–3 years	300 mcg
Children 4–8 years	400 mcg
Children 9–13 years	600 mcg
Teens 14–18 years	800 mcg
Adults	1,000 mcg

Are there any interactions with folate that I should know about?

Folic acid supplements can interact with several medications. Here are some examples:

Folic acid could interfere with methotrexate (Rheumatrex®, Trexall®) when taken to treat cancer.
Taking anti-epileptic medications such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®), and valproate (Depacon®) could reduce blood levels of folate. Also, taking folic acid supplements could reduce blood levels of these medications.
Taking sulfasalazine (Azulfidine®) for ulcerative colitis could reduce the body's ability to absorb folate and cause folate deficiency.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Folate and Healthful Eating

People should get most of their nutrients from food, advises the federal government's Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber and other substances that benefit health. Dietary supplements might be helpful in certain situations to increase the intake of a specific vitamin or mineral. For more information on building a healthy diet, refer to the Dietary Guidelines for Americans and the U.S. Department of Agriculture's food guidance system, MyPlate.

Where can I find out more about folate?

For general information on folate:
- Office of Dietary Supplements Health Professional Fact Sheet on Folate
- Vitamins, MedlinePlus®
For more information on food sources of folate:
- U.S. Department of Agriculture's (USDA) National Nutrient Database
- Folate Content of Selected Foods, USDA
For more advice on buying dietary supplements:
- Office of Dietary Supplements Frequently Asked Questions: Which brand(s) of dietary supplements should I purchase?
For information on the government's food guidance system:
- MyPlate
- Dietary Guidelines for Americans

Disclaimer

This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.

Glossary

absorption: In nutrition, the process of moving protein, carbohydrates, fats, and other nutrients from the digestive system into the bloodstream. Most absorption occurs in the small intestine.
amino acid: A chemical building block of protein.
anemia: A condition in which the number of red blood cells in the blood, or the amount of hemoglobin in them, is lower than normal, causing a condition in which red blood cells are not able to supply enough oxygen to all the tissues in the body. Hemoglobin is the substance in red blood cells that carries oxygen to your body's cells.
cancer: A group of diseases in which cells divide abnormally and without control, and spread to nearby tissues and other parts of the body. Without treatment, cancer can stop organs from working normally, damage body systems, and cause the patient to die. Cancer may be caused by multiple factors, such as radiation, sunlight, tobacco, certain viruses, and poisonous chemicals; however, the cause of many cancers is unknown.
celiac disease: An autoimmune disorder in which eating gluten (a protein found in wheat, rye, barley, and possibly oats) causes the immune system to damage the small intestine, making it unable to absorb nutrients. It is a genetic disease that sometimes becomes active for the first time after surgery, pregnancy, childbirth, viral infection, or extreme stress. Also called sprue.
cell: The individual unit that makes up the tissues of the body. All living things are made up of one or more cells, which are the smallest units of living structure capable of independent existence.
cholesterol: A substance found throughout the body. It is made by the liver and is an important component of cells. Cholesterol is also used to make hormones, bile acid, and vitamin D. Foods that come from animals contain cholesterol, including eggs, dairy products, meat, poultry and fish. High blood levels of cholesterol increase a person's chance (risk) of developing atherosclerosis and heart disease.
consume: To eat or drink.
coronary heart disease: A disease in which the blood vessels (coronary arteries) that carry blood and oxygen to the heart are narrowed or blocked, which can cause chest pain, shortness of breath, and heart attack. It is usually caused by a build-up of fat and cholesterol deposits inside the arteries (atherosclerosis). Also called heart disease.
deficiency: An amount that is not enough; a shortage.
deoxyribonucleic acid: DNA. The molecules inside cells that carry genetic information and pass it from one generation to the next.
depression: A serious medical condition that can interfere with an individual's ability to work, study, sleep, and eat. Symptoms include ongoing feelings of sadness and despair, loss of energy, and loss of interest or pleasure in activities that were once enjoyed. A person who has depression may experience changes in eating or sleeping habits, and have thoughts of death or suicide.
Dietary Folate Equivalent: DFE. A term used to describe the Recommended Dietary Allowance of folate. DFE accounts for the easier absorption of folate in supplements and fortified foods compared with folic acid found naturally in foods, which is absorbed only about half as well. One DFE = 1 microgram (mcg) food folate = 0.6 mcg folic acid from supplements and fortified foods.
Dietary Guidelines for Americans: Advice from the federal government to promote health and reduce the chance (risk) of long-lasting (chronic) diseases through nutrition and physical activity. The Guidelines are updated and published every 5 years by the US Department of Health and Human Services and the US Department of Agriculture.
dietary supplement: A product that is intended to supplement the diet. A dietary supplement contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their components; is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and is identified on the front label of the product as being a dietary supplement.
disorder: In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.
dose: The amount of medicine or other substance taken at one time or over a specific period of time.
enrichment: In food, the replacement of important nutrients (such as vitamins and minerals) that may be lost during processing or storage. For example, white flour is enriched with thiamin, niacin, and riboflavin because those vitamins are lost when grain is made into flour.
epilepsy: A group of disorders that sometimes disrupts proper communication between brain cells, causing a seizure (a sudden change in behavior due to excessive electrical activity in the brain). It usually occurs in young children and the elderly. Epilepsy can be caused by abnormal brain development, brain damage, illness, tumors, or strokes. Often the cause is not known.
fatigue: Extreme tiredness and an inability to function due to lack of energy.
folate: A general term for the various forms of folic acid, a B vitamin. Folate is needed to make DNA, RNA, and amino acids. It occurs naturally in foods and is found in leafy green vegetables (such as spinach and turnip greens), fruits (such as citrus fruits and juices), and dried beans and peas. The synthetic (manufactured) form of folate used in supplements and fortified foods is called folic acid.
folic acid: The form of folate (a B vitamin occurring naturally in food) that is manufactured and used in supplements and fortified foods.
Food and Drug Administration: FDA, Department of Health and Human Services. FDA is the Federal government agency responsible for ensuring that foods and dietary supplements are safe, wholesome and sanitary, and that drugs, medical devices, cosmetics, and food are honestly, accurately and informatively represented to the public. FDA regulates dietary supplements under a different set of regulations than those covering conventional foods and drug products (prescription and over-the-counter). The dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to get FDA approval before producing or selling dietary supplements.
fortify: To add nutrients to a food during processing or to replace nutrients lost when a food product is produced or stored. This process is sometimes called enrichment. For example, when calcium is added to processed orange juice, the orange juice is said to be "fortified with calcium." Another example is adding folic acid to flour.
gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
health care provider: A person who supplies health care services. Health care providers include individuals with professional training (including doctors, nurses, technicians, and aides).
heart palpitation: Forceful and irregular beating of the heart.
homocysteine: An amino acid (a building block of protein). At high blood levels, it may increase the risk of developing coronary heart disease, heart attack, stroke, and Alzheimer's disease. Elevated homocysteine may also increase the risk of developing osteoporosis and bone fractures.
inflammatory bowel disease: IBD. Long-lasting (chronic) problems that cause irritation and ulcers in the digestive tract. The most common disorders are ulcerative colitis and Crohn's disease.
interaction: A change in the way a dietary supplement acts in the body when taken with certain other supplements, medicines, or foods, or when taken with certain medical conditions. Interactions may cause the dietary supplement to be more or less effective, or cause effects on the body that are not expected.
label: When referring to dietary supplements, information that appears on the product container, including a descriptive name of the product stating that it is a "supplement"; the name and place of business of the manufacturer, packer, or distributor; a complete list of ingredients; and each dietary ingredient contained in the product. Supplements must also include directions for use, nutrition labeling in the form of a Supplement Facts panel that identifies each dietary ingredient contained in the product and the serving size, amount, and active ingredients.
megaloblastic anemia: A disorder in which red blood cells are larger than normal, immature, and few in number, which reduces the amount of oxygen that can be carried by the blood to the body's tissues. It is caused by a deficiency in folate or vitamin B₁₂.
methotrexate: A drug that blocks the bodyâ€™s ability to use folic acid, which is needed by growing cells such as those making up the skin, blood, digestive tract, and the cells that protect the body against infection and disease. Methotrexate is used to treat some types of cancer, arthritis, and severe skin disorders. It belongs to the group of drugs called antimetabolites.
microgram: µg or mcg. A unit of weight in the metric system equal to one millionth of a gram. (A gram is approximately one-thirtieth of an ounce.)
mineral: In nutrition, an inorganic substance found in the earth that is required to maintain health.
multivitamin/mineral dietary supplement: MVM. A product that is meant to supplement the diet. MVMs contain a variety of vitamins and minerals. The number and amounts of these nutrients can vary substantially by product.
nerve: A bundle of microscopic fibers that carries messages back and forth from the brain to other parts of the body.
neural tube defect: A disorder in which the brain, spinal cord, or the tissues protecting the brain or spine do not develop properly during pregnancy. Examples of neural tube defects include anencephaly (most of the skull and brain are missing), spina bifida (part of the spine may be on the outside of the body), and encephalocele (part of the brain is on the outside of the skull). It is a common cause of infant death and disability.
nutrient: A chemical compound in food that is used by the body to function and maintain health. Examples of nutrients include proteins, fats, carbohydrates, vitamins, and minerals.
pharmacist: A person licensed to make and dispense (give out) prescription drugs and who has been taught how they work, how to use them, and their side effects.
poultry: Birds that are raised for eggs or meat, including chickens, turkeys, ducks, and geese.
prenatal: Before birth; during pregnancy.
prescription: A written order from a health care provider for medicine, therapy, or tests.
prevent: To stop from happening.
risk: The chance or probability that a harmful event will occur. In health, for example, the chance that someone will develop a disease or condition.
spina bifida: A disorder in which a fetus's spine does not close properly during the first month of pregnancy. It may result in permanent damage to the nerves and spinal cord, causing paralysis of the legs and feet, bowel and bladder problems, learning problems, or hydrocephalus (too much fluid on the brain).
stroke: A loss of blood flow to part of the brain. Strokes are caused by blood clots or broken blood vessels in the brain, and result in damage to a section of brain tissue. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking or understanding language. The chance (risk) of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, a family history of stroke, and a build-up of fatty material inside the coronary arteries (atherosclerosis). See also NIH publication: Know Stroke. Know the Signs. Act in Time. http://www.ninds.nih.gov/disorders/stroke/knowstroke.htm
supplement: A nutrient that may be added to the diet to increase the intake of that nutrient. Sometimes used to mean dietary supplement.
vitamin: A nutrient that the body needs in small amounts to function and maintain health. Examples are vitamins A, C, and E.
vitamin B₁₂: A group of chemical compounds that contain cobalt and are needed for certain chemical reactions in the body. Vitamin B₁₂ is involved in maintaining healthy nerve cells and red blood cells. It is needed to make DNA (the genetic material in all cells), and is required for the metabolism (chemical changes that take place in the tissues to produce energy and the basic materials needed by the body) of carbohydrate, fat, and protein. Also called cobalamin. For more information see the NIH Office of Dietary Supplements Vitamin B₁₂ fact sheet.