Yes, folic acid is synthetic, but that doesn’t mean it’s harming your child’s behaviour

Understanding Folate and Folic Acid: The Basics

Before addressing specific claims, it's important to understand what folate and folic acid actually are. Both are forms of vitamin B9, which is essential for numerous bodily functions including the production of DNA, red blood cell formation, and cellular growth.

What is Folate?

Folate is a water-soluble B vitamin naturally found in many foods including spinach, kale, Brussels sprouts, cabbage, broccoli, oranges, nuts and seeds, and some animal products like liver. The term "folate" serves as an umbrella term for all forms of vitamin B9, including naturally occurring folates and synthetic folic acid.

What is Folic Acid?

Folic acid is the synthetic form of folate discovered in the 1940s. It's commonly added to fortified foods and used in dietary supplements because it remains intact during food processing and cooking, unlike natural folates, which can be destroyed during food storage and preparation. Our ability to get enough folate using folate from food alone is limited because of its instability during cooking.

Claim 1: "Folic acid is an entirely man-made nutrient. We've been told that it's vitamin B9, it's not."

Fact check: Partially true but misleading.

Folic acid is indeed a synthetic (man-made) form of vitamin B9, but the claim that "it's not vitamin B9" is incorrect. The scientific literature clearly establishes that folic acid is a synthetic version of folate, and both are forms of vitamin B9. 

Folate refers to the many forms of vitamin B9, including folic acid, dihydrofolate (DHF), tetrahydrofolate (THF), and other derivatives. They all ultimately serve the same functions in the body, though they are processed slightly differently by the body. 

Claim 2: "Folate occurs naturally in nature. Folic acid does not occur anywhere on the surface of the earth."

Fact check: True.

This claim is accurate. Folate occurs naturally in many foods, while folic acid is a synthetic compound created in laboratories. Food manufacturers fortify products like bread, cereals, pasta, and rice with folic acid, not the folate found in foods such as green leafy vegetables. 

Claim 3: "About 44% of the population has a gene mutation that doesn't allow us to process [folic acid]."

Fact check: Inaccurate and Misleading.

A gene mutation is a small change in DNA that can affect how the body makes proteins. In this case, the MTHFR gene helps produce an enzyme needed to process folic acid. Some people have a common variant of this gene, which makes some of the enzymes work less efficiently, but it doesn’t mean they can’t process folic acid. 

Here’s what the research actually shows:

• Around 25% of the global population has at least one copy of this variant. It's more common in Hispanic (47%) and European (36%) populations than in African (9%) populations.
• People with one copy of the mutation still retain about 65% of normal enzyme function. 
• People with two copies of the mutation have about 30% of normal function, meaning they can still process folic acid, just less efficiently.
• Evidence shows that folic acid supplementation can be still effective in people with these mutations. 

So while the 44% figure isn't entirely off for some populations, the claim that this mutation prevents folic acid processing altogether is incorrect. It just reduces efficiency, which may be relevant for certain health conditions but doesn’t mean folic acid is useless for those with the mutation. 

Claim 4: “Remember, [grains, cereals, breads, pastas] contain folic acid and they could be sabotaging your health.”

Fact check: Unsupported by scientific evidence.

This claim suggests that eating foods fortified with folic acid is harmful, but research does not back this up.

Folic acid is absorbed more efficiently than natural folate. This means that consuming large amounts of folic acid can lead to some unmetabolised folic acid in the bloodstream. 

Some studies have suggested possible links between high unmetabolized folic acid levels and adverse health outcomes such as colorectal cancer. However, experts caution that there is no clear evidence that unmetabolised folic acid causes harm, and other studies contradict these concerns. According to published research, “there are no definitive studies that have found health effects from exposure to unmetabolized folic acid”. 

The benefits of folic acid fortification are clear. In the US, pregnancies with neural tube defects have fallen by 23% since fortification began in 1998. The public health benefits of folic acid far outweigh the theoretical risks for most people.

Claim 5: "Try eating a folic acid-free diet for one week and see the behavioural changes in your children."

Fact check: Unsupported by scientific evidence.

There is no substantial scientific evidence supporting the claim that removing folic acid from children's diets for one week will result in noticeable changes in behaviour. 

This advice is concerning, given there is overwhelming evidence that folate (in all its forms) is crucial for proper brain function, healthy cell growth and DNA formation, and red blood cell production. There is also convincing evidence that later in life folic acid may play a role in the prevention of stroke and heart disease. Folic acid fortification has been implemented as a public health measure in many countries because it has proven benefits, particularly in reducing neural tube defects in developing fetuses, and it’s been shown that countries with mandatory folic acid fortification have reduced the number of neural tube defects among children. The Centers for Disease Control and Prevention recommends that women capable of becoming pregnant consume 400 micrograms of folic acid daily to prevent birth defects.

In fact, research shows that when mothers get enough folic acid during pregnancy, it helps support their baby's brain development and childhood behavioural development. 

The Debate Over Folate

Some health professionals and scientists argue that we should recommend a different form of folate called 5-methyltetrahydrofolate (5-MTHF or methyl folate) instead of folic acid. This is because, theoretically, this form bypasses the less efficient steps involving the mutated enzyme and is more bioavailable than folic acid. 

However, it's important to note that folic acid is the only form extensively tested and proven to reduce neural tube defects. Even people with MTHFR mutations can still process folic acid, just less efficiently. Plus, major health organizations still recommend folic acid supplementation for all women of childbearing age, regardless of MTHFR status. 

Conclusion

While folic acid is indeed synthetic and not naturally occurring, it is still a form of vitamin B9. MTHFR gene variants that affect folic acid metabolism are common, but having such variants doesn't mean someone cannot process folic acid at all. Most importantly, there's no scientific evidence supporting the claim that removing folic acid from children's diets for a week will improve their behaviour.

Decisions about dietary supplements should be made in consultation with healthcare providers based on individual health needs, rather than on generalized claims that lack scientific support.