Folate vs methylfolate vs folic acid explained

Folic acid, folate, methylfolate — these words appear on different packs at the pharmacy, and it is easy to get confused: are they the same thing or different vitamins? This article explains folate vs methylfolate and folic acid in plain words: what each name means, what methylfolate is for, how much truth there is in the MTHFR gene stories, and when you should talk to a doctor. The goal is not to scare you but to help you read a label and ask your doctor the right questions.

Folate, folic acid and methylfolate: three names for one vitamin

All three words refer to vitamin B9. The difference is the form:

Folate is the natural form of B9 in food — leafy greens, legumes and some vegetables.
Folic acid is the synthetic form used in tablets, multivitamins and fortified foods (such as some breakfast cereals). The body converts it into the active form in several steps.
Methylfolate (5-methyltetrahydrofolate, 5-MTHF) is the main active form of folate that circulates in the blood. In supplements it is given "ready to use".

In everyday speech people also say "folate acid", which usually means folic acid. Check the label for the exact form: "folic acid", "folate", "5-MTHF", "L-methylfolate".

Why does the body need folate?

Folate takes part in cell division and renewal, so it matters for tissues that renew quickly, especially red blood cells. Without enough folate, blood formation suffers and folate deficiency anaemia may develop: tiredness, weakness, shortness of breath.

The second key role is in the first weeks of pregnancy. Folate helps lower the risk of neural tube defects in the baby (such as spina bifida). The neural tube forms in the first weeks, often before a woman knows she is pregnant. That is why folic acid advice focuses on the time before conception.

The body cannot store folate for long, so it needs a regular supply from food. For most people a varied, balanced diet is enough.

Folic acid vs methylfolate: what is the difference?

The main difference is the path each takes in the body and how well each has been studied:

Form	Where it is found	In the body	What is known
Folate (natural)	Leafy greens, legumes, cabbage, broccoli	Converted to the active form	Main source for everyday needs
Folic acid	Tablets, multivitamins, fortified foods	Converted to the active form in several steps	The only form proven to help prevent neural tube defects
Methylfolate (5-MTHF)	Some supplements	Already the active form	Natural active form; evidence that it can replace folic acid before pregnancy is not yet sufficient

The key row is the last column. The US Centers for Disease Control and Prevention (CDC) stresses that folic acid is so far the only type of folate shown to help prevent neural tube defects. The World Health Organization (WHO) also recommends folic acid for women preparing for pregnancy.

What is methylfolate for, and who is it for?

Methylfolate is the form the body uses directly, so it is added to many supplements. It is often promoted as "the ready form", which is true. But that does not mean methylfolate is "better" than folic acid: most people convert folic acid to the active form without trouble.

In practice methylfolate comes up in these situations:

as part of multi-ingredient supplements for general health;
when a doctor recommends a different form for a specific reason;
in women's health supplements, for example together with inositol.

If you are planning a pregnancy, do not swap folic acid for methylfolate on your own — decide this with your doctor. We cover the rest of the preparation in our article on vitamins for planning a pregnancy.

The MTHFR gene: should you worry?

The internet is full of claims that "with an MTHFR mutation, folic acid is not absorbed". Let us explain it simply.

MTHFR is the gene for an enzyme that turns folate into its main active form in the blood. Common variants (such as C677T) slightly reduce the enzyme's activity. They are very common and in most cases cause no symptoms at all. With two copies of the variant, blood homocysteine may be somewhat higher, but research on links with specific diseases is mixed.

The CDC is clear on this:

people with an MTHFR variant can process all types of folate, including folic acid;
women who could become pregnant are advised to take 400 mcg of folic acid a day regardless of MTHFR variant;
the idea that MTHFR means you should avoid folic acid and take only 5-MTHF is not supported by evidence.

So there is no need for "everyone" to test for this gene. Whether a genetic test makes sense is decided by a doctor or genetic counsellor based on family history and other factors.

Which foods are rich in folate?

An Uzbek table offers plenty of folate-rich foods, and including them every day is the simplest and safest approach:

Herbs and greens: spinach, coriander, dill, parsley, lettuce;
Cabbages: white cabbage, broccoli, Brussels sprouts;
Legumes: chickpeas, mung beans, kidney beans, lentils, green peas;
Other vegetables: asparagus, beetroot;
Liver — rich in folate, but it is advised to avoid it during pregnancy;
Foods fortified with folic acid — if stated on the pack.

Folate is water-soluble, and long boiling can reduce the amount. Eat greens fresh and avoid overcooking vegetables. Dishes with mung beans, chickpeas and beans — mastava, mashkhurda, chickpea soup — are good sources too.

Who is more likely to be low in folate?

According to the NHS, folate deficiency is most often linked to:

a monotonous diet low in greens, legumes and vegetables;
regular heavy drinking;
pregnancy — the need for folate rises;
poor absorption in the gut, for example coeliac disease;
certain medicines — some anti-epileptic drugs, methotrexate, sulfasalazine and colestyramine can lower folate levels or interfere with absorption. If you take them, discuss folate with the doctor who prescribed them.

Do not try to self-diagnose from symptoms: tiredness and weakness have many causes. A doctor will check folate and vitamin B12 with a blood test.

Can too much be harmful? B12 and "masking"

Folate and vitamin B12 are closely linked. The NHS warns that more than 1 mg (1000 mcg) of folic acid a day can hide the symptoms of vitamin B12 deficiency. Blood results look better while the B12 deficiency continues and over time may damage the nervous system. The risk is higher in older people, because B12 absorption declines with age.

if you take several supplements, add up the folate in all of them;
do not raise the dose on your own;
a high dose (for example after a previous pregnancy affected by a neural tube defect) is set only by a doctor.

How to read the label

Form: "folic acid" means folic acid; "5-MTHF" or "methylfolate" means methylfolate.
Amount per capsule and per day: if the instructions say two capsules a day, the daily amount is double.
Total: if you take a multivitamin, a women's formula and separate folic acid together, add everything up and show the list to your doctor.

For example, Nutva Immuno also contains methylfolate — 400 mcg per capsule. If you want to combine it with another folate-containing supplement, check with your doctor first.

When to see a doctor

you are planning a pregnancy — to agree on the form and amount;
there was a neural tube defect in a previous pregnancy or in the family — the dose is set individually;
ongoing weakness, shortness of breath, a fast heartbeat or headaches;
mouth ulcers, a red sore tongue, numbness or pins and needles in the hands and feet;
you take anti-epileptic drugs, methotrexate or other long-term medicines;
you are vegetarian or have known B12 deficiency — folate and B12 should be assessed together.

How Nutva Inositol may help

Nutva Inositol is a biologically active supplement (BFQ) made by «NUTVA PHARM» MChJ (Uzbekistan). Each capsule contains 1000 mg of myo-inositol (vitamin B8) and 200 mcg of 5-methylfolate (vitamin B9) (2 capsules: 2000 mg and 400 mcg), 60 capsules per pack. It supports normal function of the nervous system and cellular processes. We explain inositol itself in what inositol is; it is often discussed in the context of PCOS (polycystic ovary syndrome) and the menstrual cycle — see also our article on causes of irregular periods.

Permit number: №1594430 (Ministry of Health of Uzbekistan).
The product is not a medicine.
During pregnancy, breastfeeding or if you take diabetes medicines — only after consulting your doctor. It does not replace PCOS treatment prescribed by a gynaecologist or endocrinologist.
How to take it — follow the instructions on the pack and your doctor's advice.

The methylfolate in this product does not automatically replace the folic acid dose your doctor recommended before pregnancy — check this with your doctor. Supplements do not replace a balanced diet, sleep, activity and prescribed medicines.

Frequently asked questions

Are folate and folic acid the same thing?

Both are vitamin B9, but folate is the natural form in food and folic acid is the synthetic form used in supplements and fortified foods. The body converts both into the active form.

What is methylfolate used for?

Methylfolate is the main active form of folate, supplied "ready to use" in supplements and often found in multi-ingredient formulas. Before pregnancy, choose the form with your doctor, because folic acid is the form proven to help prevent neural tube defects.

Can I take folic acid if I have an MTHFR mutation?

According to the CDC, people with an MTHFR variant can process folic acid and are advised the usual 400 mcg. Whether you need a different plan is up to your doctor.

When should I start folic acid before pregnancy?

WHO recommends 400 mcg of folic acid a day from the moment you start trying to conceive until week 12 of pregnancy; the CDC advises starting at least one month before. Agree on the exact plan with your doctor.

Do men need folate too?

Men need folate from food as well, and for most a balanced diet is enough. Whether a supplement is needed is something a doctor can tell from tests and overall health.

Is too much folic acid harmful?

More than 1 mg of folic acid a day can hide the signs of B12 deficiency. Add up the folate from all your supplements and do not increase the dose yourself.