Harmony Hub Health
Functional Medicine, Hormone Health and Weight Loss with Michele Postol, CRNP
Harmony Hub Health
Folic Acid is Cancelled: The B9 Bait and Switch
Synthetic folic acid has infiltrated our food supply and supplement industry, creating potential health havoc while masquerading as an essential nutrient. This deep dive into the critical differences between natural folate and its synthetic counterpart reveals why so many of us might be suffering unnecessarily from issues like fatigue, brain fog, anxiety, hormone imbalances, and even fertility challenges.
The FDA's 1998 mandate requiring folic acid fortification in enriched grains successfully reduced neural tube defects in newborns, but created an unintended consequence: massive population-wide exposure to a synthetic nutrient that up to 40% of people struggle to properly metabolize. For those with MTHFR gene variants, this synthetic form can build up in the bloodstream as unmetabolized folic acid (UMFA), blocking folate receptors and creating a functional deficiency—even when blood tests show normal or high folate levels.
From enriched bread and cereals to protein bars and conventional vitamins, I expose the hidden sources of folic acid lurking throughout the standard American diet. A typical day might include multiple fortified foods, creating a perfect storm for methylation disruption. The consequences extend beyond fatigue and brain fog to include increased homocysteine (raising cardiovascular risk), masked B12 deficiency leading to neurological damage, impaired detoxification, and hormone imbalances that manifest as PMS, PMDD, or estrogen dominance.
The solution lies in both avoiding synthetic folic acid and ensuring adequate methylation support through properly formulated supplements containing methylfolate (5-MTHF), methylcobalamin (B12), and other methylation cofactors. I provide practical guidance for navigating restaurants, grocery shopping, and supplement selection to support optimal methylation and folate status—without resorting to synthetic shortcuts that your body wasn't designed to process.
Ready to transform your health by addressing this often-overlooked nutritional factor? Test, don't guess, and give your cells the bioavailable nutrients they truly need to thrive.
Welcome to Harmony Hub Health, where my mission is to provide comprehensive, affordable, integrative care that addresses the root cause of health issues. At the Hub, the focus is on individual patient journeys. I strive to optimize health, vitality and longevity, fostering a community where each person can thrive in body, mind and spirit. Today we're going to talk about folic acid, the synthetic imposter hiding in your vitamins, and why your body is begging for real folate. If you've ever taken a multivitamin, a prenatal or fortified cereal, thinking you're giving your body what it needs, there's something that you should know that little label that says folic acid. It's not the same thing as folate, the active, bioavailable form your body actually recognizes and uses. In fact, if you have certain genetic mutations, like MTHFR, that synthetic version may not only be useless, it might be clogging your detox pathways, elevating homocysteine and contributing to symptoms like fatigue, brain fog, anxiety, hormone imbalance or even infertility. And even for those that don't have mutations like MTHFR, this can cause some really big problems, you know so? We've been told folic acid is essential, especially for pregnancy and anemia, but the truth is that's a one-size-fits-all fix in a world where personalized, functional nutrition should really be the standard. So what's the difference between folic acid and folate. Why do so many people have trouble converting synthetic folic acid and how do you know if your body is silently struggling? Today I want to unpack the science and why choosing the right form of B9 could be a game changer for your mood, your metabolism and your mitochondria.
Speaker 1:So first we'll talk about the essential nutrient often confused with folic acid, and you know, folate. Folate is benign. It's crucial for various bodily functions, including DNA synthesis, cell division and the formation of red blood cells. Dna synthesis, cell division and the formation of red blood cells. However, many people often confuse folate with its synthetic counterpart, folic acid. This misunderstanding can lead to complications, especially regarding health and nutrition. So folate is naturally found in foods like leafy greens, legumes and citrus fruits, while folic acid is a synthetic form used in supplements and fortified foods. When ingested, folic acid has to be converted into the active form of folate in the body. This conversion is critical because your body primarily utilizes folate for its biological functions.
Speaker 1:Folic acid is added to many foods in the standard American diet, primarily due to mandatory fortification policies aimed at preventing neural tube defects in newborns. However, there are several reasons why it's so widespread, and they're not all beneficial. So in 1988, the FDA mandated folic acid fortification in enriched grains like flour, bread, cereals, pasta, rice to reduce birth defects like spina bifida and anencephaly. Luckily this public health effort was successful in lowering neural tube defect rates. But it really didn't consider genetic mutations like MTHFR which affect folic acid metabolism. So folic acid is synthetic and more stable than natural folate found in whole foods. It's cheap. It's a very stable form of folate. It extends shelf life so it makes it ideal for processed and packaged foods. You know shelf life, so it makes it ideal for processed and packaged foods. You know natural folate from leafy greens, liver and legumes degrades much faster.
Speaker 1:The standard American diet is heavy in refined grains and processed foods, which are often stripped of nutrients during production. And to compensate, manufacturers add synthetic vitamins like folic acid to enrich the food. Synthetic vitamins like folic acid to enrich the food. This makes it seem healthier, even though these foods are still ultra-processed and nutrient-depleted. And many food companies market fortified foods as healthy. Pushing products with added folic acid, breakfast cereals, snack bars and bread are the prime examples. Consumers associate fortification with improved nutrition, despite the risks of overconsumption, and those with MTHFR mutation struggle to convert folic acid into active 5-MTHF, leading to unmetabolized folic acid buildup, or UMFA. But you don't have to have a genetic mutation like MTHFR. Umfa is linked to cancer risk, to immune dysfunction, to neurological issues. Overconsumption of folic acid can also mask B12 deficiency, which is very dangerous.
Speaker 1:So let's go over some of the biggest culprits for hidden folic acid in the standard American diet. The number one, of course, is the enriched grains and bread. This is a major source. So white bread, wheat bread unless labeled whole wheat, and unfortified pasta unless it's organic or whole grain without enrichment. Flour tortillas, bagels, hamburger and hot dog buns and crackers Some of that might just have been everything you've already eaten today. Number two are the breakfast cereals. They're a huge folic acid load in these cereals. Cheerios, which we all think is very healthy, special K Raisin, bran, corn Flakes, lucky Charms one of my old favorites and I used to think that that was okay to eat because it was gluten-free and I couldn't understand why sometimes I would still get sick after eating a bowl. I blame the milk. No, it's the folic acid. Frosted flakes and many organic cereals are also fortified. So you really have to check the labels as you continue down those processed food aisles.
Speaker 1:We have the processed and packaged foods, which are granola bars, protein bars, instant oatmeal, boxed mac and cheese, frozen waffles, pancake mix and instant noodles. Again, you've probably already eaten several of these today. Then we have white rice. Unless it's labeled as unfortified, instant rice is a huge no-no. And then there's pasta made from enriched flour. Then we have the baked goods and convenience foods. So muffins, donuts, pastries, croissants, packaged cookies, many gluten-free breads and baked goods. Ironically, they often add folic acid for, quote, unquote nutrition, um, even nutrition drinks and meal replacement. So ensure and boost carnation.
Speaker 1:Breakfast essentials, which I was giving that to my son every single morning, thinking that they had vitamins. Um, slim fast. And many protein powders are fortified, even multivitamins. You want to look at the labels. Many conventional prenatal vitamins contain synthetic folic acid instead of methylfolate. You want to look for 5-MTHF or methylfolate in your multivitamins. Even canned and processed meats, like deli meats, a lot of noodle-based soups are fortified. You need to really read labels. You want to avoid anything that says folic acid in the ingredients. You want to opt for organic and whole grain versions of bread, pasta and rice when you can choose fresh whole foods and make sure your supplement has methylfolate instead of folic acid like that 5-MTHF If you're eating out fast food.
Speaker 1:There are some places that are more folate friendly. Chipotle is a big one. They use whole ingredients. There's no fortified greens. You can get a bowl or salad with rice, meat, veggies, guac, salsa Just skip the tortilla. Cava is a big one I keep reading about. I personally have never been, but my husband eats there. You can get a Mediterranean bowl with fresh ingredients, no fortified bread. You can choose greens, lentils, hummus, tzatziki and grilled protein. There also is sweet green, which I've also never been to. I don't really eat out very much for lunch, but all salads and bowls are unprocessed ingredients and it's great for clean whole food meals.
Speaker 1:Shake Shack is another good one. Their fries are made with real potatoes and cooked in non-seed oils. You can get that lettuce wrapped. Um, and and that is really good, um, I'm trying to think of what, oh? Five guys which I was surprised to see when I did some research. You can get their lettuce wrapped burger. They do not use fortified bread there, which is odd, right? Um, and their fries are also only potato salt and peanut oil. Um, not like poor McDonald's, which I know tastes amazing, but they even add chemicals to make their french fries look yellow, which to me is very odd, and that's why when you get Five Guys, you ever get Five Guys and your bag is like dripping with grease. But hey, at least all it is is peanut oil, salt and potatoes.
Speaker 1:Panera Bread does have some options. I would avoid all of their sandwiches and their their pastries because it's all fortified flour. But they do have good salads, they do have good broth bowls and they do have steel cut oatmeal for people that like that. Even Starbucks, their egg bites, their protein box, which was my favorite, that has like the eggs and the grape and the cheese. I just throw out the bread only because I'm gluten free. Um, they have a bacon and gruyere egg bites that are folic acid free and their oatmeal there is also safe. Even though people may prefer other coffee shops Coffee, I like Starbucks, so they have good stuff.
Speaker 1:If you're going to sit down at a restaurant, it's always best to pick something that's a farm to table and organic restaurant. One of my favorite places is here in Columbia, maryland. It is Seasons 52. That is a farm to table restaurant, so you can check for places that emphasize local whole food ingredients. Or what we usually do is pick a steakhouse stick with steak, grilled chicken or seafood with veggies and avoid the bread and enriched sauces. And avoid the bread and enriched sauces. Sushi is a good one. Sushi rice is often fortified, though, so you want to opt for sashimi or rolls wrapped in cucumber Even Mexican restaurants if you can get the corn tortillas instead of flour, because they're less likely to be enriched, or you can get a burrito bowl without tortillas, and if you're going to eat Italian, you can use gluten free pasta or zoodles.
Speaker 1:I tell many, many people that I'm not surprised when, even though they don't have celiac, when they eat gluten free options, they feel better and they're like oh, maybe I have celiac too and it's like, no, you're just eating those fortified pastas. So you want to make sure, if you are eating Italian, you ask for their gluten-free option, because they're usually unfortified. Some places also have the zucchini noodles or spaghetti squash, and some of my favorite grocery stores Sprouts. That's number one on the list. We actually emptied out our pantry last week and went shopping because we still had to be careful and we still had to read the ingredient labels, which was a great experience for my son. But a lot of their food is organic. It's unfortified there, and so is Whole Foods. Whole Foods is another good one. We just don't live as close to a Whole Foods like we do a Sprouts.
Speaker 1:My son's favorite is Trader Joe's. He loves their salads. He swears they taste better than everyone else's. They also have a really good cauliflower and gnocchi and they have pre-made meals at Trader Joe's that are folic acid free, and I think they label it that way as well. Or if you're looking for, you know, bulk buying, costco is a great choice because they have the rotisserie chicken and they have a lot of organic snack options.
Speaker 1:And you know you can avoid a lot of those processed options. And a lot of people ask me do I have to never eat anything? I'm not saying that. I do tell people. You know it's that ultra processed foods. You know, try to really limit it, because here's the danger of too much folic acid and too little folate. It's that UMFA buildup, or unmetabolized folic acid. Because folic acid is synthetic. It has to be converted by your liver using the DHFR enzyme, which is slow and easily overwhelmed. So when folic acid intake exceeds what the body can process, especially in supplements and fortified foods, it builds up as UMFA in the bloodstream. Umfa equals biologically inactive, but it competes with real folate and may block folate receptors and it creates a functional deficiency.
Speaker 1:You can have high folic acid levels and be very folate deficient. One example would be what my son used to eat for breakfast. Um, let's see you wake up in the morning. Maybe you have your flintstone vitamin, then you have a Pop-Tart okay, then you may have a cinnamon roll that right there, insane. And then you pack your lunchbox and you have an enriched bread peanut butter sandwich. You have your Cheetos which are sprayed with folic acid. Then you come home to a nice spaghetti and meatball which is enriched pasta, and then your meatballs with your sauce. That is just crazy. But that was a typical day and I wondered why my son had ADHD and an attitude problem.
Speaker 1:So the folate is required for methylation. It's a critical process that regulates your DNA repair, your detoxification, your neurotransmitter synthesis, your hormone balance and your immune function. Too much folic acid can clog up methylation pathways, especially if you have that MTHFR gene but you don't have to have that MTHFR gene, that MTHFR gene, but you don't have to have that MTHFR gene. You could just have a dirty gene and it could lead to brain fog, mood issues, infertility, estrogen dominance or even detox issues. So without active folate that L5MTHF, your body can't recycle homocysteine back to methionine, so this is all part of your methylation process.
Speaker 1:High homocysteine causes an increased risk of heart disease, stroke and inflammation. Folic acid does not lower homocysteine effectively in those with poor conversion capacity. Okay, folic acid does not lower homocysteine. So Excess folic acid can also mask low B12 by correcting megaloblastic anemia on your blood work. But it can also cause neurological damage. So you get these B12 deficiency symptoms like neuropathy or cognitive decline, and it goes very unnoticed until it's too late, because it can make your blood work look like you have an excess of B12 when you don't have enough at all. And there are some studies that suggest excess folic acid helps promote tumor growth in individuals with precancerous or active cancer cells. So real folate supports normal cell repair, but synthetic folic acid in excess may push abnormal cells to divide more rapidly.
Speaker 1:So here are some symptoms and how it happens. So you can have brain fog and fatigue because of that methylation dysfunction. You can have infertility, bad PMS or estrogen issues because of poor hormone detoxification. You can have anxiety and depression because of the impaired neurotransmitter production, especially ADHD. You can have cardiovascular disease from that high homocysteine, you can have that nerve damage because of the masked B12 deficiency. You can also have potential tumor growth from abnormal cell proliferation and immune dysregulation because of the poor DNA repair and detox.
Speaker 1:So folate and vitamin B12, they work closely together in the body, particularly in the synthesis of red blood cells and DNA. So a deficiency in either nutrient can lead to macrocytic anemia. I say that word a lot when I'm going over blood work in my loom videos. It's a condition characterized by the production of abnormally large red blood cells that don't function properly. And if you have a low folate, here are some of the signs and symptoms that you might have and we'll break it down into systems.
Speaker 1:So the first one is your hematologic. This is all blood related. This is when you're having fatigue, weakness, you might have pale skin, you might get short of breath. You may tell me you have dizziness or lightheadedness, even heart palpitations. You'll have that megaloblastic anemia that I mentioned on your blood work. You may have poor iron utilization or the inability to absorb iron, even though you claim that you've gotten iron transfusions or you've taken iron supplements and your iron level never budged. Or we might find elevated homocysteine levels.
Speaker 1:Next, if we're talking about neurological and cognitive a lot of people. I would say the biggest symptoms that I face in my practice is numbness and tingling in the hands and feet, burning or pins and needles sensation, peripheral neuropathy, poor balance or coordination, brain fog, memory issues, difficulty concentrating, irritability, depression, anxiety, insomnia or poor sleep and headaches. These are all signs of low folate. The next one is vascular and circulatory. This is when you have cold hands, cold feet. You can have Raynaud's-like symptoms where you have color changes in your fingers and your toes. You can have Raynaud's-like symptoms where you have color changes in your fingers and your toes. You're at increased risk of blood clots because of that elevated homocysteine and you just have poor circulation. If you look at my legs, I have a lot of little spider veins, I have the MTHFR and I have very poor circulation. I've already had my saphenous veins in my legs burnt out by lasers because my circulation was so poor and I didn't even know at that time that I had that mutation.
Speaker 1:Next is hormonal and reproductive. So PMS or PMDD-like symptoms happen when you are low in folate. You have fertility challenges. You have irregular menstrual cycles. You have a very high increased miscarriage risk. You have a high risk of neural tube defects in pregnancy and you have these estrogen-dominant symptoms due to your impaired detox. Next, you know, especially if you do have MTHFR and you have methylation-related issues, you can have detox issues. You'll have, you know, sensitivity to chemicals, smells, medications. You can have poor stress tolerance and you might have histamine intolerance symptoms and mood swings, more so if you have MTHFR. But you don't have to have that variant to have these methylation related symptoms, especially if you are just so depleted in folate.
Speaker 1:Next, for your oral and gastrointestinal, it's very common to see mouth ulcers or mouth sores, sore or swollen tongue, known as glossitis. I can usually tell because people have cracks at the corners of the mouth. That's that angular chilitis and nausea, diarrhea, poor appetite and I'm like, yep, you are low in folate. Other things I might see when I look at your blood work. Besides, low serum folate is an elevated homocysteine. And remember, when I say low serum folate, I don't even want you to look at the reference range on your labs because you know conventional medicine and functional medicine have different standards of where you should be to be healthy. We might find a low red blood cell folate which is more accurate than a serum folate in most chronic cases. Usually it's the enlarged red blood cell, so the high MCV on your complete blood cell count, and then you might have either a low B12, ferritin or other synergistic nutrient.
Speaker 1:There are other causes of low folate as well. Usually they are inadequate dietary intake, so insufficient consumption of folate-rich foods. You can have a malabsorption disorder like celiac disease or Crohn's disease. They can hinder folate absorption. Sometimes you just have increased demand. That would be usually pregnant or lactating women. They have a significantly increased requirement for folate. And then if you're taking certain medications like methotrexate, anticonvulsants, they all interfere with folate metabolism. There are some people also that can have just really high folate and high levels of folate can happen because of excess supplementation. If you're taking high doses of folic acid, it can lead to elevated folate levels in your blood. If you do have liver disease, an impaired liver function can affect how you metabolize folate and how you clear it.
Speaker 1:Okay, so methylated folate is the bioactive form of folate that the body can utilize directly without the need for conversion, and this is important for individuals with the MTHFR gene, as they may struggle to convert folic acid to active folate efficiently. So supplementing with methylated folate can help bypass this metabolic block and ensure adequate folate levels in the body. And Orthomolecular's methyl CPG is such an excellent choice and a functional medicine favorite for comprehensive methylation support. And let me break down what's in that for you. So it does have the quatropholic, that's L5, mthf 400 micrograms. It's all active folate, no folic acid. So it supports DNA synthesis, neurotransmitters and homocysteine regulation. It does have the methylcobalamin B12. It has a full gram milligram I'm sorry, that's a lot An active form of B12 for nervous system and methylation. The methylcobalamin it's essential if folate is being supplemented because it prevents masking of B12 deficiency.
Speaker 1:A lot of the supplements you'll find over the counter. It has cyanocobalamin, which is not the same. It also has riboflavin B2, and that's required for folate cycle and MTHFR enzyme function. It also has the B6, and it's the active B6 to support homocysteine clearance by the transsulfuration pathway. And it has TMG and betaine. This is the trimethylglycine. This supports the BHMT pathway, providing backup methylation support for homocysteine recycling. So this is my absolute favorite supplement because it has all of the methylated Bs.
Speaker 1:So this is great for anybody that does have the MTHFR gene variant. It's good for anyone with high homocysteine levels, even if they don't have the MTHFR gene variant. It's good for people with mood disorders like focus, anxiety and depression. It's good for detox support, it's good for fertility, it's good for hormone imbalances, especially if you have estrogen dominance, and it's good for nervous system issues, including neuropathy. You want to start low and slow, especially if you're sensitive to methyl donors. If you're sensitive to methyl donors, it can cause anxiety, irritability or some sleeplessness in some people, but it can also be combined with glutathione or an antioxidant support for deeper detox protocols.
Speaker 1:It works beautiful in combination with lifestyle and dietary folate from leafy greens, liver, avocado, all of those really high folate foods. So methylcpg is more comprehensive than standalone folate because it supports the entire methylation cycle, not just one part. So it is ideal if you want to address systemic issues fatigue, detox, overload, mood inflammation at a root level and I do carry this in the office and you can come and pick that up if you would like to try it. We have been told for decades that folic acid is essential, but now we know better. Your body deserves more than a synthetic shortcut. If you're dealing with fatigue that won't budge, mood swings that feel hormonal and neurological, or symptoms like cold hands, brain fog or fertility struggles, it may be time to look beneath the surface and support your methylation pathways the way nature intended, with active folate, not a counterfeit. So in functional medicine, we don't guess, we assess. And when it comes to folate, the difference between synthetic and bioavailable isn't just technical, it's transformational.
Speaker 1:If any of this podcast hit home, or any of this sounds like it could be you, I would love to see you for a functional medicine consultation. You can find me at HarmonyHubHealthcom. You can email me at Michelle M-I-C-H-E-L-E at HarmonyHubHealthcom, or you can come see me in person at Monarch Beauty and Spa in Manchester, maryland, and I would love to help guide you through your methylation process and get you feeling much better. So remember, when it comes to folate, it's not just about what you take, it's about what your body can actually use. So test, don't guess, and give your cells the fuel they need to thrive.
Speaker 1:Until next time, stay curious and stay well. This content is for educational purposes only and it's not intended to diagnose, treat or replace medical advice from your health care provider. Always consult with a licensed medical professional before starting any new supplements, especially if you are pregnant, nursing, have a medical condition or you're taking medications. Lab testing and personalized care plans are strongly recommended for optimal results. I am not your nurse practitioner yet, but I would love to be, so make sure you reach out to HarmonyHubHealthcom.