What Every Woman With PCOS Needs to Know About Folic Acid

What Every Woman With PCOS Needs to Know About Folic Acid

Guest Post: by  Dr. Fiona McCulloch ND 

We’ve all been told about the importance of folic acid when it comes to pregnancy health. New information is challenging much of what we’ve learned about the role of folic acid and folates in our bodies.  As women with PCOS, we are at increased risk for miscarriage and infertility. Folate is one of the most important nutrients involved in reproductive health, so this is a key topic for us.

First, let’s talk about the difference between folic acid and folate. Folic acid is a synthetic lab-produced B vitamin that can’t be used by our bodies without some extra help. Folic acid must go through several conversion steps in our intestinal cells before becoming a form that we can use.

Natural folate, which is found in leafy green vegetables (the word folate comes from the Latin root for “leaf”) does not have to be processed by our intestinal cells and can be readily used.

Where Is Folic Acid and Natural Folate Found?

Over the years, synthetic folic acid has received a lot of attention for its importance in pregnancy. Most vitamins and prenatals contain synthetic folic acid. Certain prenatal vitamins even have extremely large amounts of folic acid, up to 5mg – a whopping 5x times more than the generally recommended 1mg. These megadose folic acid supplements are often recommended to women with infertility and for women who have experienced miscarriages. Synthetic folic acid is also widely added to our food supply, commonly to bakery products such as breads, crackers and other processed grains such as pasta.

Naturally, folate occurs in fresh fruits and vegetables, as mentioned above. It’s particularly abundant in dark green vegetables however as cooking does destroy natural folate many people are deficient in this nutrient. This is why the fortification of food products with synthetic folic acid began.

 So, What Exactly Does Folate Do for Us?

The role of folate involves many complex processes that boil down to a few very important things. Folate is needed for DNA synthesis. It’s involved in a process called methylation, where carbon groups are passed back and forth in our cells to form different compounds that keep our cells running. Basically folate is required for life, for

growth and for metabolism – pretty important, right? It’s essential in pregnancy, since healthy DNA production and cell division are so crucial at that time.

So, What’s the Concern with Synthetic Folic Acid these Days?

You may have noticed a big movement recently with regards to the standard inclusion of synthetic folic acid in vitamins and foods. This is because the field of genetics has given us information that we never had in the past. Around 40 percent of the population has a mutation in a gene called MTHFR.

To make things simple, MTHFR is a gene that takes synthetic folic acid and turns it into usable folate. People who have the MTHFR gene can be up to 80% less efficient in converting folic acid.

This is concerning, right? Of course! A large proportion of us can’t use all of the synthetic folic acid that we are ingesting.

How do I know If I Have MTHFR?

If you’d like to know if you have MTHFR, you can get tested through companies like ALCAT, Spectracell, or 23andme. There are many different variants of MTHFR, with around 10% of all individuals having two copies of the more concerning variants (homozygous) and a much more serious problem in using folic acid, and around 40% have one copy of the gene (heterozygous) which does also significantly reduce the conversion.  The two most commonly tested variants of MTHFR, are C677T and A1298C. The C677T variant tends to be the most problematic when it comes to converting folates, however A1298C can also have an impact.

How Do I Reach My Folate Requirements If I’m Concerned about MTHFR

Fortunately, bio-available folates are now readily available in vitamin form. Some companies that make advanced formulations are using this in all of their products already (and have been for quite some time) and have removed folic acid altogether from their formulas. If you check the label, you’ll see some of these folates listed as L-5-methyltetrahydrofolate, or methylfolate. Methylfolate doesn’t need to be converted and is able to be used by your body, whether you have MTHFR or not.

What’s the Problem with Taking Synthetic Folic Acid if I can’t use it?

If you have a mutation in MTHFR, like 40% of the population does, the folic acid that your cells can’t convert mostly floats around your body. Research has found that folic acid has a half-life of around 100 days[1].

How Folic Acid Gets In the Way

Unused folic acid can bind to the folate binding proteins in the blood and receptors on the surface of our cells. Research has found that synthetic folates can even bind more strongly to the folate receptors than active folates can – blocking out these crucial nutrients from entering into our cells[2]. As you can imagine, this doesn’t spell greater health and is particularly important when it comes to pregnancy and the development of an embryo. Mutations in MTHFR have been linked to recurrent miscarriage and now I hope that you can see exactly why.

Although we don’t know the full extent of the problems that this may be causing, this could be in some way related to the increase in many of the diseases we see on the rise today in children, and even in adults.

Some researchers believe that the rise in autism, mental/emotional disorders, and even food allergies could be related to or aggravated by this. Only time and more research will give us information on exactly the health effects that this may be causing on our population.

For now, it makes sense to avoid folic acid and to use supplements that contain the active forms of folate such as methylfolate. These forms should be included in all vitamins, and particularly in vitamins for women of reproductive age.

What Can You Do?

  1. Avoid vitamins that contain folic acid. Instead, choose vitamins that contain active forms of folate like L-5-methyltetrahydrofolate. Companies that contain these forms include Pure Encapsulations, Douglas Labs, Xymogen, and Thorne.
  2. Avoid folic acid fortified foods like baked goods and commercially produced pastas. Many organic or natural products will not have added folic acid but it’s important to check the label and try to minimize the amount you are eating.
  3. Eat raw, dark leafy greens daily. Good choices are spring greens, romaine lettuce, and spinach. Adding a large salad to your lunch or evening meal is a VERY good start. 2 cups of raw spinach for example can contain up to 500mcg of folates.
  4. Lentils, pinto beans, and chickpeas even if cooked do contain significant amounts of folates – so include these in your diet if you tolerate them well.
  5. Get tested for MTHFR with a naturopath or functional medicine doctor who can then identify your specific needs for folate supplementation.



[1] http://jn.nutrition.org/content/128/11/1896.full

[2] http://www.ncbi.nlm.nih.gov/pubmed/23740686


Dr. Fiona McCulloch is a board certified Naturopathic Doctor who has been in practice for 13 years in Toronto, Canada.  She

graduated with a Bachelor of Science degree (Biological Sciences) from the University of Guelph and went on to graduate from the Canadian College of Naturopathic Medicine. She is the founder and owner of White Lotus Integrative Medicine, a busy clinic specializing in women’s health and fertility.  Her clinical focus is on the treatment of a wide range of fertility and hormonal conditions, and she is an avid writer and researcher, having published articles in major naturopathic journals.  Fiona has been able to reverse her own PCOS with natural methods and is thrilled to be able to share what she has learned with other women suffering through the same concerns.  Her first book 8 Steps to Reverse Your PCOS is now available.  She lives in Toronto with her husband and 3 boys



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  1. So u mean to say v shouldnt use tht medicines as my doc gave me like glucophage and pregnacare advance which has folic acid in it

  2. Is there a prenatal vitamin with active folate instead of folic acid that you would recommend? I’ve only found ones with folic acid…