Should I take folate or folic acid for anemia?

November 15, 2025 •

5 min read

According to the World Health Organization, folate deficiency is a common cause of megaloblastic anemia worldwide. Understanding if you should take folate or folic acid for anemia is crucial for effective treatment, as these two forms of vitamin B9 behave differently within the body.

Quick Summary

Folic acid is the synthetic form of vitamin B9, more stable and easily absorbed from supplements. Folate is the natural version found in foods. For treating folate-deficient anemia, folic acid is typically prescribed. However, some individuals with a specific gene variation may benefit from active folate.

Key Points

Folic acid for treatment: For most people with diagnosed folate-deficiency anemia, a doctor will prescribe folic acid supplements, as this synthetic form is more stable and reliably absorbed.
Folate from diet: Folate is the natural form of vitamin B9 found in leafy greens, legumes, and citrus fruits; it is important for prevention but less effective for correcting a severe deficiency.
Check B12 first: Never self-medicate with folic acid for anemia, as it can mask an underlying vitamin B12 deficiency, potentially leading to irreversible neurological damage.
Consider MTHFR: Individuals with an MTHFR gene variation may have difficulty converting folic acid; in such cases, an active folate supplement like L-methylfolate might be more beneficial, as determined by a healthcare provider.
Diet and supplements combined: Treatment often involves a combination of folic acid supplements to quickly correct the deficiency and dietary changes to increase long-term intake of folate-rich foods.
Diagnosis is crucial: Anemia can have various causes, including iron deficiency, so a proper medical diagnosis is essential to ensure the correct treatment plan.

Understanding the Roles of Folate and Folic Acid

Folate and folic acid are both forms of vitamin B9, an essential nutrient for the body. Vitamin B9 plays a critical role in producing red blood cells and synthesizing DNA, making it vital for treating certain types of anemia. A deficiency leads to megaloblastic anemia, where red blood cells become abnormally large and can't function correctly. The decision to take folate or folic acid for anemia depends on several factors, including your body's specific needs and genetic makeup.

What is Folate?

Folate is the general term for all naturally occurring forms of vitamin B9 found in various foods. Rich dietary sources include leafy green vegetables like spinach and kale, citrus fruits, and legumes such as lentils and beans. While beneficial, natural folate is less stable than its synthetic counterpart. It can be easily destroyed by heat during cooking or processing, which can limit the amount the body absorbs from food. The body metabolizes folate in the small intestine, and any excess is typically excreted, posing a low risk of toxicity from food sources.

What is Folic Acid?

Folic acid is the synthetic, man-made form of vitamin B9 used in supplements and fortified foods. Since the 1990s, many countries, including the United States, have mandated the fortification of cereals and grains with folic acid to combat widespread deficiency and prevent birth defects. Unlike natural folate, folic acid is highly stable and boasts excellent bioavailability, meaning the body absorbs a higher percentage of it. The liver and other tissues metabolize folic acid into its active form, 5-methyl-THF (5-MTHF). Because it is so stable and well-absorbed, folic acid is the standard treatment for correcting a diagnosed folate deficiency.

Folate vs. Folic Acid: Which is Better for Anemia?

For most people, a doctor will prescribe folic acid supplements to treat folate-deficient anemia. The superior stability and absorption rate of synthetic folic acid make it the most reliable method for quickly raising folate levels in the body. However, an emerging area of research concerns the MTHFR gene variation.

Some individuals have a genetic mutation, specifically the MTHFR C677T variant, that makes it harder for their bodies to convert folic acid into its active form, 5-MTHF. For these people, taking an active folate supplement, like L-methylfolate, may be more effective. A healthcare provider can order a blood test to check folate levels and genetic testing to determine if an MTHFR variation is present. It is important to note that this is not a concern for the general population and does not negate the effectiveness of standard folic acid supplementation.

Comparison Table: Folate vs. Folic Acid for Anemia


Feature	Folate (Natural)	Folic Acid (Synthetic)
Source	Found naturally in foods like leafy greens, citrus fruits, and legumes.	Found in dietary supplements and added to fortified foods (e.g., cereals, bread).
Absorption	Processed in the small intestine; absorption can vary.	More stable and easily absorbed by the body, with higher bioavailability.
Metabolism	Immediately usable by the body.	Requires a conversion process in the liver to become active folate (5-MTHF).
Stability	Sensitive to heat and light, easily degraded during cooking.	Highly stable and resistant to degradation.
Treatment Efficacy	Effective for prevention through a healthy diet, but less reliable for correcting a severe deficiency.	Standard treatment for correcting folate-deficient anemia due to superior absorption and stability.
Genetic Factors	May be a better option for those with the MTHFR gene variation.	Requires an effective MTHFR enzyme for proper conversion; high doses can mask B12 deficiency symptoms.

When to Seek Medical Advice

Before you start taking any supplement, it is critical to consult a healthcare professional. This is especially true for anemia, as the correct diagnosis is paramount.

The Importance of B12 Testing

A key reason for medical supervision is the relationship between folic acid and vitamin B12. Both deficiencies can cause megaloblastic anemia and present similar symptoms. Taking high-dose folic acid supplements can correct the anemia symptoms of a vitamin B12 deficiency but can mask the underlying neurological damage caused by the untreated B12 issue. For this reason, doctors will always test your vitamin B12 levels before prescribing folic acid, ensuring you get the right treatment without causing further harm.

Other Causes of Anemia

Anemia can also be caused by iron deficiency or chronic disease, and folate or folic acid supplementation will not correct these issues. For example, iron deficiency anemia requires iron supplementation, while anemia of chronic disease requires treatment of the underlying condition. A medical professional can conduct a complete blood count (CBC) and other tests to pinpoint the exact cause of your anemia.

Conclusion

In summary, the choice between folate and folic acid for anemia primarily depends on a proper medical diagnosis. While natural folate from food is important for general health, synthetic folic acid is the standard, most effective treatment for a diagnosed folate deficiency due to its stability and high absorption. However, individuals with certain genetic variations may benefit from an active folate supplement. The most crucial step is to consult a doctor who can accurately diagnose the cause of your anemia and ensure that a vitamin B12 deficiency is not masked by the treatment. By working with a healthcare provider, you can receive the correct supplementation and dietary advice to effectively manage your anemia and restore your health.

For more detailed information on folic acid and its uses, you can visit the Drugs.com Folic Acid resource.

Folate-Rich Food Sources

Leafy green vegetables (spinach, kale, collard greens)
Legumes (lentils, chickpeas, black beans)
Asparagus
Citrus fruits (oranges, grapefruits)
Broccoli and Brussels sprouts
Beef liver and other animal livers
Nuts and seeds
Eggs and dairy products

Causes of Folate Deficiency Anemia

Inadequate dietary intake: Not consuming enough folate-rich foods.
Overcooking food: Heat and light destroy natural folate.
Excessive alcohol consumption: Alcohol interferes with folate absorption.
Malabsorption issues: Conditions like celiac disease or Crohn's disease.
Increased demand: Pregnancy and breastfeeding require higher folate levels.
Certain medications: Some anti-seizure drugs and other medicines affect folate absorption.
Genetic factors: The MTHFR gene variation can hinder the conversion of folic acid.

Frequently Asked Questions

While a folate-rich diet is vital for prevention and long-term health, it is typically not sufficient to correct an existing deficiency that is causing anemia. For this, a doctor will prescribe higher-dose folic acid supplements.

Most people with folate-deficiency anemia respond well to treatment within 3 to 6 months of taking folic acid supplements. A doctor will monitor your progress with blood tests to determine the duration of your treatment.

Taking folic acid can mask the symptoms of a vitamin B12 deficiency, allowing the underlying neurological damage to progress undetected. It is crucial to have both folate and B12 levels checked before beginning treatment.

Folic acid is the more stable, synthetic form of vitamin B9, and is absorbed more efficiently by the body than the natural folate found in food. Natural folate can be lost during cooking, further affecting absorption.

MTHFR is an enzyme needed to convert folic acid into its active form. A genetic variation in the MTHFR gene affects some people's ability to perform this conversion. A doctor may recommend active folate (L-methylfolate) instead of folic acid for these individuals.

While folate from natural sources is very safe, high doses of folic acid can potentially cause side effects like bloating, nausea, and loss of appetite. Excessive intake can also hide a vitamin B12 deficiency.

Folic acid is only effective for megaloblastic anemia caused by a folate deficiency. It will not treat anemia caused by iron deficiency, chronic disease, or other factors. The correct treatment depends on the underlying cause, which requires a medical diagnosis.