Should You Remove Folic Acid From Your Diet? Examining Risks, Benefits, and Personal Factors

October 8, 2025 •

4 min read

Since 1998, mandatory fortification of grain products in the US with folic acid has significantly reduced the incidence of neural tube defects. This makes the question, 'Should you remove folic acid from your diet?' a complex one, as its inclusion has widespread public health benefits.

Quick Summary

Deciding whether to avoid folic acid requires understanding its vital health role, especially in preventing birth defects. Key considerations include potential risks from high doses, interactions with conditions like B12 deficiency or cancer, and the impact of the MTHFR gene variant.

Key Points

Folic Acid is Not Inherently Dangerous: For the vast majority of people, folic acid intake from fortified foods and standard supplements is safe and beneficial for preventing deficiency.
High Doses Carry Risks: Excessive, long-term intake of folic acid from supplements can mask a vitamin B12 deficiency, potentially leading to irreversible neurological damage if left untreated.
MTHFR Variant is Not a Red Flag: Having an MTHFR gene variant does not mean you need to remove folic acid from your diet. Most individuals with the variant can still process it, and standard supplementation is still effective.
Consider Cancer Concerns with Caution: Some research suggests a complex relationship between high folic acid intake and cancer progression, particularly in individuals with pre-existing tumors. Always consult a doctor if you have a history of cancer before taking high-dose supplements.
Pregnancy is a Special Case: For women who are or could become pregnant, daily folic acid supplementation is vital to prevent neural tube defects, and this recommendation is based on decades of robust scientific evidence.
Personalized Advice is Best: The decision to alter your folic acid intake should be based on your unique health profile. A healthcare provider can help assess your individual needs and risks.

The Vital Role of Folic Acid

Folic acid, the synthetic form of vitamin B9, plays an essential role in numerous bodily functions. It helps the body produce and maintain new cells, which is crucial for overall health. Folate, the naturally occurring form, and folic acid are both necessary for the formation of red blood cells and DNA synthesis. While low levels can lead to fatigue, weakness, and megaloblastic anemia, adequate intake has been linked to several health benefits.

Folic acid and pregnancy

For women who could become pregnant, sufficient folic acid intake is critically important. The Centers for Disease Control and Prevention (CDC) recommends 400 micrograms (mcg) daily for all women of childbearing age to help prevent neural tube defects (NTDs) like spina bifida and anencephaly. Since these defects develop in the first month of pregnancy, often before a woman knows she is pregnant, daily supplementation is key.

Other health benefits

Beyond pregnancy, folic acid and folate contribute to a number of other health outcomes. They help break down homocysteine, an amino acid linked to an increased risk of heart and blood vessel disease. Supplementation has been shown to potentially improve cognitive function in older adults and may support heart health by lowering high blood pressure and reducing stroke risk.

Folic Acid vs. Natural Folate: An Important Distinction

Folic acid and folate are both forms of vitamin B9, but they are not identical. Folate is found naturally in foods, while folic acid is the manufactured version used in supplements and fortified foods. Folic acid is generally more stable and better absorbed by the body than natural folate, which is why it is used for fortification. This easy absorption has made it highly effective for public health initiatives but also brings up specific considerations for certain individuals.

When is Folic Acid Removal Considered?

While folic acid is beneficial for most, there are specific situations where a re-evaluation of intake is warranted. Concerns generally fall into three categories: excessive intake, genetic factors, and specific health conditions.

The MTHFR gene variant

The methylenetetrahydrofolate reductase (MTHFR) gene provides instructions for creating an enzyme that helps process folate. Some individuals have a genetic variant that makes it more challenging to convert folic acid into its active form, methylfolate (or L-5-MTHF). However, the CDC states that even with this variant, individuals can still process all forms of folate, including folic acid, and that it is not a reason to avoid standard supplementation. For those with the variant who have very low folate levels, their doctor may recommend an active form like L-5-MTHF.

High doses and potential side effects

Long-term high doses of folic acid (typically over 1 mg daily from supplements and fortified foods) can cause a buildup of unmetabolized folic acid in the bloodstream. A primary concern with excessive folic acid is its potential to mask a vitamin B12 deficiency. Since both deficiencies can cause a specific type of anemia, folic acid can resolve the anemia while allowing neurological damage from an underlying B12 deficiency to progress undetected. Modern lab tests make detecting B12 deficiency easier, but awareness is still important.

Folic acid and cancer: The ongoing debate

The relationship between folic acid and cancer is complex and often described as a “U-shaped curve,” meaning both too little and too much may carry risks. Research suggests that adequate folate levels may help prevent cancer initiation, while very high intakes could potentially fuel the growth of existing, undetected cancers. For this reason, individuals with a history of cancer, or those undergoing treatment, should consult a healthcare provider before taking high-dose folic acid supplements.

Folic Acid vs. Methylfolate: A Comparison


Aspect	Folic Acid	Methylfolate (5-MTHF)
Form	Synthetic, inactive	Active, bioavailable
Conversion	Requires enzymatic conversion to become active	Does not require conversion; ready for use
Absorption	Readily absorbed by most individuals; high doses can build up unmetabolized folic acid	More readily absorbed, especially for those with impaired conversion processes
MTHFR Variant	Effective for most, including those with variants, but higher levels can lead to unmetabolized accumulation	May be preferred by those with impaired conversion due to genetic variants; bypasses conversion step
Cost	Typically more affordable	Generally more expensive

Dietary Folate and Fortified Foods

Many foods are excellent sources of natural folate, while others are fortified with synthetic folic acid. To maintain healthy levels, a combination of both is often recommended.

Natural Folate Sources

Leafy greens: Spinach, kale, romaine lettuce
Legumes: Lentils, black-eyed peas, black beans
Fruits: Oranges, papayas, cantaloupe
Other vegetables: Asparagus, broccoli, Brussels sprouts
Nuts and seeds: Peanuts, sunflower seeds
Animal products: Liver, seafood, eggs

Folic Acid in Fortified Foods

Enriched breakfast cereals
Bread
Flour
Pasta
Rice
Cornmeal

Conclusion: A Personalized Approach to Folic Acid

For most healthy adults, there is no need to remove folic acid from the diet, especially considering the benefits of fortified foods and general supplementation. For women of childbearing age, it is highly recommended to continue supplementation to prevent birth defects. However, a personalized approach is necessary for individuals with specific health conditions, genetic variants, or who take high-dose supplements.

Instead of removing it entirely, the best course of action is to discuss your specific dietary and health needs with a doctor. A healthcare provider can help you assess your risk factors for deficiency, monitor for conditions like B12 deficiency, and determine the safest and most effective folate strategy for you, whether that includes standard folic acid, a methylated form, or a focus solely on natural food sources.

Expert Consultation is Key

Before making any significant changes to your diet or supplement regimen, consulting with a healthcare professional is crucial. They can evaluate your personal health history, conduct necessary lab tests, and provide tailored advice to ensure you maintain optimal health without unintended consequences.

For more information on folate and folic acid, visit the National Institutes of Health Office of Dietary Supplements.

Frequently Asked Questions

Yes, it is possible to get enough folate from foods like leafy greens, legumes, and citrus fruits. However, folic acid from fortified foods and supplements is more easily absorbed by the body. For women of childbearing age, it is still recommended to take a folic acid supplement in addition to a folate-rich diet to ensure adequate intake for preventing neural tube defects.

Folate is the naturally occurring form of vitamin B9 found in various foods. Folic acid is the synthetic, manufactured form of the vitamin used in supplements and fortified foods like bread and cereals. Folic acid is more stable and better absorbed by the body than natural folate.

No, the CDC confirms that having a common MTHFR variant is not a reason to avoid folic acid. Most people with the variant can still effectively process it. You should only consider alternatives like methylfolate after consulting with a healthcare provider who can evaluate your specific needs.

Yes, taking very high doses (e.g., above 1 mg daily) over a long period can lead to a buildup of unmetabolized folic acid in the bloodstream. This can potentially mask a vitamin B12 deficiency, allowing for neurological damage to occur undetected.

Folic acid is critical during early pregnancy to help prevent serious birth defects of the baby's brain and spine, known as neural tube defects (NTDs). Since these defects develop in the first month, intake before and during early pregnancy is crucial.

The relationship is complex and inconclusive, with some studies suggesting both too low and too high folate levels may influence cancer risk. Experts generally agree that low folate status is associated with certain cancers. High doses, particularly in individuals with pre-existing cancers, may be a concern. Consultation with a healthcare provider is essential for anyone with cancer concerns.

Symptoms of a folate deficiency can include fatigue, weakness, lack of energy, pale skin, a smooth or tender tongue, and headaches. If you experience these symptoms, a doctor can perform tests to determine if you have a folate or B12 deficiency.