Folat – folsyra, metylfolat och olika sätt att ange mängd

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URL: https://www.cdc.gov/folic-acid/hcp/clinical-overview/
Source date: 2026-07-15
Capture: Complete main.cdc-main text including clinical guidance, label explanation and displayed references. HTML retained; linked references not separately fetched; this is a CDC synthesis, not a clinical trial.

Folic Acid: Facts for Clinicians
For Health Care Providers
July 15, 2026
Key points
Folic acid is the only type of folate (vitamin B9) shown to help prevent neural tube defects.
All women capable of becoming pregnant should get 400 micrograms of folic acid daily.
It's important to educate patients about folic acid, its benefits, and its sources.
Overview
Folic acid is a type of folate (vitamin B9) that is essential for cell growth and development. The terms "folate" and "folic acid" are often used interchangeably. However, folate is a general term used to describe all the different types of vitamin B9. This includes folates found in foods, like leafy greens, and other types found in supplements, like folic acid.
Folic acid is more stable than food folates and it remains stable even through cooking or baking. This allows it to remain active in supplements and fortified foods. That is why folic acid is added to foods such as bread, pasta, some breakfast cereals, and some corn masa flour.
A woman needs enough folate in early pregnancy to properly form the neural tube, which becomes the baby's brain and spine. Folic acid plays a particularly important role in early pregnancy. Many studies show that taking folic acid before and during early pregnancy lowers the chance of
neural tube defects
.
1
Getting 400 micrograms (mcg) of folic acid daily can help prevent neural tube defects (NTDs).
Prevention
General recommendation
CDC recommends all women capable of becoming pregnant get 400 mcg of folic acid daily.  This recommendation is supported by the
Institute of Medicine
and
US Preventive Services Task Force.
It can be difficult for most people to get the recommended daily amount from food folates (like leafy greens) alone. In addition to eating folate-rich foods from a balanced diet, folic acid can be obtained through:
Dietary supplements
. A daily multivitamin containing 400 mcg of folic acid.
Fortified foods.
Folic acid is added to foods like some breakfast cereals and corn masa flour. These products are labeled as "enriched."
A combination of the two
. Eating fortified foods and taking a daily multivitamin.
Recurrence prevention after a prior NTD affected pregnancy
Women who had a previous pregnancy affected by an NTD face higher risks of having another pregnancy affected by an NTD. If they are planning another pregnancy, it is recommended they get 4,000 mcg of folic acid daily. This should start one month before trying to conceive and continue through the first 3 months of pregnancy.
If they are not planning a pregnancy, the general recommendation of 400 mcg of folic acid daily applies.
See Also
Folic Acid: The Best Tool to Prevent NTDs Training
Patient counseling
As a healthcare professional, you play an important role in educating patients about the benefits of folic acid.  Below are some key considerations for counseling.
Start conversations about folic acid and its benefits before pregnancy. Encourage all women capable of becoming pregnant to get 400 mcg of folic acid daily.
For patients planning pregnancy and not currently taking folic acid, advise starting a folic acid containing vitamin at least 1 month before conception and continuing during pregnancy. Waiting until the first prenatal visit to start folic acid consumption will not prevent NTDs.
Share information on the
different sources of folic acid
, such as multivitamins and fortified foods. Explain how patients can get the recommended amount of folic acid daily by including fortified foods and/or multivitamins in their diets.
Encourage patients to check their supplement and fortified food labels to ensure they contain folic acid.  Explain how to read Supplement and Nutrition fact labels or show them what to look for.
Keep Reading
Folic Acid Resources
MTHFR
gene variants
The
MTHFR
gene provides instructions for an enzyme that helps process folate in the body.
2
After testing with a direct-to-consumer genetic testing kit, patients may be seeking guidance on taking folic acid given their
MTHFR
genotype.
The most common variant in the
MTHFR
gene is MTHFR C677T.
3
This variant involves a change at position 677 in the
MTHFR
gene, which can result in the following genotypes:
MTHFR
677 CC
MTHFR
677 CT
MTHFR
677 TT
With similar folate intake, people with the
MTHFR
TT genotype have an average amount of folate in their blood that is only slightly lower (about 16% lower) than those with the
MTHFR
CC genotype.
4
However, studies show that getting 400 mcg of folic acid daily can increase blood folate levels, regardless of their
MTHFR
genotype.
5
Folic acid
is the only type of folate shown to help prevent NTDs.
2
6
4
7
8
There are no clinical recommendations at this time to test for
MTHFR
status or for consuming a different amount of folate or folic acid on the basis of the
MTHFR
genotype.
No matter which
MTHFR
genotype your patient has, you can assure them that folic acid is safe and essential for all women capable of becoming pregnant.
See Also
MTHFR and Birth Defects: Does Type of Folate Matter?
Observed trends
Daily multivitamin use
Daily multivitamin use has declined among women of reproductive age in the United States.
9
Specifically, this decline was observed among women aged 25–44 years, as well as among non-Hispanic White and Hispanic women. Among different age groups, women aged 18–24 years reported the lowest daily multivitamin use.
Additionally, a CDC study found that about half of U.S. women report enriched cereal grain products as their only source of folic acid.
10
Consuming folic acid from a combination of sources like supplements and fortified foods:
Helps people get the recommended 400 mcg of folic acid daily; and
Can prevent up to 700 additional NTDs each year.
10
At-risk populations
Research shows that some groups are still not getting enough folic acid to lower their risk of NTDs. Hispanic/Latina women have a high risk of a having a child born with an NTD.
11
12
13
Changes to Nutrition and Supplement Facts labels
Nutrition Facts and Supplement Facts labels have recently undergone changes, including the units of measure for folate. Folate is now shown as "mcg DFE" (micrograms of dietary folate equivalents). The new labels provide information on both the amount of folate in mcg DFE and the amount of folic acid per serving. If folic acid is present in the product, it will be listed in parentheses alongside the total folate content.
400 mcg of folic acid is part of the total folate per serving.
To prevent anemia, individuals should get 400 mcg DFE (100% daily value (DV) for folate). This is equal to 240 mcg folic acid. However, it takes more folic acid to help prevent NTDs than to prevent anemia. The recommendation is to get 400 mcg of folic acid to help prevent NTDs. This is equal to 667 mcg DFE (167% DV).
Generally, vitamins contain 400 to 800 mcg of folic acid, but some contain other types of folate (such as 5-MTHF) instead. Folic acid is the only type of folate shown to help prevent NTDs. No scientific studies exist that show that supplements containing other types of folate can prevent NTDs. It's important to remind patients to check supplement labels to ensure they contain folic acid.
On This Page
Overview
Prevention
Patient counseling
MTHFR
gene variants
Observed trends
Changes to Nutrition and Supplement Facts labels
July 15, 2026
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Folic Acid
References
Crider, K. S., Qi, Y. P., Yeung, L. F., Mai, C. T., Head Zauche, L., Wang, A., Daniels, K., & Williams, J. L. (2022).
Folic acid and the prevention of birth defects: 30 years of opportunity and controversies.
Annual Review of Nutrition
,
42
(1), 423–452.
Crider KS, Yang TP, Berry RJ, Bailey LB. Folate and DNA methylation: A review of molecular mechanisms and the evidence for folate's role.
Adv Nutr.
2012;3(1):21-38.
Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. MIM Number: 236250: 12/11/2014:
https://omim.org/entry/236250#genotypePhenotypeCorrelations
Tsang BL, Devine OJ, Cordero AM, et al. Assessing the association between the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism and blood folate concentrations: a systematic review and meta-analysis of trials and observational studies.
Am J Clin Nutr.
2015;101(6):1286-1294.
Crider KS, Zhu JH, Hao L, Yang QH, Yang TP, Gindler J, Maneval DR, Quinlivan EP, Li Z, Bailey LB, et al. MTHFR 677C->T genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation. Am J Clin Nutr 2011;93(6):1365-72. doi: 10.3945/ajcn.110.004671.
Wilcken B, Bamforth F, Li Z, et al. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): Findings from over 7000 newborns from 16 areas world wide.
J Med Genet.
2003;40(8):619-625.
Seyoum E, Selhub J. Properties of food folates determined by stability and susceptibility to intestinal pteroylpolyglutamate hydrolase action.
J Nutr.
1998;128(11):1956-1960.
Crider KS, Devine O, Hao L, et al. Population red blood cell folate concentrations for prevention of neural tube defects: Bayesian model.
BMJ.
2014;349:g4554.
Wong EC, Rose CE, Flores AL, Yeung LF. Trends in multivitamin use among women of reproductive age: United States, 2006–2016.
J Women's Health (Larchmt).
2019;28(1):37–45.
KS, Qi YP, Devine O, Tinker SC, Berry RJ. Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: Have we reached optimal prevention?
Am J Clin Nutr.
2018;107(6):1027–1034.
Williams J, Mai CT, Mulinare J, et al. Updated estimates of neural tube defects prevented by mandatory folic acid fortification – United States, 1995–2011.
MMWR Morb Mortal Wkly Rep.
2015;64(1):1–5.
Centers for Disease Control and Prevention (CDC). Racial/ethnic differences in the birth prevalence of spina bifida – United States, 1995–2005.
MMWR Morb Mortal Wkly Rep.
2009;57(53):1409–1413.
Canfield MA, Mai CT, Wang Y, et al. The association between race/ethnicity and major birth defects in the United States, 1999–2007.
Am J Public Health.
2014;104(9):e14–23.
Sources
Centers for Disease Control and Prevention (CDC). Use of folic acid for prevention of spina bifida and other neural tube defects–1983–1991.
MMWR Morb Mortal Wkly Rep.
1991;40(30):513–516.
Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects.
MMWR Recomm Rep.
1992;41(RR-14):1–7.

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Full current exact imported definitions of distinct identities; not an identity merge

{"id":"chebi-27470","version_id":"e2b5cd7e-78aa-4aac-af93-21cd2bccb089","name":"folic acid","definition":"An <em>N</em>-acyl-amino acid that is a form of the water-soluble vitamin B<small><sub>9</sub></small>. Its biologically active forms (tetrahydrofolate and others) are essential for nucleotide biosynthesis and homocysteine remethylation."}

{"id":"chebi-37445","version_id":"dd3d80cd-6434-4222-b3a0-49c84d4c013c","name":"folic acids","definition":"A group of heterocyclic compounds based on the pteroic acid skeleton conjugated with one or more <small>L</small>-glutamic acid units."}

{"id":"chebi-62501","version_id":"b28f00c0-189c-4f6e-9887-6122b701955d","name":"folate(2-)","definition":"The dicarboxylic acid dianion formed from folic acid by loss of a proton from each of the two carboxy groups in the glutamic acid moiety."}

{"id":"chebi-67011","version_id":"11df216f-b032-4227-aabe-8fead9612d75","name":"folates","definition":"An <em>N</em>-acyl-<small>L</small>-α-amino acid anion obtained by deprotonation of any folic acid."}

{"id":"chebi-136009","version_id":"5f5a680a-b626-49d5-bc79-d9ccff663765","name":"(6S)-5-methyltetrahydrofolic acid","definition":"A 5-methyltetrahydrofolic acid that has 6<i>S</i>-configuration."}

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Explicit selected whole publisher paragraphs and research-recommendation bullets; not the full opinion, annexes or clinical studies.

URL: https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2023.8353
Title: Scientific opinion on the tolerable upper intake level for folate
Source year: 2023
Capture: Whole selected paragraphs from the official publisher's web reader on 2026-10-18. Selected section 3.1 paragraph on synthetic forms, section 3.5.2 paragraphs on natural food folate and 5-MTHF uncertainty, section 3.6 scope, the section 4 lead-in, and the complete section 5 research-recommendation bullets. This is not the whole article, its annexes, or the original clinical studies. Publisher HTTP status not captured. Link citation markers replaced by their displayed labels. Direct HTML request returned 403; no bypass attempted. Selection boundaries are explicit below.

3.1 — selected whole paragraph on synthetic forms

Several synthetic forms of folates are authorised for addition to food or used in food supplements (Table 3). Folic acid is a fully oxidised monoglutamate. It is the most chemically stable form and is also the most widely used. It has vitamin activity after it has been fully reduced to THF. Other synthetic forms of folate include Ca-salts or glucosamine salts of (6S)-5-methyl-THF (denoted 5-MTHF hereafter), e.g. 5-MTHF-glucosamine and CaLMF (EFSA NDA Panel, 2022a).

3.5.2 — selected whole paragraphs on natural food folate and retained adult UL

The SCF did not set an UL for natural folate because no adverse effect was found from background intakes of folates (SCF, 2000). At that time, synthetic forms of reduced folates were not available for addition to food or use in food supplements.

Considering the totality of the available evidence and related uncertainties (Section 3.4), the Panel found no basis to change this conclusion. The Panel retains the UL previously established by the SCF of 1000 μg folic acid/day for adults.

3.5.2 — selected whole paragraphs on 5-MTHF salts

The Panel notes that most of the data available for this risk assessment concern folic acid. The Panel acknowledges that there are differences in ADME of these forms compared to folic acid and that there is no indication that 5-MTHF salts would correct the haematological manifestations of cobalamin deficiency, thereby increasing the risk of progression of the neurological manifestations of cobalamin deficiency.

On the other hand, no new data have been identified regarding 5-MTHF-glucosamine or l-5-MTHF-Ca and the Panel considers that no statement can be made about the safety of 5-MTHF-glucosamine or l-5-MTHF-Ca above the UL for folic acid. The Panel retains that the proposed UL applies to the combined intake of folic acid and 5-MTHF salts under their authorised conditions of use.

3.6 — first whole paragraph

The ULs are established for the general European population and apply to the combined intake of supplemental folate from currently authorised forms for addition to food and use in food supplements.

4 CONCLUSIONS — complete lead-in before the age-specific table (table not captured here)

The following ULs are established for the intake of supplemental folate (i.e. folic acid, 5-MTHF-glucosamine and L-5-MTHF-Ca; Table 12) from fortified foods and food supplements:

5 RECOMMENDATIONS FOR RESEARCH — complete six bullets

Further research is required regarding all groups of the population to characterise potential critical effects of excess folate intake. This should address potential differences in the toxicity profile of the various forms of folate added to foods and used in food supplements. Also, investigations of the potential vulnerability of specific subgroups of the population, such as infants and children, pregnant women and older adults, is needed, taking into account specific issues in terms of absorption, metabolism, distribution and excretion of various folate forms in these groups.

Further investigation of the relationship between high folate intake and the risk of cancer is needed, including colorectal and prostate cancer. Additional research is needed on the relationship between high folate intake and the risk of SSA/Ps.

Further research is required to clarify the impact of high doses of folic acid and 5-MTHF on brain structures and functions.

Research is needed to investigate whether the epigenetic changes found in interventions with high doses of folic acid in some populations are causally related to alterations in any phenotypic characteristics. Research is also needed in that respect on the other forms of folate.

Additional research on UFA is required, in particular whether UFA can specifically affect biological pathways leading to adverse health effects.

Data on the consumption of fortified foods and food supplements containing folic acid and/or 5-MTHF salts in EU populations are scarce. For the risk characterisation, there is a need to generate more and harmonised data on folate intake in its different forms from food supplements and fortified foods among users of those products.

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Supplement Facts
Serving Size: 1 Tablet
Servings Per Container: 180
	Amount Per Serving	%Daily Value
Vitamin B6 (as pyridoxine hydrochloride)	5 mg	294%
Folate (as 400 mcg folic acid)	667 mcg DFE	167%
Vitamin B12 (as cyanocobalamin)	1,000 mcg	41,667%

Xylitol, mannitol, citric acid, microcrystalline cellulose, natural berry flavor, silicon dioxide, sodium starch glycolate, croscarmellose sodium, sucralose, magnesium stearate. 
Free of sugar, yeast, wheat, egg, artificial colors, flavors, and preservatives.

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Germe de sarrasin, magnésium marin (oxyde de magnésium extrait d’eau de mer), gélule végétale (pullulan).Déclaration nutritionnelle pour 2 gélules :Germe de sarrasin : 712 mgdont vitamine B6 (pyridoxine) : 1,30 mg (93 % des VNR*)dont vitamine B9 (acide folique) : 238 µg (119 % des VNR*)dont vitamine B12 (cobalamine): 2,5 µg (100 % des VNR*).Magnésium : 273 mg (72 % des VNR*)*Valeurs Nutritionnelles de Référence.

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Magnesiumoxid, Füllstoff Cellulose, Füllstoff vernetzte Carboxymethylcellulose, Trennmittel Siliciumdioxid, Überzugsmittel Hydroxypropylmethylcellulose, Palmfett (ganz gehärtet), Trennmittel Talkum, Farbstoff , Trennmittel Calciumsalze der Speisefettsäuren, Überzugsmittel Schellack, Pyridoxinhydrochlorid, Emulgator Mono- und Diglyceride von Speisefettsäuren, Thiaminmononitrat, Olivenöl, Emulgator Polysorbat 80, Pteroylmonoglutaminsäure, Cyanocobalamin.