Folic Acid: What It Is, What It Does and Who Should Take It

Folic acid is the synthetic form of vitamin B9, a water-soluble vitamin that the body cannot produce and that takes part in DNA synthesis, cell division and red blood cell formation. The question "what is it for?" has a short answer: it keeps the body working normally and, in specific situations, supplementation is clearly recommended — above all before and during pregnancy, to reduce the risk of neural tube defects. For most healthy adults, a varied diet provides enough folate and a supplement brings no extra benefit.

This article explains what the research shows (and what it does not), who is most likely to benefit, what gummy supplement labels say and when it is worth talking to a healthcare professional.

What is folic acid and how does it differ from folate?

"Folate" is the term for the natural forms of vitamin B9, found in foods such as leafy green vegetables, pulses, nuts and fortified cereals. "Folic acid" is the synthetic form used in supplements and fortified foods; it is more stable and absorbed more efficiently than food folate. In the body, both are converted into the active form needed for reactions that transfer carbon groups — processes that are indispensable for cell replication.

This role in cell division explains why folate requirements are higher during phases of rapid growth (pregnancy, childhood, adolescence) and in tissues that renew constantly, such as blood cells.

What does folic acid do in the body?

Folate is needed for DNA and RNA synthesis and for red blood cell production. It also helps convert homocysteine into another amino acid, methionine. When folate levels are low, homocysteine tends to rise — and high homocysteine is a known risk factor, which has prompted many trials on supplementation and cardiovascular health.

It is important to distinguish "taking part in a function" from "correcting a problem". Folate is needed for the normal functioning of the body; that does not mean that taking more than you need produces extra effects.

What does the evidence say about the benefits of folic acid?

The strongest evidence concerns pregnancy. A systematic review for the US Preventive Services Task Force, which pooled observational studies in populations from highly developed countries, concluded that folic acid supplementation is associated with the prevention of neural tube defects ¹. That is why supplementation before conception and in early pregnancy is a well-established recommendation.

Outside pregnancy, the results are more mixed and depend heavily on the population studied.

Cardiovascular health: what the trials show

Several trials have assessed the effect of folic acid on lowering homocysteine and on cardiovascular risk, with results that vary according to population and region. A meta-analysis of 21 randomised trials, with 115,559 participants, found a 10% reduction in the risk of stroke with folic acid supplementation; the effect was greater in regions without flour fortification or with partial fortification ².

In people with established cardiovascular disease, a meta-analysis of 11 trials with 65,790 participants found a significant reduction in stroke risk, with more favourable effects in those whose homocysteine fell by 25% or more and at daily doses below 2 mg ³. A broader meta-analysis, with 12 trials and 47,523 participants with cardiovascular disease, also observed a lower stroke risk, but with no difference in all-cause mortality ⁴.

These numbers do not mean that folic acid is a "heart protector" for everyone. The effects were seen mainly in populations with high homocysteine levels or in regions without food fortification, and they do not replace the management of risk factors such as blood pressure. In people with chronic kidney disease, a meta-analysis of 11 trials showed no clear cardiovascular benefit from lowering homocysteine with folic acid ⁵.

Inflammation: marker results, not disease results

Some trials measured inflammatory markers. A meta-analysis of 18 randomised trials with 2,286 adults found reductions in C-reactive protein, TNF-α and interleukin-6 with folic acid supplementation, with suggested effects at doses up to 5 mg per day and in studies lasting more than 12 weeks ⁶. Another meta-analysis of 10 trials with 1,179 participants also found a reduction in C-reactive protein, with a greater effect in women and in people with type 2 diabetes ⁷.

These results refer to laboratory markers, not to clinical outcomes such as preventing disease. They do not allow the conclusion that folic acid treats or prevents any inflammatory disease.

Blood vessel function

A meta-analysis of 21 trials with 2,025 adults assessed endothelial function and found an improvement in flow-mediated dilation, a marker of vascular health ⁸. This is an intermediate marker, not proof of a reduction in cardiovascular events.

Cognition and dementia

Here the evidence is less favourable. A meta-analysis that pooled 95 studies with 46,175 participants concluded that B vitamins may benefit cognitive function in some contexts, but the results are not consistent ⁹. A systematic review of 16 trials with 6,276 participants found no effect of vitamin B12 alone or of a B complex (B12 with folic acid, with or without B6) on any cognitive domain, or on depressive symptoms, in people without evident B12 deficiency ¹⁰. In a trial with 120 people with Alzheimer's disease, combined supplementation of folic acid (1.2 mg/day) and vitamin B12 (50 µg/day) for 6 months had beneficial effects on some cognitive scores ¹¹ — but this is a population with a diagnosed disease, so the results do not generalise to healthy adults.

Male fertility

A randomised trial with 2,370 couples undergoing infertility treatment tested 5 mg of folic acid and 30 mg of zinc daily, for 6 months, in men; there was no improvement in semen quality or in the live birth rate ¹². This contradicts the idea that supplementation improves male fertility in general.

Who should take folic acid?

The groups with the clearest indication for supplementation are:

• Women planning a pregnancy or of childbearing age — to ensure adequate levels before conception, since neural tube defects occur in the first weeks of pregnancy ¹.
• Pregnant women — supplementation is part of prenatal care; the dose should be set by a healthcare professional. In pregnant women, iron supplementation with folic acid is studied for the prevention of anaemia and other maternal and infant outcomes ¹³.
• People with a diagnosed folate deficiency — confirmed by blood tests, not by self-diagnosis.
• People with malabsorption — such as coeliac disease, Crohn's disease or other inflammatory bowel diseases.
• Those taking medicines that interfere with folate — such as methotrexate; supplementation should be guided by the prescribing doctor.
• People with high alcohol consumption — alcohol can reduce absorption and deplete folate stores.

If you do not fall into any of these groups, your diet is probably sufficient. Leafy green vegetables, pulses, citrus fruits, nuts and fortified cereals are good sources.

Folic acid in gummy form: what does the label say?

Folic acid supplements come as tablets, capsules and gummies. There are no studies directly comparing the effectiveness of gummies with that of tablets; the difference lies mainly in convenience and in adherence to the daily intake. What matters is checking the dose per serving on the label.

In the TuttiBear range, Hair & Nails Gummies provide 442 µg of folic acid per serving of 2 gummies (221% of the reference intake). Appetite Control Gummies provide 400 µg per serving of 2 gummies (200% of the reference intake). Multivitamin Gummies state 10 µg of folic acid (expressed as µg DFE) per serving of 2 gummies. Kids' Multivitamin Gummies (+2 years) provide 115 µg of folate per 1 gummy (58% of the reference intake), with a recommendation of 1 gummy per day for children from 2 years of age, under adult supervision.

Bear in mind that the doses used in clinical trials are not dosing instructions. For example, the trial in couples undergoing infertility treatment used 5 mg of folic acid per day ¹², a dose far higher than that of over-the-counter supplements; that dose was used in a research setting and should not be replicated without medical advice.

Folic acid and vitamin B12: why the combination matters

Folic acid and vitamin B12 work together in homocysteine metabolism. A B12 deficiency can cause neurological symptoms that folic acid may mask if it is taken on its own in high doses, delaying diagnosis. That is why anyone with symptoms suggestive of deficiency should have blood tests before supplementing, and should not start high doses on their own.

In addition, the evidence on B complex and cognition suggests that supplementation brings no cognitive benefits in people without a deficiency ¹⁰.

Safety and limits of supplementation

Folic acid is safe at the doses usually found in food supplements. High, prolonged doses should be supervised by a healthcare professional, especially in people with a history of B12 deficiency or with kidney disease.

The tolerable upper intake level set by EFSA for synthetic folic acid is 1,000 µg per day in adults ¹⁴. This value applies to the sum of folic acid from supplements and fortified foods, and not to the natural folate in foods.

There is no evidence that folic acid helps with weight loss, strengthens hair or nails in people without a deficiency, or improves mood. If you see those promises, be sceptical. For vitamins and minerals, the health claims authorised in the European Union are specific and limited; for example, folic acid contributes to maternal tissue growth during pregnancy and to the normal function of the immune system ¹⁵.

If you suspect a deficiency — through symptoms such as tiredness, paleness, shortness of breath or skin changes — the first step is to talk to a doctor and have blood tests, rather than self-diagnosing. Only a healthcare professional, based on the results, can say whether there is a deficiency and what dose is appropriate. Do not take high doses on your own, because this can mask a vitamin B12 deficiency and delay the diagnosis of neurological problems.

If you are pregnant, breastfeeding, ill or taking medicines, always consult a healthcare professional before starting any supplement. To learn more about the daily dose and what to consider before taking it, see our article on folic acid daily dose.

Practical questions before choosing a supplement

If you decide to supplement, check the dose per serving on the label, the number of gummies per pack and the warnings. Gummies can be a convenient option for anyone who has trouble swallowing tablets; if daily adherence is better with a gummy, that is a practical advantage, even though there is no evidence of superiority over other forms. You can compare formats in the article folic acid gummies or tablets and clear up safety questions in is folic acid bad for you?.

For an overview of the ingredient, see the folic acid page. If you are looking for supplements with this vitamin, you can explore folic acid gummies.

Frequently asked questions

What is folic acid and what is it used for?

Folic acid is the synthetic form of vitamin B9. It takes part in DNA synthesis, cell division and red blood cell formation. Its best-established indication is the prevention of neural tube defects when taken before and during early pregnancy.

Who should take folic acid supplements?

Women planning a pregnancy or of childbearing age, pregnant women, people with a diagnosed folate deficiency, people with intestinal malabsorption, those taking medicines that interfere with folate and people with high alcohol consumption. Outside these groups, diet is usually sufficient.

Does folic acid help prevent cardiovascular disease?

Some trials showed a reduction in stroke risk in specific populations, especially in regions without food fortification and in people with high homocysteine. However, the results are not consistent and do not replace the management of risk factors such as blood pressure.

Does folic acid make you gain weight or help you lose weight?

There is no evidence that folic acid has any effect on body weight. Any weight-loss promise linked to this vitamin has no scientific support.

Can I take folic acid without a blood test first?

If you are pregnant or planning to become pregnant, supplementation is usually recommended. Outside those cases, it is best to talk to a healthcare professional, because high doses can mask a vitamin B12 deficiency.

Are folic acid gummies as effective as tablets?

There are no studies directly comparing folic acid gummies and tablets. The active substance is the same; the difference lies in convenience and in adherence to the daily intake. Always check the dose per serving on the label.