Paul Saladino has recently urged people to avoid folic acid, including in prenatal supplements. In a recent Instagram reel he says to “avoid folic acid and replace it with folate,” framing synthetic folic acid as harmful and implying it should be swapped out during pregnancy. Source. He has voiced similar views in older videos about fertility and pregnancy. Source.
Claims like these are not only unsupported by high quality evidence, but they risk undoing one of public health’s biggest success stories. Folic acid taken before conception and in early pregnancy prevents serious birth defects of the brain and spine known as neural tube defects.
What folic acid is and why timing matters
Folic acid is the stable, synthetic form of vitamin B9 used in supplements and food fortification. It raises blood folate reliably and has been the form tested in clinical trials that show prevention of neural tube defects. The neural tube closes very early in pregnancy, around four weeks after conception, often before a person knows they are pregnant. That is why guidance stresses starting before conception and continuing through the first trimester.
What the strongest evidence shows
- Prevention of neural tube defects: Daily folic acid of 400 micrograms reduces first occurrence of neural tube defects. Higher doses reduce recurrence risk by more than 70 percent in high risk pregnancies.
- Population impact: Countries that fortified staple foods with folic acid saw large falls in neural tube defect rates. Supplementation is still advised because many pregnancies are unplanned and fortification alone does not guarantee adequate intake.
- Clear recommendations: The USPSTF gives folic acid an A grade and advises 400 to 800 micrograms daily for anyone who could become pregnant. UK guidance says 400 micrograms daily from preconception to 12 weeks, with 5 milligrams for defined high risk groups under medical advice.
MTHFR variants and “use folate, not folic acid” claims
Saladino’s argument often pivots on genetics, particularly MTHFR variants, and on the idea that unmetabolised folic acid builds up and causes harm. Here is what authoritative bodies say:
- MTHFR is not a reason to avoid folic acid: The NHS states that people with MTHFR variants should still take 400 micrograms of folic acid daily and that testing is not recommended for routine care.
- Only folic acid is proven to prevent neural tube defects: Expert groups emphasise that folic acid is the form with definitive evidence for prevention. Substituting other folate forms has not shown the same population benefit.
Safety, upper limits, and what the “too much” debate really means
Standard prenatal doses are considered safe and beneficial. Concerns about excessive folic acid relate to sustained intakes above the adult upper limit of 1,000 micrograms from supplements and fortified foods, masking B12 deficiency in older adults, and theoretical risks in certain cancer contexts at high doses. These concerns do not overturn the clear benefit of 400 to 800 micrograms per day around conception for neural tube defect prevention. Clinicians sometimes prescribe 5 milligrams daily for specific high risk groups under supervision.
What happens if people follow Saladino’s advice
Skipping folic acid in the preconception window risks more babies being born with neural tube defects like spina bifida and anencephaly. These conditions can cause paralysis, bladder and bowel dysfunction, severe disability, or death. They often occur before pregnancy is recognised, so waiting until a positive test is too late for the full protective benefit.
UK specific notes
In the UK the advice is straightforward. Take 400 micrograms folic acid daily when trying to conceive and until 12 weeks of pregnancy. Some people need 5 milligrams under medical advice, for example with a previous neural tube defect pregnancy, diabetes, certain anti-epileptic medicines, or specific family histories. Fortification of flour is being implemented to support population folate status, but it does not replace individual supplementation.
Bottom line
Advising pregnant women or those planning pregnancy to avoid folic acid ignores a large and consistent body of evidence and risks real harm. Folic acid at recommended doses is safe and is the only form proven to prevent neural tube defects at a population level. If you could become pregnant, start 400 micrograms daily now, and speak to your GP or midwife about whether you need a higher prescribed dose.
Key sources
- USPSTF. Folic acid to prevent neural tube defects. A recommendation. Link
- NHS pregnancy vitamins guidance. Link
- CDC. MTHFR and folic acid facts. Link
- NICE NG247 and evidence reviews on high dose folic acid. Link | Evidence review
- NCBI review of folic acid and neural tube defect prevention. Link
- Fortification impact review. Link
- Saladino’s recent statement to avoid folic acid. Link; prior video: Link
- NIH Office of Dietary Supplements. Folate fact sheet for health professionals. Link
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