Complete Testing & Optimization Guide
Optimal ranges, provider comparison, and strategies to improve your Folate levels
Only 5 providers include this test
Vitamins &Nutrients
>3.0 ng/mL, Optimal:7-15 ng/mL
Abnormal Folate levels can indicate underlying health issues that may go undetected without proper testing. Regular monitoring helps catch problems early when they're most treatable.
Understanding your Folate levels enables targeted interventions, tracks treatment effectiveness, and helps optimize your overall health and performance.
Folate (vitamin B9) is a water-soluble vitamin essential for DNA synthesis, cell division, methylation, and red blood cell formation. The term "folate"refers to the natural form found in foods (leafy greens, legumes, citrus), while "folic acid"is the synthetic form used in supplements and fortified foods. Folate is critical during periods of rapid cell division—pregnancy, infancy, adolescence—and deficiency causes neural tube defects (spina bifida) in developing fetuses, which is why folic acid fortification of grain products has been mandatory in the US since 1998.
Here's the critical insight:not all folate is created equal. Folic acid (synthetic) must be converted to the active form, 5-methyltetrahydrofolate (5-MTHF or methylfolate), via the MTHFR enzyme. ~40% of people have MTHFR gene variants (C677T or A1298C) that reduce enzyme activity by 30-70%, impairing folic acid metabolism. These individuals may have normal serum folate but functional deficiency at the cellular level. Methylfolate supplements bypass this issue entirely and are preferred, especially for those with MTHFR variants, depression, or cardiovascular disease.
Folate works in tandem with B12 in the methylation cycle, converting homocysteine→methionine. Deficiency of either vitamin causes elevated homocysteine (>10 mcmol/L), a risk factor for cardiovascular disease, stroke, cognitive decline, and Alzheimer's. If folate is low but B12 is also low, you MUST correct B12 first—giving folate alone can mask B12 deficiency anemia while allowing irreversible neurological damage to progress.
Bottom line: TSH and Free T4 alone miss people with conversion problems. Free T3 is the only way to know if you have enough active thyroid hormone at the tissue level.
| Range Type | Level | Clinical Significance |
|---|---|---|
| Optimal (Longevity) | >20 ng/mL | Target for optimal methylation, brain health, CVD prevention. Many functional medicine doctors target >15-20 ng/mL. |
| Adequate (Standard) | >10 ng/mL | Meets standard guidelines. Sufficient to prevent megaloblastic anemia but may be suboptimal for methylation and homocysteine. |
| Suboptimal | 4-10 ng/mL | Low-normal. May have elevated homocysteine. Consider supplementation, especially if MTHFR variant or CVD risk factors. |
| Deficient | <4 ng/mL | Frank deficiency. Causes megaloblastic anemia, elevated homocysteine, increased NTD risk in pregnancy. Requires immediate folate supplementation. |
Standard lab range:>3.0 ng/mL, Optimal:7-15 ng/mL
>20 ng/mL
Folate Supplementation (Dose and Form)
Dietary Sources of Folate
Optimize Methylation Cofactors
MTHFR Testing and Methylfolate
Note: Address Elevated Homocysteine
Note: Fatigue, weakness|Shortness of breath, palpitations (megaloblastic anemia)|Pale or jaundiced skin|Glossitis (sore, red, smooth tongue)|Mouth ulcers, sores|Depression, low mood, irritability|Cognitive decline, memory problems, brain fog|Elevated homocysteine (>10 mcmol/L)|Increased CVD risk (via homocysteine)|Neural tube defects in pregnancy (spina bifida, anencephaly)|Premature graying of hair (rare)
Excessive folic acid supplementation (>1000 mcg/day). Natural folate from food cannot cause toxicity.|Fortified foods + supplements:Easy to exceed 1000 mcg/day if consuming fortified grains + multivitamin + B-complex.|Rarely, kidney disease (impaired excretion).
Source:Baseline:Check serum folate if symptoms (fatigue, anemia, depression) or risk factors (low vegetable intake, malabsorption, alcohol use, MTHFR variant).|Check homocysteine:More sensitive marker of functional folate status. If homocysteine >10 mcmol/L, consider folate (and B12) deficiency even if serum folate appears normal.|After starting supplementation:Retest folate and homocysteine in 3 months. Goal:folate >15 ng/mL, homocysteine <8 mcmol/L.|Pregnancy:Baseline folate before conception. Supplement 400-800 mcg/day throughout pregnancy.|If on methotrexate:Monitor folate closely;may need leucovorin (folinic acid) rescue to prevent toxicity.
Folic acid supplementation (400-800 mcg/day) started before conception reduces NTD risk by 70%. US grain fortification (since 1998) reduced NTD prevalence by 25-30%. Neural tube closes by day 28 of pregnancy—before most women know they're pregnant—hence recommendation for all women of childbearing age to supplement.
Source:MRC Vitamin Study Research Group. Prevention of neural tube defects with folic acid. Lancet. 1991;338(8760):131-137.
Folate supplementation lowers homocysteine by 25-30%. Meta-analyses show folic acid supplementation (800 mcg/day) reduces stroke risk by 10-20%, with greater benefit in populations without grain fortification. CVD benefit is modest in RCTs, possibly because started too late in disease process or because homocysteine is a marker, not a cause.
Source:Wang X, et al. Efficacy of folic acid supplementation in stroke prevention:a meta-analysis. Lancet. 2007;369(9576):1876-1882.
Folate deficiency is common in depression (15-40% of depressed patients have low folate). Low folate associated with poor antidepressant response. Methylfolate (15 mg/day) improves treatment-resistant depression when added to SSRIs in RCTs. Methylfolate enhances serotonin, dopamine, and norepinephrine synthesis.
Source:Papakostas GI, et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression. Am J Psychiatry. 2012;169(12):1267-1274.
Low folate (<10 ng/mL) associated with 2-3x higher dementia risk. Folate + B12 + B6 supplementation slows cognitive decline and brain atrophy in elderly with elevated homocysteine. Benefits greatest when started early (MCI stage) before significant dementia.
Source:Durga J, et al. Effect of 3-year folic acid supplementation on cognitive function in older adults. Lancet. 2007;369(9557):208-216.
| Provider | Includes Test | Annual Cost | Total Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ |
 WHOOP Advanced Labs | — | $349 | 65 |
 Labcorp OnDemand | — | $398 | 30+ |
| — | $486 | 40+ | |
| — | $468 | 83 | |
| ✓ | $798 | 100+ | |
 InsideTracker | — | $680 | 48 |
 Function Health | ✓ | $499 | 100+ |
| ✓ | $900 | 70+ | |
| ✓ | $1150 | 110 | |
| — | $Varies | 75+ |
Choose from 5 providers that include this biomarker in their panels
Folate is a vitamins &nutrients biomarker that B vitamin important for cell division and DNA synthesis The normal reference range is >3.0 ng/mL, Optimal:7-15 ng/mL. Regular testing helps track changes and identify potential health issues early.
5 out of 10 major blood testing providers include Folate in their standard panels. These include Superpower, Blueprint, Mito Health and others.
For most people, testing Folate 2-4 times per year is recommended to establish baseline levels and track trends. If you have abnormal results or are actively working to optimize this biomarker, more frequent testing (quarterly) may be beneficial. Always consult with your healthcare provider for personalized testing frequency recommendations.
The standard laboratory reference range for Folate is >3.0 ng/mL, Optimal:7-15 ng/mL. However, many functional medicine practitioners recommend tighter "optimal" ranges for peak health and performance. Your ideal range may vary based on your age, sex, health goals, and other individual factors. Work with a healthcare provider familiar with optimal ranges to determine your target levels.
Most direct-to-consumer blood testing services that include Folate provide the physician order as part of their service. However, some states have restrictions on direct-to-consumer testing. Check with your chosen provider about availability in your state and whether they provide the necessary physician authorization.
Essential for DNA synthesis and red blood cell formation. Critical in pregnancy to prevent neural tube defects. Deficiency causes anemia.
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs and before making decisions about blood testing.
