16KETO KETO Diet Information
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Folate (Vitamin B9)

For life to exist, folate is required. Yes, it is that important to our survival. Our bodies’ cells depend on folate every minute.

Among its various roles, B9 is the key component of the “methylation” process, which keeps all of our cells alive and without which they would all perish. Almost every aspect of our day-to-day functioning, including energy generation, hormone balance (estrogen synthesis and breakdown), gene expression, mood regulation, and cravings, depends on methylation.

If you try to resist the need to eat carbohydrates without adequate folate, you’ll probably fail. Neurotransmitters that regulate our cravings and give us a sense of happiness and contentment include serotonin and dopamine, which folate modulates. Additionally, the production of red blood cells and the DNA for rapidly dividing cells (found in the skin, lungs, and gut lining) both eat up folate. You can undoubtedly now understand why it’s critical to have a lot of B9 on hand, but sadly, folate levels can become low when following a ketogenic or Atkins-style diet.

An analysis of almost 11,000 pregnant women who gave birth over a 13-year span in 2018 found that mothers who followed a low-carb diet had a 30 percent higher risk of giving birth to a fetus with a neural tube abnormality (spina bifida and anencephaly). In conclusion, the “mean dietary intake of folic acid among women with restricted carbohydrate intake was less than half that of other women” was the cause.


Given that the keto diet limits carbohydrates to an absolute minimum and that many plants include carbohydrates, it is simple to understand how eliminating leafy greens can lead to a steady reduction in a supply of folate (B9).

Pregnant women commonly take folic acid, a precursor to folate, as a vitamin both before and throughout pregnancy. However, since folic acid is absent from nature, taking supplements containing it is not advised (whether you are pregnant or not). This is because folic acid must go through a challenging process in order to be converted into “active” folate, also known as “methyl-folate,” which can then be utilized by our cells.

Methylene Tetra Hydro Folate Reductase is the major enzyme responsible for this process of turning folic acid into “active” methyl-folate (MTHFR). Even without being on a low-folate diet like keto, 10–50% of us have genetic mutations called SNPs (also known as “snips”) that slow MTHR by 30–80%, making it challenging to maintain appropriate folate levels.

Action Items:

• If you’re on a no-carbohydrate or extremely low-carbohydrate diet, make sure you eat 1-2 portions of leafy green vegetables, such as kale, chard, and spinach, every day.

• If you want to ensure you have enough folate while eliminating most carbs, consider taking an active” folate supplement—a methylated form of folate that is ready to use by the body. Adding active B-12 (methyl cobalamin) usually makes methylation work even better, especially if you carry mutations such as MTRR, which affect your ability to make “active” B-12. Testing is easy and this is also available in your 23andMe report.

• Avoid “folic acid” supplementation as folic acid as it needs to be converted to the active methylated folate form and this process can be significantly slowed, especially when dealing with the MTHFR or MTRR mutations (mentioned above). If you have an MTHFR mutation, folic acid can actually be detrimental as it accumulates and will compete with folate for its receptor, preventing it from doing its work.

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