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Folic acid and food folates are absorbed and metabolized by different pathways. After digestion, food folates are converted in the small intestine to 5-methltetrahydrofolic acid, a biologically active vitamer of vitamin B9. Folic acid is absorbed and transported in the bloodstream to the liver, where it is converted to tetrahydrofolate, a second biologically active vitamer, by dihydrofolate reductase. The liver has a limited capacity to metabolize folic acid into tetrahydrofolate. Any folic acid that is not converted to tetrahydrofolate in the liver remains in the blood until it is either metabolized in the liver or excreted by the kidney. Folic acid that remains in the blood stream is considered unmetabolized folic acid. Since the introduction of mandatory folic acid fortification in the US, most people have a variable amount of unmetabolized folic acid circulating in their blood.