Folate, also known as vitamin B9 is a vital nutrient necessary for body functioning. Folate is crucial for many bodily processes, including the production of DNA, the formation of red blood cells, and the proper functioning of the nervous system. Folate is a nutrient found in food sources like breads, nuts, grain products, fortified breakfast cereals, strawberries, green leafy vegetables, Brussel sprouts, corn meals, and peas.

Prior to folic acid fortification in the US, folate deficiency was observed in various population groups. This included school-age children (2.3% of the folate-deficient population), adults (24.5%), and older individuals (10.8%). Around 5 % of the US population experienced folate deficiency overall.

The global folate market was valued at USD 876.52 million in 2021 and is projected to reach over USD 1,481.05 million by 2030, according to Precedence Research.

 

Daily Requirement of Folate

The recommended daily amount of folate varies depending on factors like age, gender and life stage. For adults, the recommended dietary allowance (RDA) of folate is generally around 400 to 600 micrograms (mcg) per day. However, during pregnancy, the requirement increases to 600 to 800 mcg per day to support the growing baby. Lactating women also have higher folate needs, typically around 500 to 600 mcg per day. It’s important to remember that these recommendations are general guidelines and individual needs may vary. Consulting with a healthcare professional or registered dietitian can help determine the specific folate requirement for your circumstances.

 

The Link Between Folate And Other Diseases

  • Heart health: It helps regulate homocysteine in the blood levels, and high levels of homocysteine have been associated with an increased risk of cardiovascular diseases. Sufficient intake of folate along with other B vitamins may help reduce homocysteine levels and potentially lower the risk of heart disease.
  • Cancer prevention: Folate plays a complex role. While folate is essential for DNA synthesis and cell division, which can help prevent abnormal cell growth, the relationship between folate and cancer is not straightforward. High-dose supplementation of folate, especially in individuals with pre-existing cancerous or precancerous conditions, may have mixed effects and needs to be carefully evaluated. It’s generally recommended that people obtain folate through a balanced diet rather than high-dose supplementation.
  • Immune system: It is involved in the production of white blood cells, which are key components of the immune system. Adequate folate intake supports the proper functioning of the immune system and helps maintain its effectiveness in fighting off infections and diseases.
  • Energy levels: Folate can contribute to energy levels as it is involved in the metabolism of carbohydrates, proteins, and fats, which are sources of energy for the body. It helps convert these nutrients into usable energy. Adequate folate levels support proper energy production and metabolism, which can help combat fatigue and maintain optimal energy levels.
  • Hair, skin, and nails: Folate helps in the growth and repair of cells in the body, including those in the hair, skin, and nails. Having enough folate supports the overall health and appearance of these tissues.
  • Weight management:  Folate itself does not directly impact weight management. However, maintaining adequate folate levels through a balanced diet is important for overall health, including metabolism. A healthy diet that includes folate-rich foods can support weight management when combined with other healthy lifestyle habits.
  • Bone health:  Folate plays a role in supporting bone health indirectly by helping in the production of new cells involved in bone formation. Maintaining sufficient folate levels along with nutrients like calcium and vitamin aspartic acid contributes to overall bone health.
  • Eye health: Folate supports eye health by aiding in the production of new cells for eye tissue, but a balanced diet with additional eye-healthy nutrients is necessary for managing specific eye conditions and maintaining overall eye health.
  • Age-related macular degeneration: While there is some evidence suggesting a possible connection between folate and a lower risk of age-related macular degeneration (AMD), the research is inconclusive. To support eye health and potentially reduce the risk of AMD, it’s important to take a comprehensive approach, including regular eye exams and a balanced diet rich in antioxidants and omega-3 fatty acids.
  • Liver health: Folate contributes to liver health by aiding in nutrient metabolism and cell production. However, maintaining liver health requires a balanced lifestyle, including a healthy diet, limited alcohol intake, and avoiding risk factors. These factors, along with adequate folate intake, supports overall liver health.
  • Digestion and gut health: Folate indirectly support digestion and gut health by promoting cell production and repair in the digestive tract. However, digestion and gut health depend on various factors like diet, exercise, and gut bacteria balance.
  • Anti-inflammatory: Folate has anti–inflammatory properties and may aid in reducing inflammation within the body. It can contribute to the regulation of immune responses and the production of anti-inflammatory substances.

 

Nurturing Well-Being, Brain Function, and Pregnancy Health

Folate plays a crucial role in maintaining our overall well-being. It is involved in various important processes in our body. This is important for cell growth, repair, and overall development. Additionally, folate is involved in the synthesis of certain chemicals in the brain called neurotransmitters, which help regulate our mood such as serotonin and dopamine, emotions, and cognitive function. By supporting these processes, folate contributes to our overall well-being, including our energy levels, brain function, and mental health. Additionally, it is vital during pregnancy for the proper development of the baby’s brain and spinal cord.

 

Folate Deficiency: Symptoms

Folate deficiency can lead to various symptoms such as muscle weakness, fatigue, memory problems, and vision issues. It may also cause conditions like depression and mouth ulcers. Certain groups, including individuals with alcohol use disorder, certain genetic mutations, nutrient absorption issues, or eating disorders, are at a higher risk of folate deficiency.

 

Folate Supplements and Interaction Certain Medications

Folate supplements can interact with certain medications, and it’s important for individuals taking these medications to discuss their folate intake with their healthcare providers. Here are a few examples:

  • Methotrexate: Methotrexate is used to treat cancer and autoimmune diseases, and it acts as a folate antagonist. Patients taking methotrexate for cancer should consult their oncologist before taking folate supplements because the supplements could interfere with the anticancer effects of methotrexate. However, for patients taking low-dose methotrexate for rheumatoid arthritis or psoriasis, folate supplements might help reduce gastrointestinal side effects.
  • Antiepileptic medications: Medications like phenytoin, carbamazepine, and valproate are used to treat epilepsy, psychiatric diseases, and other medical conditions. These medications can reduce serum folate levels. Additionally, folate supplements might lower the serum levels of these antiepileptic drugs.
  • Sulfasalazine: Sulfasalazine is primarily used to treat ulcerative colitis. It inhibits the absorption of folate in the intestines and can lead to folate deficiency.

 

Public Health Initiatives And Folate

Public health initiatives often emphasize the importance of folate in promoting overall health and preventing folate deficiency-related conditions. These initiatives may include education campaigns, fortification programs, and recommendations for dietary intake to ensure that individuals have access to and consume sufficient folate, particularly during critical life stages such as pregnancy. By addressing folate needs on a population level, public health efforts aim to improve well-being and reduce the risk of folate-related health issues in communities.

 

Bioavailability Of Folate: Absorption And Utilization By The Body

Bioavailability refers to the extent to which a nutrient, in this case, folate, is absorbed and utilized by the body after consumption. The bioavailability of folate can vary depending on its form and the food source from which it is derived. Natural food sources of folate, such as fruits, vegetables, and legumes, generally have good bioavailability. On the other hand, synthetic forms of folate, such as folic acid found in fortified foods and supplements, have higher bioavailability. Factors such as digestion, absorption, and individual variations can also impact the bioavailability of folate. It is important to consider bioavailability when assessing dietary intake and evaluating the effectiveness of folate supplementation.

 

Metabolic Diseases Related To Folate

Metabolic diseases linked to folate include hereditary folate malabsorption, cerebral folate deficiency (CFD) syndrome, and DHFR deficiency. These conditions affect folate absorption, transport, and metabolism, leading to various symptoms such as anemia, neurological abnormalities, and developmental disorders. Treatment with folinic acid can help alleviate symptoms and improve outcomes. These diseases underscore the vital role of folate in metabolic processes and brain function.

 

Supplements Of Folate

Folic acid is a form of folate that is commonly used as a dietary supplement. It can be found in various products, including single-ingredient supplements, as well as combination products like B-complex vitamins and multivitamins. When taking folic acid supplements, it’s important to follow the recommended dosage.

For higher dosages of folic acid, such as 1 mg or more, a prescription from a healthcare provider is required. This is because higher doses may have specific medical purposes and should be supervised by a healthcare professional.

The US Food and Drug Administration (FDA) have approved the supplementation of folate in oral contraceptives. Levomefolate calcium, a form of folate called MeTHF, is added to oral contraceptives to help improve folate levels in women in the ages of childbearing. This is important because adequate folate levels are crucial for the healthy development of a baby during pregnancy.

However, despite the availability of folic acid supplements and the importance of sufficient folate intake, many women in the US are not meeting the recommended daily intake of 400 micrograms (μg) of folic acid. This information comes from a national survey that found only 24% of non-pregnant women aged 15-44 years are meeting this recommendation. It highlights the need for improved awareness and education about the importance of folic acid in maintaining overall health, particularly for women who are planning pregnancy.

 

Assessing Folate Status: Diagnosis

  • Serum Folate: This blood test measures the level of folate in the blood. It provides an assessment of the current folate status in the body.
  • Red Blood Cell (RBC) Folate: RBC folate test measures the level of folate specifically in the red blood cells. It reflects the long-term folate status and can help identify folate deficiency.
  • Homocysteine and Methylmalonic Acid (MMA) Levels: Elevated levels of homocysteine and MMA in the blood can indicate insufficient folate levels. These tests indirectly assess folate status and are commonly used alongside serum folate measurements.
  • Folate Loading Test: This test involves administering a high dose of folic acid orally and measuring the subsequent rise in serum folate levels. It helps evaluate the body’s ability to absorb and utilize folate.

 

Some Common Questions on Folate

What Is The Difference Between Folate And Folic Acid?

Folate is the natural form of vitamin found in food, while folic acid is the synthetic form used in supplements and fortified foods. Once inside our bodies, both forms are converted into the same active form that our cells need. Consuming folate–rich foods is often recommended because some individuals may have difficulty in converting folic acid to its active form.

 

What Are The Consequences Of Folate Deficiency?

Folate deficiency can have various consequences on our health. A deficiency in folate can impact cell growth, DNA production and the repair of cells in our body. This can lead to symptoms such as fatigue, weakness, and shortness of breath. Folate deficiency can also affect the production of red blood cells, leading to anemia, which can cause symptoms like pale skin, dizziness, and difficulty concentrating. In pregnant women, folate deficiency is particularly concerning, as it can increase the risk of neural tube defects in the developing baby, such as spina bifida. Folate deficiency can have an impact on brain function and mental health, potentially leading to symptoms such as depression, anxiety and cognitive impairment.

 

Can I Get Enough Folate From My Diet Alone?

It’s important to consider that factors like cooking methods and storage can influence the folate content in foods. Additionally, some individuals may have higher folate needs or absorption issues that make it difficult to meet their requirements through diet alone. In such cases, a healthcare professional may recommend folate supplements to ensure adequate intake.

 

Who Is At Risk Of Folate Deficiency?

Several groups of people are at a higher risk of folate deficiency. Pregnant women require higher levels of folate to support the development of their baby. People with poor dietary habits, or certain medical conditions affecting nutrient absorption, such as celiac disease or inflammatory bowel disease, may also be at risk. Alcoholics and individuals taking certain medications that affect folate metabolism may also have an increased risk of deficiency. The elderly population may be more prone to folate deficiency due to decreased absorption and lower dietary intake.

 

Potential Risks Of Excessive Folate Intake

While folate is generally safe in moderate amounts, excessive intake can pose certain health risks. These risks include vitamin B12 deficiency, potentially accelerating the progression of preneoplastic lesions, the presence of unmetabolized acid affecting the immune system, potential cognitive impairment, and interactions with certain medications.

 

Are There Any Side Effects Of Folate Supplementation?

Folate supplementation is generally safe when taken as recommended. However, in some cases, it may cause mild side effects such as nausea, bloating, and digestive issues. These side effects are usually temporary and resolve on their own.

 

Can Folate Help With Insomnia Or Sleep Disorders?

Folate indirectly affects sleep quality by helping produce neurotransmitters involved in sleep regulation. Adequate folate levels support a healthy sleep-wake cycle, but other factors like sleep hygiene and stress management also impact sleep. Folate is not a standalone solution for sleep disorders, so it’s best to consult a health professionals for an appropriate treatment.

 

Is Folate Beneficial For Hormonal Balance?

Folate plays a role in supporting hormonal balance by participating in various processes in the body. It helps in the synthesis and regulation of certain hormones, which are chemical messengers that control various bodily functions. Adequate folate levels can contribute to maintaining hormonal balance, but it is just one factor among many that influence hormone levels.