Folate/Folic Acid

Stunning statistics released recently suggest folate deficiency is staggeringly common:

up to 60% of children (age 11-18), 56% of adults up to the age of 64 and 36% of adults over 65 were in the risk group for folate insufficiency. Even more concerning, out of all women in child-bearing age, a staggering 75% had inadequate folate levels for the prevention of foetal neural tube defects!

Heck! Rather than reinvent the wheel, here’s a really useful summary about folic acid from Biocare.

I like Biocare products because they have good knowledge, especially about the methyl nutrients, of which folate is one. So important. I am most often asked for a folate to help methylation and then I advise you take it with the other methylators and co-factors, so something like this, which is a methyl-strong multi.

The other reason I am asked is for pregnancy and they have a brilliant ante natal product now with the methyl forms of folate and really good amounts of the other nutrients needed. You can see that here.

Meantime, here’s their summary on folate for you, with a few comments from me, of course…!

Folic acid, folate, methylfolate, vitamin B9; so many names for one nutrient! Are you confused about folate; the different forms, what it does and whether you might be deficient?

Folate is an umbrella term for a group of molecules found in foods and supplements. The name folate comes from the Latin word ‘folium’, which stands for leaf, as it’s commonly found in a lot of leafy vegetables. In fact, it was first isolated from spinach. Other dietary sources of folate include meat, eggs and dairy, broccoli and legumes.1,2,3

By supporting a process called methylation, folate indirectly supports many functions:

  • Cell replication, DNA synthesis and repair,4 thus crucial during periods of growth such as childhood or pregnancy, as well as for repair of damaged tissue caused by general wear and tear and ageing, injuries or an inflammatory condition such as arthritis.
  • Red blood cell formation5 for oxygen delivery throughout the body.
  • Hormone and neurotransmitter metabolism, including detoxification of oestrogen.6
  • Homocysteine metabolism7 – high homocysteine increases the risk of heart disease,8 cognitive impairment9 and depression.10
  • Histamine breakdown11 and so it is helpful in allergic conditions such as hay fever or asthma. (And others, see the Histamine factsheet here)
  • Healthy pregnancy and foetal development.

The symptoms and risk associated with folate deficiency include:

  • Low energy and fatigue
  • Megaloblastic anaemia – abnormally large and dysfunctional red blood cells
  • Female hormone imbalances e.g. heavy and painful periods
  • Heart disease, high blood pressure
  • Infertility
  • Increased risk of neural tube defects (NTDs) such as spina bifida12 and cleft-lip and palate in babies.13,14
  • Memory, cognitive and mental health problems

Are you getting enough?

A recent National Diet and Nutrition Survey concluded some worrying statistics. According to their findings, up to 60% of children (age 11-18), 56% of adults up to the age of 64 and 36% of adults over 65 were in the risk group for folate insufficiency. Even more concerning, out of all women in child-bearing age, a staggering 75% had inadequate folate levels for the prevention of foetal neural tube defects!15

Folate absorption and utilisation depends on multiple factors, including our genetics,16,17,18digestion, environment, and general state of health and metabolism. This means that we all have unique folate requirements.

In the body, folate exists in the three bioactive forms:

  • Methylfolate or 5-MTHF (5-methylene tetrahydrofolate) – the most abundant form of folate in the body19 and a major co-factor for chemical reactions.
  • 10-formyltetrahydrofolate and 5,10-methylenetetrahydrofolate – needed for DNA synthesis and repair.

Some folate found in foods, as well as folic acid from supplements, needs to be converted to these active forms in the body. Some individuals may struggle with that conversion meaning they won’t get the full benefit. You can overcome poor conversion by supplementing with methylfolate directly instead. In fact, it’s been shown that the Quatrefolic® form of methylfolate is 3 times more bioavailable than folic acid.20

One of the mutations that has been linked to poor folate conversion is MTHFR (methylenetetrahydrofolate reductase) gene, which codes for an enzyme that synthesises methylfolate. Mutations are quite common, with up to 50%21 of population affected, depending on ethnicity,22 and can reduce folate conversion by between 45%23 and 70%.24 This mutation has been studied extensively and linked to miscarriages,25 pre-eclampsia,26 birth defects,27 cardiovascular disease,28 multiple sclerosis, rheumatoid arthritis and autism.29 You can test for MTHFR problems here.

How much do you need? The recommended daily intake of folate in the EU for adults is 200mcg and increases up to 300mcg in pregnancy,30 while in Australia, for example, they recommend 400mcg in adults and 600mcg in pregnant women.31 In general, supplementation varies from 100-1000mcg with higher dosages being sometimes recommended to people with underlying health issues, or those with genetic variants. Although if supplementing with methylfolate, you may not require very high dosage because of its superior absorption. For example, 400mcg of methylfolate is effective at reducing homocysteine levels,32 while in people with infertility, a higher dose (800mcg) may be required.33 It is important not to supplement with too much folate however, so make sure you consult a health practitioner if you have specific issues or are deficient. You can test your folate levels quite simply; I can do that if you ask me, or so can your GP.

Top tips to increase your folate status:

  • Steam your vegetables, rather than boiling them to prevent folate loss through cooking. Folate is very sensitive to light, heat and oxygen and so long-term storage. One study found that boiling spinach and broccoli resulted in between 40-50% of folate loss, whereas steaming had had barely no effect.34
  • Eat your greens in the least processed form as possible. Use them in salads or use kale and spinach in smoothies.
  • Soak your beans and lentils to decrease the amount of phytates – ‘antinutrients’ which bind to vitamins and minerals in the gut and prevent their absorption.
  • Avoid drinking caffeinated drinks with your meals as they can also reduce absorption of nutrients.
  • Minimise alcohol intake as it is linked to folate deficiency.35
  • Look after your gut health with probiotics – common probiotic bacteria, especially from the Lactobacilli and Bifidobacterium species, can produce folate, which contributes to overall folate status.36 Check the Probiotics Factsheet here.
  • Increase your intake of B2 sources. Vitamin B2 helps your body make methylfolate – beetroot tops, mushrooms, asparagus, sea vegetables, eggs, collard greens, broccoli, swiss chard, green beans, kale, peppers, daikon radish, liver.37 In fact, I find many people low in B2 – especially migraine sufferers!
  • Avoid excessive exposure to UV light as it can break down folate in the skin.38 Or make sure you increase your dietary intake in the summer months or when on holiday.
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