What is Folate and Why Do You Need It?
Key Takeaways
Vitamin B9, also known as folate, is an essential nutrient that’s important for many different body functions, including red blood cell production and nervous system function.
Folic acid is a synthetic form of folate, which is converted by the liver into the active form of folate.
Folate is particularly important just before and during pregnancy, to support the healthy development of the baby. If a pregnant woman doesn’t get enough folate, this can lead to serious birth defects.
Folate deficiency can lead to symptoms like anemia (low red blood cell count) and may increase the risk of serious health issues like heart disease and dementia.
Most people are able to get enough folate through their diet, but supplements are recommended for women who are pregnant or may become pregnant and for those who have a confirmed folate deficiency or are at a high risk for deficiency.
A blood test for folate can be used to confirm whether you’re getting enough of this essential nutrient.
Vitamin B9 is an essential nutrient that plays a role in many different functions in the body. The naturally occurring form of vitamin B9 is known as folate.
When you eat foods containing folate, the body converts the folate into its active form, which is known as 5-methyltetrahydrofolate (5-MTHF). This conversion occurs in your digestive tract, before the folate enters your bloodstream. The active form of folate is important in several different biological processes, including DNA synthesis and the production of signaling molecules in the brain.
There’s also a synthetic form of this vitamin, which is known as folic acid. After folic acid is absorbed from the digestive tract, the liver can convert it to the active form of folate (5-MTHF). This process is slower in some people than in others, and in some cases, some of the folic acid that you consume may never be converted into active folate.
Folic acid is commonly used in supplements and for fortifying foods. This is partly because it’s a very stable molecule, so it doesn’t break down while a food or supplement is being transported or sitting on the shelf. It’s also more easily absorbed by the body than naturally occurring folate is, and it has been proven in many research studies to reduce the risk of certain health issues. Even if not all of the folic acid is converted into folate, the conversion almost always works well enough to meet the body’s needs.
Folate is important for heart and brain health, so those who are interested in improving their lifespan and healthspan should pay particular attention to making sure that they’re getting enough of this crucial vitamin.
Key Benefits of Folic Acid
Folate is important for the health of many different body systems, including:
Red blood cell production. Folate is important for the synthesis of DNA, which is necessary for cells to divide. Because red blood cells must be replaced every three to four months, it’s important to have enough folate to be able to make enough red blood cells. Without enough, people may develop anemia.
Brain health. Folate is needed to make certain neurotransmitters (signaling molecules in the nervous system), including serotonin and dopamine. It’s also important in the formation of myelin, a crucial substance that functions as electrical insulation in the nervous system.
Cardiovascular health. Folate is needed for the body to process homocysteine, which is a natural byproduct of protein metabolism. High levels of homocysteine have been linked to a higher risk for heart attacks and strokes, and potentially other health issues as well, such as dementia. Getting enough folate helps to keep homocysteine levels from rising too high and causing these health issues.
Energy production. Folate is important for the production of energy in the mitochondria, which are your cells’ power generators. Without enough folate, the mitochondria are far less efficient at producing energy.
Protecting DNA. Folate is an antioxidant, meaning that it helps to protect DNA and other molecules from damage. It also helps the body to produce other antioxidants, like glutathione. In addition, folate is important for maintaining the stability of DNA and properly repairing any damage that occurs. Damaged DNA can compromise a cell’s function and can sometimes lead to cancer.
Folic Acid in Pregnancy
Because cells are dividing very rapidly in a developing baby, it’s crucial to have enough folate to ensure that all of the important processes during this time are able to be completed. Without enough folate, serious birth defects can occur.
A lack of folic acid during pregnancy is strongly associated with an increased risk for a very serious type of birth defects, which are known as neural tube defects. There are two major types of neural tube defects:
Spina bifida, a problem with the formation of the spinal cord which can result in paralysis.
Anencephaly, a very serious problem where parts of the brain don’t fully form. This virtually always results in the death of the baby.
The American Academy of Pediatrics reports that if pregnant women consume enough (at least 400 mcg, or 0.4mg) of folic acid daily before and during pregnancy, this reduces the likelihood of neural tube defects by 40 to 80%. Because many pregnancies are unplanned, it’s best for all women of childbearing age to be sure that they’re getting enough folic acid every day. Women who are pregnant are usually advised to take a prenatal vitamin containing folic acid throughout the pregnancy.
Causes of Folate Deficiency
Severe folate deficiency is uncommon in developed countries like Singapore, because people have access to a wide variety of foods, and many foods are fortified with folic acid. However, even if they don’t have an overt folate deficiency, many people still have insufficient levels of folate for optimal health. Studies in other developed countries, like the US, have found that more than 20% of adults have insufficient folate levels.
There are a few different reasons that a person might have low folate levels, including:
Inadequate dietary intake. In some people, folate deficiency is caused by not eating enough foods that either naturally contain folate or are fortified with folic acid.
Malabsorption. Certain conditions reduce the absorption of folate from the digestive tract. These include celiac disease, Crohn’s disease, gastric bypass surgery, and low acid levels in the stomach.
Increased folate requirements. When a woman is pregnant or nursing, her body needs extra folate. Certain medical conditions, such as severe skin conditions or some types of anemia, also cause the body to need extra folate, because the body needs to produce large numbers of new cells. If a person keeps eating their usual diet, but their body has a need for extra folate, then they may develop a folate deficiency.
Medications. Certain medications, including certain antibiotics as well as medications used for cancer, epilepsy, and ulcerative colitis, are known to cause folate deficiency.
Genetic conditions. Certain rare genetic conditions cause changes in how the body metabolizes folate, which can lead to deficiency.
Folic Acid Supplementation
In general, HealthHub Singaopre recommends that all adults get at least 400mcg (0.4mg) of folate each day. Women who are pregnant or breastfeeding need a little more – 600mcg per day during pregnancy, and 500mcg while breastfeeding.
Most people are able to get enough folate through their diet, and don’t need to take supplements. Many foods naturally contain folate, including dark leafy greens, legumes (like lentils and beans), asparagus, avocados, and eggs. Additionally, grain products, including bread, cereal, and pasta, are often fortified with folic acid.
However, there are some groups for whom folic acid supplementation is recommended. These include:
Women who may become pregnant, particularly those who are trying to conceive
Women who are currently pregnant or breastfeeding
People with a medical condition that puts them at a high risk for folate deficiency
People who are found to have low folate levels in their blood
For women who are pregnant or who may become pregnant, a supplement containing 400mcg of folic acid per day is generally recommended. For those who have a medical condition or who have been found to have low folate levels, your doctor will recommend a specific dose of folic acid based on your situation.
Risks of Excessive Folic Acid
While folic acid deficiency can cause health issues, getting too much folic acid may also be dangerous. Some studies have associated high intakes of folic acid with serious health issues, possibly increasing the risk of certain cancers.
It’s important to note that not all studies have found these risks to be associated with high folic acid intake. Still, it’s safer to get your folate through foods if possible, unless you’re in one of the groups where folic acid supplementation is recommended. If you do take supplements of folic acid, stick to the maximum dose recommended on the bottle.
High folic acid levels can also cover up some of the symptoms of a deficiency of vitamin B12. Vitamin B12 deficiency can lead to nerve damage, which is sometimes permanent. If you’re taking folic acid, it’s important to make sure that you’re getting enough vitamin B12 as well.
Recommended Reading: Choosing the Right Supplement
Assessing your Folate Levels
The only way to know for sure whether you’re getting enough folate is to have a test to check the level of folate in your blood. If your folate level is low, this could impact your energy levels and overall health, and may increase your risk for serious conditions like heart disease and dementia.
Our NOVI Assessment Max clients receive comprehensive testing, including checking their levels of several key nutrients. If you have a deficiency of folate or any other nutrient, it’s important to detect this. Then you and your doctor can make a plan to address the issue through diet, supplements, or a combination of both, to help support your long-term health.