Vitamin folate is found in certain foods and plays a critical role in producing and maintaining new cells. The cells of an unborn baby need folate to develop normally and, if not enough folate is present during pregnancy, birth defects may occur.
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A diet low in folate can lead to anemia, weight gain, weakness, heart disease, or stroke. In other words: don’t skip out on the leafy greens! If you have a genetic disorder called MTHFR that affects how your body processes folate, be sure to consult your doctor before starting a supplement regimen.
Folate is essential for the proper functioning of the brain, heart, liver, and other organs. It is especially important for pregnant women to take folic acid during pregnancy to prevent neural tube birth defects.
The percentage of folate that the body is able to absorb from foods is about 20%; therefore, a supplement of 400 mcg can ensure you are getting enough. Folate is abundant in leafy green vegetables such as spinach and turnip greens, as well as whole-grain cereals, beans, citrus fruits, and orange juice.
Although folate is critical for all forms of life, even before birth, you should take a folate supplement. This is because:
For pregnant women: High levels of folate can prevent pregnancy loss and neural tube birth defects. It also may prevent postpartum depression and stress urinary incontinence.
Other groups who should take a folate supplement are seniors, adolescents, people with gastrointestinal diseases, alcoholics, people with depression with suicidal tendencies, smokers, people on certain medications (such as isotretinoin or metformin), or those with anemia caused by low blood cell production at the bone marrow.
Beneficial Functions of Folate
Folate plays many roles, including:
Serving as a single-carbon donor in the synthesis of purines and pyrimidines during DNA production. This means that folate is essential for proper cell growth and division.
Helping to make red blood cells, which transport oxygen throughout the body. Low levels of folate can lead to anemia, low blood pressure, fatigue, weakness, tingling muscles, headaches, confusion, and behavioral changes.
Helping to make white blood cells. Low levels of folate may increase your risk for developing infections like the common cold or pneumonia.
Helping to make DNA. A folate deficiency can lead to a decrease in sperm count and quality.
Activating several amino acids. One of these amino acids is tryptophan, which is needed to produce serotonin – a hormone that helps you feel happy and relaxed. In people with low levels of folate, this process is impaired. This may lead to depression and the development of suicidal thoughts or actions.
In people with low levels of folate, this process is impaired. This may lead to depression and the development of suicidal thoughts or actions. Acting as a cofactor for other amino acids, including methionine, tryptophan, and lysine.
Helping to make the neurotransmitter dopamine. Positron emission tomography imaging has shown that people with low levels of folate tend to have reduced activity in the brain’s dopamine-producing areas.
Acting as a storage form of vitamin B12. Vitamin B12 is needed by the body for numerous functions, including maintaining healthy red blood cells and nervous system activity, producing DNA and promoting cell division, and transmitting nerve impulses throughout the body. If you are deficient in vitamin B12, you may be at an increased risk for nervous system damage, heart disease, and dementia.
If you are deficient in vitamin B12, you may be at an increased risk for nervous system damage, and dementia. Acting as an antioxidant. It plays a role in protecting cells from oxidative damage, which can lead to cell death.
It plays a role in protecting cells from oxidative damage, which can lead to cell death. Protecting your body against damage caused by environmental pollutants. People with low folate levels tend to have high levels of biochemical markers for oxidative stress.
Side Effects and Interactions
Folic acid supplements should not be taken if you are pregnant or nursing unless your doctor advises it. They can reduce the effectiveness of oral contraceptives, making them less effective at preventing pregnancy. Although this occurs only at higher doses (1000 mcg or more), it is safer to avoid supplements altogether while you are pregnant or nursing.
Regardless of whether you are pregnant or nursing, it’s best to avoid taking folic acid supplements if you are trying to conceive. There’s no proof that they are safe or effective in conception, and they may cause birth defects. This means that women who take folic acid supplements while trying to get pregnant have an increased risk of having a baby with birth defects. Whereas the risk is only 1% in women who take 200 mcg daily, it rises to 10% for women who take 400 mcg daily. Pregnant women should also avoid using folate supplements if they are planning on becoming pregnant soon, as prenatal supplementation with high doses of folate can lead to neural tube defects in their babies.
You should also avoid folic acid supplements if you have an autoimmune disorder, such as psoriasis or rheumatoid arthritis. High levels of folic acid may increase your risk of developing skin cancer. You should also avoid taking folic acid if you’re taking any medication that can interfere with folate metabolisms, such as methotrexate, trimethoprim-sulfamethoxazole (Bactrim), and sulfasalazine (Azulfidine).
If you are taking medications called anticonvulsants (used to prevent and control seizures), folate may interfere with their effectiveness.
Pregnant women should avoid folic acid supplements if they are planning on becoming pregnant soon, as prenatal supplementation with high doses of folate can lead to neural tube defects in their babies. This is because, during early development, the heart is situated outside the spinal cord, and is therefore vulnerable to injury from a toxic environment. It can also be potentially fatal when damaged from lack of oxygen or from not receiving enough blood supply. Neural tube defects develop when the brain does not form properly in utero. This is because the brain develops from the neural tube, which eventually forms the spinal cord and brain.
Vitamin B12 is commonly found in food sources such as meat, fish, dairy products, and eggs. Folic acid is found in leafy green vegetables such as spinach and kale; legumes; and fruits such as cantaloupe and oranges.
Vitamin B12 is also found naturally in foods, but there is no natural form of folic acid that we can consume. You can take a supplement if you’d like to increase your intake of folate or vitamin B12.
If you take folic acid supplements, make sure to take vitamins that contain vitamin B12 as well. Some people get nervous that they will develop a B12 deficiency if they’re taking folate, but this is not the case.
The RDA for folic acid is 200 mcg for adults and 400 mcg for pregnant and lactating women. (27) The RDA for vitamin B12 is 2.4 mcg daily for all adults over the age of 13.
Dosage and Duration of Use
Women who are planning a pregnancy should talk to their doctors about folate supplementation in order to prevent birth defects in their unborn children. For nonpregnant women, the recommendation is to take 400 mcg of folic acid daily.
For women who are pregnant or hoping to become pregnant, it may be beneficial to take a multivitamin supplement that contains both folic acid and vitamin B12. Typically, these supplements contain 1–5 mg of vitamin B12 or 2–10 mcg of folic acid. If you are trying to conceive or are pregnant, talk with your doctor about your supplementation needs.
Based on the RDA values listed here, you would need to take 1.8–4.8 mg of vitamin B12 or 5–15 mcg of folic acid daily in supplement form to meet your body’s needs if you are planning a pregnancy, but this is very difficult for people to achieve.
Instead, take an individual supplement that contains the amounts listed above and that contains vitamin B12 and folic acid. You can find them at most large grocery or health food stores.
If you’re taking medications such as anticonvulsants, ask your doctor if it’s safe for you to take folic acid supplements as well as your medication.
Folate: Food Sources and Recommended Intake
Folate is found in many food groups including vegetables, especially green leafy ones, dairy, meat/poultry, and grains. Fortified cereals and grain products are a good source of folate.
According to the Office of Dietary Supplements (ODS), foods high in folate include asparagus (cooked), Brussels sprouts (cooked), broccoli (cooked), citrus fruits, along other vegetables such as peas and spinach. Milk, cheese, and yogurt also provide folate. The U.S. Department of Agriculture (USDA) recommends that women who are pregnant or trying to become pregnant consume 400 micrograms of folate per day. The recommended intake for men, however, remains 600 micrograms per day.
How to Take Folate
For people who want optimal health and well-being, taking a daily supplement of 400 milligrams of folic acid in addition to their other daily vitamin and mineral requirements is highly recommended. Taking a supplement allows individuals to achieve higher blood levels and absorption than when the same amount of folic acid is provided through food alone.
There are many different types of supplements on the market today. There are daily supplements, monthly supplements, and 1-month and 3-month extended-release supplements. The extended-release type that is available in most health food stores should be taken daily to maintain the RDA (Recommended Dietary Allowance) of 400 micrograms.
Daily Folic Acid Supplements: Adults can take 1 tablet daily, while children over the age of 12 should take 2 tablets daily. Licensed healthcare professionals recommend taking a supplement containing 400 mcg twice a day.
Monthly Folic Acid Supplements: This type contains either 3 or 6 months' worth of folic acid. Pharmaceutical companies produce these tablets. They are not recommended for use by the general public. Licensed healthcare professionals only recommend taking this type of supplement for women who intend to become pregnant or who are pregnant, or for their prenatal care.
3-month Folic Acid (Extended Release): These tablets contain 3 months' worth of folic acid. They should be taken once a month. Each tablet provides 100 mcg of folic acid, which is higher than the RDA of 400 mcg/day. Licensed healthcare professionals only recommend taking these tablets if they are prescribed by a medical professional for other reasons including pre-conception care, before pregnancy, or during pregnancy.
Over-the-counter prenatal vitamins are combined with folic acid. These are considered one of the best sources available.
A deficiency in folate can lead to fertility problems, as well as a decrease in sperm count and quality.
It can also cause a risk of death from a bleeding ulcer, which is a serious complication that increases the longer the deficiency continues. Folate deficiencies are also known to increase your chances of having an impaired immune system that doesn’t fight off infections as well as it should. If you have had surgery or are undergoing chemotherapy, you may be at an increased risk for bleeding and infection if your levels of folate are too low. You must be on supplemental folate before and after any surgery or chemotherapy treatment to help protect yourself from these complications.
If you are considering pregnancy, it is important to make sure that your folate levels are adequate before trying to conceive. This can be done by taking a prenatal vitamin with 200 mcg of folate. If you are planning to become pregnant, talk with your doctor about how much folate you should take during the first trimester, as this is the most crucial time for protecting against birth defects. You may also want to meet with a nutritionist or dietician to plan all your meals and ensure that you are getting enough folate.
As always, talk with your doctor before making any changes in diet or supplements. Pregnant women should avoid taking folate supplements if their water breaks.
When using folic acid for health benefits, it is best to use a supplement specifically labeled as “folate” rather than the more common “folic acid,” which is actually a synthetic form of folate. The body can convert folic acid very easily to the form needed for health benefits, but it may have trouble converting lower-quality forms to active folate. You can find folate in foods or take a supplement to get the recommended daily dose of 400–800 mcg per day.
Folate Deficiency Symptoms
Major signs of folate deficiency include fatigue, muscle weakness, numbness, tingling in hands and feet, loss of coordination, paralysis of the legs or arms, depression, forgetfulness, seizures, anemia (sick all over), swollen tongue or throat, or mouth sores.
Men who take large amounts of Metformin for diabetes have a high risk of developing folate deficiency because metformin interferes with absorption and utilization of food and vitamin intake. Men with diabetes may be at risk of developing folate deficiency if their diet is poor, they are on metformin, or they are taking medications that also interfere with folate.
Folate deficiency during pregnancy may cause problems during pregnancy. Maternal folate level below 200 micron/dl is associated with an increased risk of neural tube birth defect.
Folate Levels in Pregnant Women
Folate levels in pregnancy are important. If the level is high enough it will help prevent birth defects such as spina bifida and anencephaly (absence of a major portion of the brain and skull). To help prevent these types of birth defects, women taking folic acid supplements during pregnancy should take at least 400 mcg/day.
Low folate levels may be associated with miscarriages and stillbirths. Women who have had a miscarriage or stillbirth should see their doctor before planning another pregnancy to see if their folate levels are normal.
Folate and Breastfeeding
The need for folate while breastfeeding is not as high as it is during pregnancy. The recommended intake for breastfeeding women is about 300 mcg/day.
Women who breastfeed and take a multivitamin or prenatal vitamin will be getting enough folic acid to meet the needs of their babies. If you are taking other supplements, such as iron, remember to check with your health care provider before taking them while breastfeeding. They may contain too much iron and cause serious problems for your baby. If you already take a calcium supplement, make sure it does not also contain additional iron.
Folic Acid Side Effects
Taking a high level of folic acid supplements can cause side effects including nausea, diarrhea, constipation, or bloating. It can also cause abdominal cramping. If you have an autoimmune disease you should check with your doctor before taking folic acid supplements.
If you are taking a multivitamin or prenatal vitamin with other supplements, it is important to check with your health care provider before taking them while breastfeeding. Taking too many vitamins at once may cause vitamin overdose and lead to life-threatening problems for your baby. Some prenatal vitamins contain more iron than the recommended daily amount of iron for both women and babies.
When consuming 400 mcg of folic acid per day, there are rare but serious side effects that can happen in people who have a genetic disorder called MTHFR.
Symptoms include weakness, numbness, confusion, loss of balance, and trouble walking. In these cases, a medical professional should be consulted immediately for further instructions. People with MTHFR can still get the benefits from folate through food sources. These individuals should take folate from natural food sources instead of through supplements.
Pregnant women should not consume more than 1 milligram of folic acid per day without consulting a physician first to avoid birth defects. Women should not take supplements or use multivitamins containing folic acid, which is not recommended.
Environmental contamination of folic acid has been identified at levels above the acceptable levels set by the European Union. The UK has addressed the problem through its Food Standards Agency. The United States may also implement similar guidelines in the future.
Folate is also absorbed through food, water, or air exposure, e.g., via dust exposure to vinyl chloride, methylene chloride, etc., exposure to ototoxic drugs such as aminoglycosides (antibiotics), exposure to other maternal medications, exposure to various ergot alkaloids (maternal usage of maternal medications), etc.
Methylenetetrahydrofolate Reductase Genetic Variants
If you have a genetic disorder called MTHFR that affects how your body processes folate, be sure to consult your doctor before starting a supplement regimen. MTHFR Genetic variants can negatively impact the metabolism of folic acid. If you have an MTHFR variant, it is suggested to take 5-methyl folate (5-MTFH), which is the active form of folate for humans. Folate from food has been converted by MTHFR genes to 5-MTFH with a 4-carbon bond.
Conversely, folic acid is converted by the enzymes necessary in the human body to become 5-methyl folate (5-MTFH). If you have an MTHFR variant, it is suggested to take 2-methyl folate (2-MTFH), which is the inactive form of folate for humans. Folate from the diet has also been converted by MTHFR genes into 2-MTFH with a 6 carbon bond.
Folate is found in many food groups including vegetables, especially green leafy ones, dairy, meat/poultry, and grains. Fortified cereals and grain products are a good source of folate. For example, fortified cereals contain 100 mcg of folate. If you have a genetic mutation that prevents your DNA from being properly read or translated into proteins that help your body to utilize folic acid appropriately, you may need an alternative form of folic acids such as 5-MTHF (5-methyl tetrahydrofolate) or 5-MTHF within a formulation containing another form of vitamin B12 which will convert the folic acid into its active form.
Folate Vs Folic Acid
Folate and folic acid are both synthetic compounds that can be found in different foods, though it is widely used in dietary supplements. Vitamin B9 (Niacin) is also known as Folate-Folic Acid.
While folic acid can be synthesized, folate cannot. It must be ingested in food or supplements. Folate is important for building red blood cells, DNA synthesis, production of neurotransmitters (serotonin), and hormone production (folic acid shows promise for the prevention of neural tube birth defects). Folate deficiency is usually treated with folic acid vitamin supplementation; however folate deficiency may occur in some people who eat little fruits and vegetables.
Folate deficiency may also occur in people who are not consuming normal amounts of fruits and vegetables. People who take folate-deficient diets for prolonged periods should replace folic acid with food sources of folate. Folic acid will be used by the body to make proteins, while food sources of folate will be used to make DNA, RNA, hormones, and neurotransmitters.
It appears that folic acid is not harmful when consumed at levels above 400 mcg/day (0.4mg daily). Increased intake of folic acid does not appear to have any adverse effects on the health of individuals over 6 years of age. The upper limit for folic acid is 1000 mcg/day (1mg) unless indicated otherwise by a doctor. Although many other countries have set the maximum folic acid levels at 600 mcg/day, it is recommended to consult with your doctor before you continue taking folic acid if you are an older adult.