The B vitamin folate, also called folic acid, is a water-soluble vitamin. Water-soluble vitamins are stored in the body in very limited amounts and are excreted through the urine. Therefore, it is a good idea to have them in your daily diet. Folate is considered a crucial vitamin, especially before and during pregnancy. Research has shown that folate deficiencies during pregnancy can lead to neural tube birth defects in babies.
Folate's functions include:
- Helping amino acid metabolism and conversion
- Producing and maintaining new cells
- Making DNA and RNA, the building blocks of cells
- Preventing changes to DNA that may lead to cancer
- Making red blood cells, preventing anemia
- Assisting in the creation of neurotransmitters (chemicals that regulate sleep, pain, and mood)
Folate deficiency is a common vitamin deficiency that can occur for a variety of reasons, including:
- Increased need, as with pregnancy, without increased intake
- Low levels of folate containing foods in diet
- Abnormally high levels of folate passing out of the body
Medications that interfere with the body's ability to use folate such as:
- Anti-convulsant mediations
Populations at Risk of Folate Deficiency
The following populations may be at risk of folate deficiency and may require a supplement:
- Pregnant women—Folate is critical for the production and maintenance of new cells. This is especially important during pregnancy—a period of rapid cell division.
- People who consume excessive amounts of alcohol—Alcohol interferes with the absorption of folate and increases excretion by the kidneys. In addition, many with alcohol use disorders tend to have diets low in essential nutrients, like folate.
- People on certain medications—Certain medications can interfere with the body's ability to use folate. Check with your doctor about supplementation if you are on medication that may affect your folate levels.
- People with inflammatory bowel diseases—Malabsorption of folate can occur with inflammatory bowel diseases.
- The elderly—Many elderly have low blood levels of folate, which can occur from low intake of the vitamin or problems with absorption.
Health Implications of Deficiency
Folate deficiency may lead to:
- Megaloblastic anemia (abnormally large red blood cells)
- Irritability, hostility
- Weight loss
- Apathy, forgetfulness
- Loss of appetite
- Sore tongue, glossitis (inflammation of tongue)
- Heart palpitations
- Paranoid behavior
In 1991, a landmark study found a relationship between folate and birth defects. Subsequent research has supported the finding that adequate folate intake during the period before and just after conception protects against a number of neural tube defects, including spina bifida and anencephaly.
The crucial period is before and very early after conception—a time when most women do not know they are pregnant. Therefore, the recommendation is that all women of childbearing age make sure they have a folate intake of at least 400 mcg.
Major Food Sources
There is a variety of foods that contain folate. Some foods, like cereal, rice, and flour, are fortified with folate. Here is a list of major food sources and their folate content.
Tips for Increasing Your Folate Intake:
To help increase your intake of folate:
- Spread a little avocado on your sandwich in place of mayonnaise.
- Drink a glass of orange juice or tomato juice in the morning.
- Add spinach to your scrambled eggs.
- Slice a banana on top of your breakfast cereal.
- Sprinkle some toasted wheat germ on top of pasta or a stir-fry.
- Throw some chickpeas or kidney beans into a salad.
- If you take a vitamin supplement, make sure it contains folate.
Too Much Folate
There can be too much of a good thing. While there is no upper limit for ingesting folate found naturally in foods, there are recommended intake limits for folate consumed from fortified foods and supplements:
Large doses of folate can mask symptoms of a different type of vitamin deficiency called B12 deficiency. A B12 deficiency causes some similar symptoms as folate deficiency, but it can also cause damage to the nervous system. Folate supplementation will mask the B12 deficiency by relieving the anemia-associated symptoms, but not decreasing damage to the nervous system. This is why it is important that you talk to your doctor before you take a folate supplement. A blood test will help determine if your folate and vitamin B12 levels are appropriate or low. It may be necessary for you to take vitamin B12 supplements along with the folate. Talk to your doctor before starting any vitamin supplement to make sure it is appropriate for you.
- Reviewer: Michael Woods, MD
- Review Date: 01/2016 -
- Update Date: 03/06/2014 -