Vitamins and Minerals, Women's Health

The importance of folate

What is folate? And folic acid?
Folate is an important nutrient that is naturally present in many foods. Folic acid is the synthetic version (lab-made version) of folate that is added to enriched foods and is available as a dietary supplement.

Folate functions as a coenzyme. Enzymes are biological molecules that speed up reactions in the body and coenzymes are important for the full functionality of these enzymes. Without enough coenzymes (e.g. folate), multiple reactions in the body would slow down and things won’t function how they should.

Folate is important for the formation of DNA and RNA, the formation of neurotransmitters, the metabolism of amino acids, and the proper formation of the nervous system (1). So, in other words, absolutely essential for a healthy normally functioning body!

What are common sources of folate?
Folate is naturally present in a wide variety of foods, including vegetables, fruits, nuts, beans, seafood, eggs, dairy products, poultry, and grains. Folic acid is obtained as a dietary supplement and also from enriched bread, cereals, flours, cornmeal, pasta, rice, and other grain products, due to mandatory folic acid fortification programs in the United States (2).

How much folate do I need?
Folic acid has higher bioavailability than food folate, which means that the body can utilize a larger proportion of folic acid compared to food folate. At least 85% of folic acid is estimated to be bioavailable, while only approximately 50% of food folate is bioavailable (3). For this reason, recommended folate intakes are listed as dietary folate equivalents (DFE). 1 mcg DFE is equal to 1 mcg of folate from a food source, or 0.5-0.6 mcg folic acid from fortified foods or supplements.

Folate requirements vary depending on age and pregnancy/breastfeeding status (1):

  • Infants under 6 months require 65 mcg DFE per day
  • Infants 7-12 months require 80 mcg DFE per day
  • Toddlers 1-3 years require 150 mcg DFE per day
  • Recommendations gradually increase through childhood until the adult value of 400 mcg DFE per day by 14 years of age
  • Pregnant women should obtain 600 mcg DFE each day
  • Breastfeeding women should obtain 500 mcg DFE each day

Why do pregnant women need more folate?
Folate is essential for the proper formation of DNA—the genetic code providing instructions for everything in our body! During pregnancy, another entire human is being created, so there are added demands for many nutrients, in particular folate.

Females with low folate intake are at increased risk of giving birth to infants with neural tube defects, low birth weights, preterm delivery, and fetal growth retardation (3).

It is recommended that the added requirement during pregnancy and breastfeeding is obtained from dietary supplements as folic acid alone or as part of a prenatal vitamin.

What happens if I don’t obtain enough folate?
The total body content of folate is estimated to be 15-30 mg, with approximately half of this stored in the liver, and the remainder in blood and other tissues (3). Folate deficiency is typically associated with serum levels less than 3.5 ng/mL or whole blood levels less than 150 ng/mL. Folate deficiency usually occurs due to poor diet, alcoholism, and malabsorptive disorders (4).

The primary clinical sign of deficiency is megaloblastic anemia. This occurs because a folate deficiency means that new red blood cells are not generating as quickly as they should be, so there are fewer red blood cells to transport oxygen around the body (1). Anemia is characterized by:

  • Weakness
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Headaches
  • Heart palpitations
  • Shortness of breath

Folate deficiency is also linked to depression and mental fatigue. This is because folate is important for the proper functioning and formation of neurotransmitters in the brain. Neurotransmitters are chemical messengers that are required to pass signals between nerve fibers in the brain.

Serotonin and dopamine are two important neurotransmitters that contribute to a feeling of well-being and happiness—“feel-good hormones”! If you’re low in folate, these “feel-good hormones” don’t work as well as they should, and there is an increased risk of psychiatric conditions like depression (5).

Research shows that folic acid supplements can be effective at reducing depressive symptoms and improving brain function (6), as well as improving the effectiveness of other antidepressants (7).

Who is at increased risk of deficiency?
Folate deficiency can be more common in certain populations. Those that drink high amounts of alcohol are at increased risk, as alcohol inhibits proper folate absorption and increases the excretion of folate from the body too (3). People who have malabsorptive disorders, such as celiac disease and inflammatory bowel disease, are also at increased risk (4).

And, the most important risk group is pregnant women. This is due to the increased demands of the developing fetus. An entire new human is getting created, so understandably demands are high, and not just for folate either. Obtaining such high levels of folate and other nutrients can be difficult during pregnancy (especially if you’re unlucky enough to suffer from nausea too!) This is why all pregnant women, as well as those trying to conceive, should take vitamin supplements that include folic acid to reduce the risk of neural tube defects and other complications (1).

Conclusions
Folate is essential for the healthy functioning of your own brain and whole body, and the healthy development of a new baby for all those pregnant females out there!

Do you know if you are getting enough? Our simple to use Folate Test can tell you if you are deficient. Or better yet, take our Nutritional Deficiency Test to measure your folate levels, as well as your vitamin B12, vitamin D, and iron levels too.

References:
1. Folate: Fact Sheet for Health Professionals. (2020, June 3). NIH
2. Food Standards: Amendment of Standards of Identity For Enriched Grain Products to Require Addition of Folic Acid. (1996, March 5). Federal Register, 61(44), 8781-8797.
3. Bailey LB, & Caudill MA. (2012). Folate. In J. W. Erdman, I. A. Macdonald, & S. H. Zeisel, Present Knowledge in Nutrition. Washington, DC: Wiley-Blackwell. 321-342.
4. Carmel R. (2005). Folic Acid. In M. Shils, M. Shike, A. Ross, B. Caballero, & R. J. Cousins, Modern Nutrition in Health and Disease. 11th ed., Baltimore: Lippincott Williams & Wilkins. 470-481.
5. Miller AL. (2008) The Methylation, Neurotransmitter, and Antioxidant Connections Between Folate and Depression. Alt Med Rev. 13(2), 216-226.
6. Folate. Mental Health America.
7. Coppen A, Bolander-Gouaille C. (2005) Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 19(1), 59-65.