Written by Carmela Pengelly. Carmela is a dietary therapist and nutritional therapist, trained in the UK.

She now lives in Perth, Western Australia, where she practices as a nutritionist, specializing in SIBO (small intestinal bacterial overgrowth), methylation issues, and vegan/vegetarian diets. She also offers consultations outside of Australia, via Skype.

Folate is one of the most important nutrients for the human body. Deficiencies can have far-reaching consequences. Sadly, with less emphasis on wholefoods in a typical Western diet, folate deficiency can be a problem. Let’s take a closer look at seven of the reasons your body needs folate, where it comes from, and how to recognize and address potential deficiency in your diet.

Folate or Folic Acid – What’s the Difference? 

First let’s clear up some of the confusion around the some of the terms used for folate. 

Folate is the general umbrella term for a family of compounds, including folic acid, 5-methyltetrahydrofolate (5MTHF), folinic acid and dietary folate. It is also sometimes called B9.

Folic acid is the synthetic version of folate most often found in supplements such as Nu U Nutrition’s multivitamin and mineral all in one formula. It is also in fortified foods in some countries but not the UK. It is easily absorbed but then has to go through a series of chemical reactions to get it to a form that the body can use.

5MTHF and folinic acid are natural forms of folate, and unlike folic acid, are readily available for use by the body. Both can be obtained in supplement form.

7 Reasons Why You Need Folate 

Folate provides a raft of vital functions in the body.

1. Making DNA/Cell Division

We need folate for DNA repair and we also need it for DNA synthesis when making new cells.

A compromised ability to repair damaged DNA increases your likelihood of cancer. Hence, folate has been termed a ‘cancer-preventive agent’. A deficiency has been linked with several cancers including: breast, ovary, brain, lung, cervical, ovarian and colorectal cancers.

It’s a long and scary list and a very good reason to eat your greens.

2. Making Healthy Blood Cells

Red blood cells have a high turnover rate. They survive in circulation for about four months and replacement ones take about the same time to make.

If folate is low, we can’t make enough red blood cells to keep up with demand. So, we end up with fewer red blood cells in circulation and also larger than normal-sized cells. This is called megaloblastic anaemia.

 

Lack of folate also affects white blood cell numbers and in particular we see a reduction of lymphocytes and granulocytes.

3. Fertility

There is promising new evidence showing that folate increases the chance of conception in couples struggling with fertility issues. Significant successes have only been seen with 5MTHF, however, and not folic acid.

4. Foetal Development

The baby’s cells are dividing at a rapid rate during pregnancy. As we’ve mentioned earlier, folate is needed to support production of healthy new cells. This is why supplementation with folic acid is well known in helping to prevent neural tube defects, for example spina bifida where vertebrae do not form properly.

Low folate in pregnancy is also associated with:

• Increased likelihood of miscarriages
• Pre-term births
• Low birth weights
• Folate deficiency in the new-born baby

All pregnant women are encouraged to eat a folate-rich diet and use folate supplements before conception and during pregnancy. Both folinic acid and 5MTHF, in particular, play important roles in healthy growth and development of the foetus.

5. Heart Health

Folate is needed for the metabolism of homocysteine in the body, along with B12 and B6. If homocysteine is not metabolised, this biochemical can accumulate, leading to narrowing of arteries, and potential heart disease and strokes.

 Stroke risk can be lowered by as much as 24% if homocysteine is reduced.

6. Energy

All the B vitamins play a role in releasing energy from food - around half of the folate in our cells is found in the energy-producing centres, known as the mitochondria.

Folate also improves our cells response to the hormone, insulin. Insulin drives sugars from the bloodstream into the cells, allowing us to burn off food as fuel.

7. Brain Health

Neurotransmitter production is dependant on folate. Neurotransmitters are the brain’s chemical messengers and include serotonin, dopamine, GABA, noradrenaline and adrenaline.

This nutrient also influences how quickly neurotransmitters are broken down in the brain, a key factor in the regulation of mood, and our stress and anxiety levels.

Cognitive function is affected by folate and low levels increase your risk of Alzheimer’s disease.

Folate, particularly folinic acid also appears to improve the symptoms of both autism and schizophrenia.

Restless syndrome can result from low dopamine levels. Since folate is needed for dopamine production, boosting your intake may help relieve symptoms of this uncomfortable syndrome.

TOP HEALTH RISKS OF FOLATE DEFICIENCY
Cancer	Heart disease
Infertility/miscarriages	Birth defects
Anaemia	Depression and anxiety

 

How to Measure Your Folate

The most common test for folate is serum in blood. However, this is not very accurate as it only reflects your recent intake. A better test is to measure folate within red blood cells as this gives you a more accurate guide of how much is actually being metabolised and made use of in the body.

You can also ask your doctor to measure homocysteine as this is a good indicator of folate status – high homocysteine indicates that your folate levels are too low.

High Folic Acid Levels Are Bad Not Good

If you have a standard serum test and it comes out high, this is something you should take notice of. It often indicates that you’re having too much folic acid or that you’re not metabolising it properly, or both.

If you are taking folic acid and start to feel very fatigued and generally unwell, check how much you’re getting from your supplements. The safe upper level is estimated at about 1 mg.

HOW MUCH DO YOU NEED? (micrograms)
Adults and children over 11 years	200
Pregnant women and women planning pregnancy	400
Lactating women	250

 

What Can Go Wrong?

We cannot make folate ourselves and depend on plant foods and supplementation to supply adequate amounts. That’s not the end of the story, however. Several factors can prevent us from utilising it.

Poor Methylation

Methylation is hugely important in the body and folate is a key player. In simple terms, methylation is the transfer of a group of atoms (methyl group) from one compound to another, as part of a chemical reaction.

For example, to make the sleep hormone, melatonin, we need to add a methyl group to serotonin. Folate is needed for this transfer, and in this instance, deficiency would cause insomnia.

Methylation occurs many times every second in every cell of your body and, according to methylation expert Dr Ben Lynch, over 200 functions in the body rely on this biochemical process.

It affects everything from how easily we put on weight to hormone balance to how happy we feel.

Many people have gene mutations that reduce enzyme activity making it harder for them to metabolise folate for use in methylation. This can affect up to 40% of the population to varying degrees.

Under normal circumstances this is not usually a problem, providing that you have reasonable amounts of folate in your diet. However, at times when there are more demands on your body e.g stress, illness, heavy exercise, methylation reactions increase and you need more folate.

If you don’t metabolise folate well your body can struggle, and it’s at these times that you can suddenly start to experience problems, such as allergies, fatigue, depression, anxiety, inflammatory conditions and hormonal imbalances.

In the long term, this can put you at higher risk of more serious diseases associated with low folate, e.g cancers and heart disease.

To get around this, you can take 5MTHF. It helps because your body can skip the enzymatic reactions needed to produce usable folate.

You don’t have to have a gene mutation to be a poor methylator. If you’re averse to eating your greens and lack folate you will also have trouble methylating, simply because you aren’t providing enough of the raw ingredient for methylation reactions.

The Trap

We need B12 as well as folate for methylation reactions.

If B12 is unavailable, folate cannot be used properly; it becomes ‘trapped’ and methylation cycles become blocked. Although you have plenty of folate, your body behaves as if you are deficient, and this is called functional deficiency. In this situation, your blood serum results would show plenty of folate but a measurement of red cell folate would show low levels.

Those likely to have low B12 include: vegans and vegetarians, those with gut disorders that inhibit absorption, older people, people suffering pernicious anaemia, and those using certain medications e.g antacids.

B12 Deficiency Risk

Megaloblastic anaemia is often caused by folate deficiency but it can also be due to low B12 levels. Supplementing with folate often fixes the anaemia but at the same time B12 deficiency goes undetected, which can have long term consequences.

So, it is important to supplement with both folate and B12 if you are diagnosed with this condition.

Lack of Co-Factors

Co-factors can be seen as facilitators in biochemical reactions. We need other B vitamins, specifically B2, B6 and B12, as co-factors to be able to metabolise folate.

Taking a good comprehensive B-complex supplement can be useful here.

Fragile Folate

Even if you are consuming plenty of folate-rich foods, you may still be low in this nutrient. Dietary folate loses its biochemical activity very easily through harvesting, storage and cooking.

To optimise your folate intake, try to source locally produced fruits and vegetables that are as fresh as possible. Local farmers’ markets are a good place to look. Eat a mixture of raw and cooked vegetables and prepare vegetables by lightly steaming them to preserve more folate.

Sprouting seeds is a good way of getting in good levels of folate. Sprouting increases the folate content of seeds and makes them more easily digestible. For example, sprouted broccoli seeds contain about 550 micrograms of folate per 100 g.

Medications

You might need extra folate if you are taking certain medications.

For example, methotrexate which is used for rheumatoid arthritis can inhibit folate metabolism. If you’re using this drug and wish to supplement, it’s best to consult your doctor first.

Sulphasalazine, which is used to treat Crohn’s disease, and the contraceptive pill can both deplete folate.

Gut Health

The utilisation of any nutrient is always dependant on gastrointestinal health. It is particularly important for folate as it is partly metabolised in the cells lining the gut.

Any disorder that reduces nutrient absorption or where the gut lining may sustain damage will affect folate levels e.g Crohn’s disease, ulcerative colitis and coeliac disease.

BEST SOURCES OF FOLATE
Sprouted broccoli seeds	550 micrograms per cup
Lentils (cooked)	360 micrograms per cup
Spinach (raw)	58 micrograms per cup
Peanuts	40 micrograms per 30 g (around 35 peanuts)
Sunflower seeds	34 micrograms per ¼ cup
Sources: USDA Food Composition Databases & US National Institutes of Health

Folate is an important part of human health, and because supplementation and careful attention to diet are needed to ensure you get enough, it’s a relatively common deficiency. If you suffer from the signs of deficiency, take the time to ask your physician about next steps for supplementation, and any dietary changes needed.

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