Folate
Recommended Intake
Folate Defiency
Folate Toxicity
Major Food Sources
Populations at Risk for Folate Defiency
Birth Defects
Heart Disease
Tips for Increasing Your Folate Intake

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 a crucial vitamin during pregnancy; research has shown that folate deficiencies during pregnancy can lead to neural tube defects in babies. Folate fortification of certain foods — like flour, rice, and cornmeal — became mandatory in 1998.

Folate's functions include:

• helping amino acid metabolism and conversion
• aiding in the conversion of homocysteine to methionine (elevated blood levels of homocysteine have been associated with an increased risk of heart attack)
• 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 and preventing anemia
• assisting in the manufacture of neurotransmitters, chemicals that regulate sleep, pain, and mood

Recommended Intake:

Folate Deficiency
Folate deficiency is one of the most common vitamin deficiencies. It can occur for a variety of reasons, including:

• Need is increased, as with pregnancy.
• Dietary intake is lacking.
• Body is excreting more than usual.
• Medications may be interfering with your body's ability to use folate. Medications that can interfere include:

  anti-convulsant medications
  metformin
  sulfasalazine
  triamterene
  methotrexate

Symptoms of folate deficiency include:

• megaloblastic anemia (shown by blood tests)
• irritability, hostility
• weakness
• weight loss
• apathy, forgetfulness
• anorexia, loss of appetite
• dyspnea (shortness of breath)
• sore tongue, glossitis (inflammation of tongue)
• headache
• heart palpitations
• paranoid behavior
• gastrointestinal tract disturbances

Folate Toxicity
The tolerable upper intake level (UL) for folate from dietary sources and supplements combined is 1,000 mcg. The risk of toxicity from folate is low, but large doses of folate can mask symptoms of a vitamin B12 deficiency. Although folate supplementation will alleviate the megaloblastic anemia caused by the B12 deficiency, the neurologic damage caused by the B12 deficiency will continue undetected.

Symptoms of folate toxicity include:

• insomnia
• malaise
• irritability
• diminished zinc status
• gastrointestinal problems
  

Major Food Sources

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. Folate deficiency has been observed in alcoholics. Alcohol interferes with the absorption of folate and increases excretion by the kidneys. In addition, many alcoholics 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 a medication that may affect your folate status.
• People with inflammatory bowel diseases. Malabsorption of folate can occur with inflammatory bowel diseases.
• The elderly. Many older people have low blood levels of folate, which can occur from low intake of the vitamin or problems with absorption.

Birth Defects
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.

Heart Disease
Homocysteine is an amino acid. While most amino acids found in the body are building blocks of protein or muscle, homocysteine is not a component of protein. It is formed as an intermediate step in the production of another amino acid, methionine. The conversion of homocysteine to methionine requires a number of vitamins, including folate, B6, and B12. A deficiency of any one of these vitamins can cause the level of homocysteine in the blood to rise, which may damage coronary arteries or make it easier for blood clotting cells to clump together and form a clot. This can increase your risk of heart attack or stroke.

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 in to a salad.
• If you take a vitamin supplement, make sure it contains folate.