Folate (Vitamin B9)
Adequate Folate is essential for health
Folate is a B-vitamin whose adequate intake from
the consumption of folate-rich foods is essential for health
It is well established that:
Folate prevents neural
tube defects in newborns – an adequate folate intake is extremely important for women of childbearing
age prior to and during pregnancy. Mothers on a folate-rich Mediterranean-type
diet have shown lower risks for baies born with Spina Bifida than those not on
this type of diet.
Folate for Pregnancy
Folate aids the complete
development of red blood cells -
These cells help carry oxygen around the body. When folic acid is
deficient, the red bloods cannot form properly, and continue to grow without
Folate supports cell
production – especially cells in
skin and cells lining exposed surfaces and cavities (E.g. cells lining GI tract
and oral cavity). Problems often associated
with folate shortage include:
In the mouth - gingivitis, cleft palate, and periodontal
In the skin -
seborrheic dermatitis, vitiligo (loss of
Cancers - of the
esophagus and lung, uterus, cervix, and intestine (especially the colon)
Folate reduces blood
levels of homocysteine helping prevent
CVD and possibly Parkinson’s disease –
folate, B6 and B12 convert potentially harmful homocysteine
(a by-product of cellular metabolism) into useful compounds. A high serum
homocysteine level is associated
with increased risk of cardiovascular disease, and low intake of folate is a key
risk factor for hyperhomocysteinemia. Preliminary research also suggests that
high homocysteine levels can lead to the deterioration of
DOPAMINE-producing brain cells and may
therefore contribute to the development of Parkinson's disease.
Folate supports nervous
system function -
in addition to its preventive function in neural tube defects in newborns, a
folate deficiency is associated with
a wide variety of other nervous system problems, including:
General mental fatigu,depression, irritability,
Restless leg syndrome
Nervous system problems in the hands and feet
Folate’s link in these conditions may involve its role in the synthesis
of neurotransmitters, to provide a proper
balance of these message-carrying molecules of the nervous system.
Folate is also
osteoporosis-related bone fractures -
research teams in the Netherlands and the U.S. confirmed that
low levels of dietary folate
significantly increases risk of osteporosis-related bone fractures,
as a consequence of increased homocysteine levels.
Rotterdam Study -
2406 subjects aged 55 years or older;
those with the highest
homocysteine levels, whether men or women, almost doubled their risk of fracture.
Boston team - found that risk of
hip fracture nearly quadrupled in men and doubled in women in the top
25% of homocysteine levels.
Both groups found that folic acid reduced the risk of osteoporotic
fractures by reducing high levels of homocysteine.
2004. Homocysteine as a predictive factor for hip fracture in older persons.
New England Journal of Medicine 350(May
13):2042–2049. Abstract available at
van Meurs, Joyce B.J.,
et al. 2004. Homocysteine levels and the risk of osteoporotic
New England Journal of Medicine
350(May 13):2033–2041. Abstract available at
Help prevent dementias -
including Alzheimer's disease.
A 2004 study evaluated 228 subjects. In those
whose blood levels of folate were lowest, the risk for mild cognitive impairment
was more than tripled, and risk of dementia increased almost four fold.
Pierluigi Quadri et al,
Homocysteine, folate, and vitamin B-12 in mild cognitive impairment, Alzheimer
disease, and vascular dementia.
Am J Clin Nutr
July 2004 vol. 80
Folate has 3 main components -
PABA, glutamic acid and
What’s the difference between folate and
“Folate” and “Folic Acid” are terms used interchangeably,
but are in fact, significantly different
Folate is a general term for a group of natural water soluble
B-vitamins, known as B9, found in
foods – folate refers to the various tetrahydrofolate (THF) derivatives naturally
found in foods, such as green vegetables/leaves, beans and brewer’s yeast.
Folate is the natural form that enters the main folate metabolic cycle, in the
mucosa of the small intestine
Acid under Scrutiny, British Journal
of Nutrition (2007), 98, 665-666
Folic acid refers to a
synthesized, oxidized form of natural folate – since its 1943 debut,
it has been used in this crystallized (allbeit stable) form, in dietary
supplements and food fortification (In
1996, the FDA mandated that
grain-based foods, such as bread and cereal, be fortified with folic acid to reduce neural tube defect risk in fetuses during early pregnancy );
In most (especially younger)
people, folic acid can be converted by the liver back
into folate -
Unlike natural folate, ingested folic acid
undergoes initial reduction (by dihydrofolate reductase/DHFR)
and methylation to tetrahydrofolate (THF) in the liver.
circumstances unmetabolized folic acid can build up in circulation, with
possible health problems:
efficiency declines with age
estimate of up to 5% of people have genetic defects in metabolizing folate from
activity of DHFR enzyme in the liver combined with a high intake of folic
studies have reported the presence of unmetabolized folic acid in the blood
following the consumption of folic acid supplements or fortified foods,
which has been linked with several health problems:
accelerate cognitive decline in some older individuals;
Increased risk of childhood asthma born to folic-acid supplemented
Increased risk of colon and rectal cancers and accelerated growth of
pre-existing cancers - Prenatal and postnatal supplementation of folic acid
in mothers resulted in the occurrence of higher numbers of cancer tumors. The
Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening trial linked
folic acid intake with 20% to 32% increased risk of breast cancer in women
consuming more than 400 microg/d supplemental folic acid.
Does a high folate intake increase the risk of breast cancer?
2006 Oct;64(10 Pt):468-75.
Folate intake, alcohol use, and postmenopausal breast cancer risk in the
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.
Am J Clin Nutr. 2006 Apr;83(4):895-904.
Hilary J Powers (2007). Folic acid under
scrutiny. British Journal of Nutrition, 98, pp 665666
dietary (i.e. natural)
folate is actually protective against breast cancer
Zheng W. Dietary
folate intake and breast cancer risk: results from the Shanghai Breast Cancer
Cancer Res. 2001 Oct 1;61(19):7136-41.
acid in the blood is associated with the immune system’s
decreased natural killer (NK) cytotoxicity -
NK cells have a role in tumor cell destruction, suggesting a way in which excess
folic acid might promote existing premalignant and malignant lesions.
Aron M. Troen
et al, Unmetabolized Folic Acid in Plasma Is Associated with Reduced Natural
Killer Cell Cytotoxicity among Postmenopausal Women (2006) J. of Nutr.
Folate from natural food sources is best
Excellent sources of dietary folate - include vegetables such
as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley,
collard greens, broccoli, cauliflower, beets, asparagus, Brussels sprouts, bok
choy and lentils. Also calf and
chicken liver (choose organic), and brewer’s and baker’s yeast
Other good sources -
include corn, beets, tomatoes, dried or fresh beans and peas, and some fruits,
including oranges, grapefruit, pineapple, cantaloupe, honeydew melon, banana,
raspberries, and strawberries.
Fresh is best -
naturally occurring folates break
down quite rapidly with heat, cold, light, even when they’re still in the food.
Folate Deficiency Symptoms
In its association with the nervous system:
In its connection to circulation and red
In its role protecting the lining of body
tract symptoms (E.g. diarrhea)
Mouth-related symptoms (E.g. gingivitis, periodontal disease)
Neutrophilic Hypersegmentation Index (NHI)
Test for Folate Status
blood test can confirm your folate levels
NHI Test for Folate Status
You can supplement with folate if your dietary intake is inadequate -
There are two types of OTC natural
(not folic acid)
- sold OTC as calcium folinate, or by prescription
as Leucovorin®( contains FD&C
yellow #10 and FD&C blue # 1)
5-MTHF (5-methyltetrahydrofolate) – sold OTC (but more
expensive than calcium folinate)
Avoid products with labels that
list “folic acid” or even “folate” (since it is still synthetic folic
acid) - most multivitamins contain folic acid, not folate;
Good brands include:
Designs for Health, Thorne, Metabolic Maintenance, Pure Encapsulations. Look for products
that contain the Metfolin brand, or list “5-methyltetrahydrofolate” or “5-MTHF”
on the label.
Add B12 to a folate Supplement - not
only is B12 a cofactor of folate, but folate can also mask some B12 deficiency
How much folate to supplement
Women planning on becoming
800 - 1000 mcg of folate /day for several months BEFORE the start of
pregnancy (Unless you’re
consuming chicken or calf’s liver and substantial amounts of leafy greens on a
regular basis )
Dr. Wright explains
differences between folate/folic acid:
And so does
healthiest foods (folate)