Are you getting enough folate?

More than 70 years ago, Dr Lucy Wills discovered that folate is a vital nutrient in the prevention of anaemia in pregnant women. By 1946, scientists were able to make a synthetic form known as folic acid and subsequent research has seen folic acid rise in importance as a treatment for a range of health conditions.

Folic acid belongs to the water-soluble B group vitamins, within which it is also known as vitamin B9. The name “folate” is derived from the Latin word folium meaning “leaf” because of its first extraction from spinach leaves. Folic acid can be found in a wide variety of foods including green leafy vegetables, asparagus, beans, kelp, soybeans, oranges, strawberries, rice and brewers yeast.

Unfortunately many people do not eat enough folic acid-containing foods; compounding this problem, cooking and over processing of foods can destroy their folic acid content. This is why folic acid is often added to products such as bread, flour and cereals.

Are you getting enough?

Certain people are particularly susceptible to folic acid deficiency, including pregnant women, adolescent girls and newborn infants. These groups are at special risk of folic acid deficiency due to the characteristically rapid growth associated with these stages of life. Folic acid is imperative for rapid cell division and growth and is needed to replicate DNA.

Low folic acid levels specifically affect bone marrow because that is where red blood cells are rapidly being made. When folic acid levels are low, the result can be a disruption in the normal production of red blood cells, leading to the production of large red blood cells called megaloblasts. The immune system will attack these large red blood cells, resulting in megaloblastic anaemia.

Megaloblastic anaemia is the form of anaemia that was recognised as the characteristic “pregnancy anaemia”. This is a little misleading as this form of anaemia is not only found in pregnant women and can affect both men and women at different stages of life. Other risk categories for folate deficiency include: anyone with a folate-poor diet, the elderly, those on certain medications and those with malabsorption issues (e.g. coeliac disease). There is also increasing evidence that smokers and heavy drinkers may need an increased intake of folic acid.

Fertility to DNA

Folic acid is a very important vitamin when looking at fertility and pre-conception care. It has been well documented that a deficiency of folic acid is associated with an increased risk of birth defects such as neural tube defects, cleft palates and cleft lips. Additionally, low levels of folate during pregnancy have been linked with an increased risk of premature birth, low infant birth weights, increased incidence of miscarriage and certain other pregnancy complications. For this reason, folic acid supplementation is responsibly recommended for the full term of pregnancy, not just until closure of the neural tubes, which usually occurs between days 21 and 27. Research also links folic acid supplementation with improvements in male fertility.

Folic for health

Folic acid is helpful in:

Anaemia (megalobastic)
Pregnancy
Promoting fertility
Heart protection
Cancer prevention

Folic acid also lowers homocysteine levels in the body. Even moderately increased homocysteine levels can increase the risk of cardiovascular disease. Observational studies have found reduced folic acid levels to be associated with certain cancers including those of the cervix, colon, rectum, lung, oesophagus, brain, pancreas and breast. As folic acid is involved in DNA synthesis, repair and functioning, it is thought that a folate deficiency may result in damaged DNA which may, in turn, play a role in cancer development. Results of trials involving supplementation of folic acid have been inconsistent regarding cervical cancer but more promising regarding colorectal cancers.

Folic acid is also critical for correct brain metabolic functioning. More research needs to be done in this area but there are currently suspected links between folic acid deficiency and insomnia, depression, dementia, restless leg syndrome and even Alzheimer’s disease.

News

A new analysis has confirmed that low folic acid levels are linked to depression. (See The Pulse, on page 12 of this issue).

Your daily requirement

Current recommended intakes for folate in Australia and New Zealand are set at 400 μg per day for adults; this increases to 500 μg per day during breastfeeding and 600 μg per day during pregnancy. Higher levels than this are not recommended unless under medical supervision as there are some concerns about the effects of very high folate levels. It is also important to note that supplementing with folic acid can mask an underlying vitamin B12 deficiency which, if not addressed, can result in neurological damage. Medical advice should also be sought before beginning supplementation if you are currently taking any medication, as folic acid can interfere with certain medications.

Top Folic Acid Foods