Folate, the natural form of vitamin B9, is an essential vitamin found in dark green leafy vegetables, nuts, and legumes. It is crucial for the production of DNA, which is key for the growth and repair of every cell in our body. Folate not only supports the formation of red blood cells but is also vital for proper cell growth and division. Read on to discover why folate should be an indispensable part of your daily diet and how it can positively impact your health!
Article at a glanc:
- The difference between folic acid and folate
- Why folate deficiency is common - MTHFR
- Foods rich in folate
- At-risk groups
- Folate and pregnancy
- Preventive benefits of folate
- Causes of folate deficiency
- Complications Associated with Folate Deficiency
The difference between folic acid and folate
Although they are often used as synonyms, folate and folic acid are not the same. To become biologically active, folic acid must undergo several transformation steps in the body. This process converts folic acid into 5-methyltetrahydrofolate (5-MTHF), the form of vitamin B9 that is most important and essential for our bodies because it is biologically active and easily utilized.
Why folate deficiency is common - MTHFR
The problem is that approximately 35% of the population has a so-called MTHFR polymorphism.[1] MTHFR stands for methylenetetrahydrofolate reductase, a key enzyme involved in the metabolic process of converting folic acid into the active form of folate - 5-MTHF. People with MTHFR polymorphism may not be able to effectively convert folic acid into its biologically active form. Therefore, even people who take high doses of folic acid may have a folate deficiency. This means that by taking active 5-MTHF folate, these conversion steps are not necessary because we are already consuming the biologically available form.
Foods rich in folate
Natural sources of folate include dark green leafy vegetables such as spinach, kale, and broccoli. Nuts are also a rich source of folate. Additionally, legumes and seafood are important sources. However, despite seeming to be surrounded by folate, it is not that simple. This vitamin is sensitive to heat, light, and pH, meaning its levels can decrease during storage and cooking. It is crucial to focus on fresh, unprocessed foods and minimize heat treatment to preserve the highest folate content. Even fresh leafy vegetables need to be stored in a cool, dark place, as they can lose up to 70% of their folate activity within three days at room temperature, and cooking in water can increase the loss to 95%.
At-risk groups
Folate deficiency is associated with birth defects, high homocysteine levels, and other lifestyle diseases. Those who should particularly monitor their folate intake include pregnant women, individuals with liver disease, people who consume excessive alcohol, and those taking laxatives and diuretics.
Folate and pregnancy
During pregnancy, folate plays a crucial role, but why is it so important? Imagine fetal development as building a house: you need all the essential components before you can start building. Folate acts as one of these essential "building blocks" for the proper development of the fetus. The neural tube, which develops in the early stages of pregnancy, is the foundation for the development of the brain and spinal cord. If the neural tube does not close properly, it can lead to serious birth defects such as anencephaly or spina bifida. [2] Since the neural tube begins to close in the first weeks of pregnancy, often before women know they are pregnant, it is recommended that women planning to become pregnant start taking folate supplements several months before conception to maximize protection against birth defects.
Preventive benefits of folate
Though not as well-known as vitamin C or calcium, folate's role in health should not be underestimated. In recent years, more attention has been given to the preventive effects of folate concerning serious illnesses such as heart disease, cancer, and even Alzheimer's disease.
Heart Disease
Heart disease is one of the leading causes of death worldwide. Studies suggest that adequate folate intake may help reduce the risk of heart disease. How does it work? [3] Folate is crucial for the proper function of our blood vessels and heart muscle. It helps lower homocysteine levels, which are associated with atherosclerosis—the buildup of plaques in arteries that can lead to heart problems.[4]
Alzheimer's Disease and Dementia
Alzheimer's disease and dementia are conditions that can affect anyone, directly or indirectly. Recently, there have been indications that folate may play a key role in preventing these neurodegenerative diseases. The exact mechanism is unclear, but it is believed that a deficiency in vitamin B12, as well as vitamin B9, reduces the synthesis of methionine and S-adenosylmethionine, which negatively impacts methylation reactions—essential for the proper function of the myelin sheath of nerve cells and neurotransmitters.[5]
Causes of folate deficiency
Several factors can contribute to folate deficiency:
- Diet: Poor dietary habits, such as low consumption of folate-rich vegetables and fruits or excessive cooking, which degrades folate, are primary culprits.
- Diseases: Certain diseases can disrupt nutrient absorption in the digestive tract, leading to folate deficiency. These include Crohn's disease, celiac disease, and some cancers. Even severe kidney problems requiring dialysis can cause low folate levels.
- Genetics: As mentioned earlier, genetics can play a role. People with a congenital MTHFR mutation have a reduced ability to convert folate from food or supplements into its active form.
- Medication Side Effects: Some medications can also contribute to folate deficiency. These include phenytoin (Dilantin), trimethoprim-sulfamethoxazole, methotrexate, and sulfasalazine.
- Alcohol Consumption: Excessive alcohol consumption disrupts folate absorption and increases its excretion in the urine.
Complications Associated with Folate Deficiency
Folate deficiency can lead to serious health issues, including:
- Megaloblastic Anemia: This condition is characterized by larger than normal and underdeveloped red blood cells, leading to a lack of oxygen in the body, causing fatigue, weakness, and other symptoms. [6]
- Low Levels of White Blood Cells and Platelets: Folate is crucial for the formation of white blood cells and platelets, which are essential for the immune system and blood clotting. A deficiency can weaken the immune system and increase the risk of bleeding.
- Serious Developmental Disorders of the Spine and Brain in the Fetus: Folate deficiency during pregnancy can have severe consequences for fetal development, leading to neural tube defects and other serious conditions.
- Peripheral Neuropathy: This condition affects peripheral nerves, causing tingling, numbness, and pain in the hands and feet.
Sources:
[1] Nefic, H., Mackic-Djurovic, M., & Eminovic, I. (2021). The Frequency of the 677C>T and 1298A>C Polymorphisms in the Methylenetetrahydrofolate Reductase (MTHFR) Gene in the Population. International Journal of Research in Medical Sciences, 9(3), 790–793
[2]Seremak-Mrozikiewicz, A., Drews, K., Kurzawińska, G., Bogacz, A., Grześkowiak, E., & Mrozikiewicz, P. M. The significance of 1793G>A polymorphism in MTHFR gene in women with first trimester recurrent miscarriages.
[3] Moat, S. J., Lang, D., McDowell, I. F. W., Clarke, Z. L., Madhavan, A. K., Lewis, M. J., & Goodfellow, J. Folate, homocysteine, endothelial function and cardiovascular disease.
[4] Li, Y., Huang, T., Zheng, Y., Muka, T., Troup, J., & Hu, F. B. Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials.
[5] Zhang, X., Bao, G., Liu, D., Yang, Y., Li, X., Cai, G., Liu, Y., & Wu, Y. The Association Between Folate and Alzheimer's Disease: A Systematic Review and Meta-Analysis.
[6] Čermák, J. Megaloblastové anémie. Retrieved from https://www.hematology.cz/wp-content/uploads/2023/03/27-Megaloblastova_anemie-verze-01-2023.pdf
