One key function of folate is in the creation of DNA and RNA, so it is of critical importance for the production and division of new cells. As a result, when a mom-to-be is low in folic acid, that deficiency can affect the chance of a child being born with a neural tube defect such as spina bifida. In utero, the neural tube helps form the brain and spinal cord, and when it does not close properly, as can happen when folate is low, brain and spinal cord defects are more likely to occur.For this reason, prenatal vitamins are fortified with additional folic acid.
Another important role for folate is in the development of red blood cells. When folic acid is low, these cells do not divide properly and cannot deliver oxygen to the body as needed. This causes a type of anemia that is not iron related, but still results in fatigue and other similar symptoms. It is important for any healthcare practitioner to be able to distinguish between an iron deficiency vs. a folate deficiency when assessing for anemia.
Dementia, Osteoporosis, Heart Disease, and Parkinson’s Disease
A true multitasker, folic acid also is essential for normal processing of a compound called homocysteine. Homocysteine is usually part of a cycle which produces agents that help our bodies detoxify, maintains normal circulation, and can impact brain function. Without folic acid, homocysteine gets blocked and can not proceed to the next step. High homocysteine levels in blood are implicated in heart disease, dementia, Parkinson’s disease and impaired excretion toxins. Elevated homocysteine levels are also linked to increases in fractures from osteoporosis. Since dementia, osteoporosis and heart disease all can result from a lack of dietary folate, it is possible that these diseases of the elderly may well be linked, and could be ameliorated by insuring there is adequate folic acid in the diet.
Depression, Cognitive Decline and Irritability
In addition to folate’s gestational effects on the brain, folate plays a role in the daily functioning of brain messengers called neurotransmitters, which affect our mood and behavior. Low folic-
acid levels have been correlated with depression, cognitive decline and irritability.
Cell Regeneration and Cancer
All cells have a limited lifespan, and in order to regenerate they need folate. The cells with the quickest turnover, such as oral and intestinal cells, are most susceptible to low folic-acid levels. In addition, certain cancers have been tied to lower folate levels, and good folate status appears cancer protective. However, this picture is complicated by the fact that excessive supplementation with folic acid also has been linked to the growth of certain cancers. Since both cancer cells and healthy tissue need folate to grow, it may be that folic acid is important before the onset of cancer, but in the presence of cancer cells, it may actually promote increased proliferation.
Folate is found naturally in leafy green vegetables, beans, peas, and liver. While orange juice and bananas are not as dense in folic acid, they are a more common source in the American diet. In addition, many grain products such as breads and cereals are fortified with folic acid, as well as iron and other B vitamins. A few of the factors that inhibit normal blood folate levels include lack of dietary folate, poor absorption and inefficient processing. The typical American diet is not rich in leafy greens or legumes, making it more difficult to meet our basic dietary need for folate.
Medications can Interfere with Folate Absorption
Many medications that interfere with folate absorption (such as antacids, anti-reflux medications, some antibiotics, birth control medications, anticonvulsants, and some cholesterol-lowering medications). This, combined with the less-than-optimum typical American diet, makes it a wonder we are not all deficient. While many of these pharmaceuticals can be used at any age, seniors are often taking a combination of drugs that interfere with folate absorption.
Emerging research also points to a genetic cause of poor folic acid status. Many people have an altered form of the gene (called a single nucleotide polymorphism or SNP) which controls the enzyme for folic-acid processing that is less efficient than typical. In these people, dietary folate is less easily converted to the active form that the body needs for the mechanisms described above. When poor intake, and multiple medications are combined with inefficient processing, poor folate stores is the likely result. The genetic SNP can easily be tested by a blood test for an enzyme called methylenetetrahydrofolate reductase (MTHFR).
While standard prenatal vitamins contain folic acid, a select few brands include the more active forms of folate, called 5MTHF, to insure that pregnant women who may be unaware they carry this SNP are able to utilize folic acid as well as possible.
Forgetfulness, Depression, Gingivitis, Diarrhea
Since folate is involved in so many biological processes, a deficiency can show up in a variety of ways. Because of its importance in brain function, low levels can cause forgetfulness, irritability and depression. It can result in gingivitis or diarrhea, due to its effects on cell regeneration and fatigue when red blood cells production is poor. However, excesses of folate can also cause similar symptoms, so it is best to get folate from dietary sources or limit supplementation to no more than 400-800mcg daily from a well-absorbed source. Try introducing this wonderful nutrient by serving dishes such as white bean and escarole soup, chili with beans, chopped liver, hummus or spinach and lentil soup. From our first day to our last, folate is a key nutrient in optimal health.
Vicki Kobliner MS RD, CD-N is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcarenutrition.com
