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Vitamin B9
Vitamin B9

Vitamin B9

Folic acid or vitamin B9 belongs to the family of water-soluble vitamins and it is essential for copying and synthesizing DNA, producing new cells, and supporting nerve and immune functions. It performs the most vital functions of the body, including everything from RBC formation to energy production. It has a positive action on cardiovascular, neural and psycho-emotional health. The research suggests that maintaining a consistent dietary intake of folate is essential to managing homocysteine metabolism and protecting long-term health. Folate  reduces the risk of cancer, prevents neural tube defects in utero when taken during early pregnancy, decreases risk of stroke and cardiovascular disease, promotes wound healing, mitigates the toxic effects of bisphenol-A in testes. and is integral to cell division and growth, particularly during infancy and pregnancy.

PubMed lists 56,178 studies that mention folate. The benefits of Folate supplementation are so well known that over 50 countries fortify certain foods with the nutrient to ensure adequate consumption by their population. Folic acid is the synthetic version used for food fortification and supplements. Folate is important because it plays a role in DNA synthesis and repair. It encourages cell and tissue growth. In fact, these benefits barely scratch the surface and its effects are far reaching. That bring us to nine incredible health benefits of folate.

The Health Benefits of Folate

1. Supports Normal Fetal Development

Folate plays an integral role in fetal development and the benefits for pregnant women and their offspring cannot be understated. Folate deficiency during early pregnancy can lead to neural tube defects. This is a serious problem that can lead to pregnancy termination or a baby born with spina bifida. [1] The good news? Studies have found increased folate levels from one month prior to conception to 3 months afterward can reduce the chance of these defects by 50%. [2]

2. Promotes Sperm Viability

Studies exploring the role of folate in spermatogenesis have linked it to sperm health and function. [3] Men with a lower folate intake have been shown to have sperm with incorrect chromosomal structure. [4] A 2012 study reported that previously infertile patients who took a nutritional supplement, which included folic acid, experienced significant improvement in sperm motility and successfully achieved pregnancy with their partners. [5]

3. Great for the Heart

Just like other B vitamins, folate plays an important role in reducing high levels of homocysteine in the blood. Homocysteine is a compound that has been linked to an increased risk of heart attacks and strokes when it lingers in the blood.

Homocysteine is an amino acid (the building blocks of proteins). It’s not possible to get homocysteine from the diet — instead, it must be made internally from methionine, another amino acid that is found in meat, fish and dairy products. Vitamins B6, B12 and folate are needed to make this reaction occur.

One of the most important folate-dependent reactions in the body is the conversion of homocysteine to methionine that occurs during the synthesis of important methyl donors. This helps normalize homocysteine levels and plays a positive role in the process of metabolizing minerals and antioxidant activities.

Generally, studies show that people who consume higher levels of folate have a lower risk of cardiovascular disease than those who have a lower intake. Although folic acid (and vitamin B12) supplements can lower homocysteine levels, research indicates that these supplements do not actually decrease the risk of cardiovascular disease, although they might provide protection from stroke.

Since we know that a diet high in plant foods like vegetables and fruits can help lower heart disease risk, this seems like the safest way to obtain folate and also benefit cardiovascular health.

4. May Reduce the Risk of Stroke

Not only is homocysteine bad for the heart, it can lead to stroke. An overabundance of homocysteine, or hyperhomocysteinemia, results from a breakdown in the methionine-homocysteine metabolism. This results in increased chances of blood vessel damage and blood clotting. Although stroke can have many causes and no one measure is a complete safeguard, folate, or the supplemental form folic acid, have been recommended for use to reduce the risk. [7]

5. Encourages Normal Cholesterol Levels

A Polish study found folic acid supplementation encourages normal cholesterol levels. In the study of 124 individuals, researchers observed significant reductions in LDL cholesterol levels in subjects who’d supplemented with .4 mg of folic acid daily for 12 weeks. The result is believed to have been derived from reduced homocysteine levels. [8]

6. Provides Neurological Support

Research suggests there may be a link between folate levels and neural health. A Korean study of elderly patients found that those suffering from dementia had the highest levels of homocysteine, and the lowest folate levels. Patients in the control group who did not suffer from dementia had higher folate levels. [9]

7. Helps Perinatal Mood Management and Depression

Often, perinatal depression cannot be addressed with pharmaceuticals due to concern for the child. This has led researchers to seek out more safe, natural alternatives. Folate, along with other B vitamins, is known to encourage the creation and absorption of neurotransmitters. Some experimental studies have indicated that micronutrients, including folic acid, can improve symptoms and outcomes. [10]

While folate alone might not prevent depression, it appears that a balanced diet with plenty of veggies and plant foods might act like a natural remedy for depression. In clinical and observational studies, folate status has been linked to depression and poor response to antidepressants. In study involving 2,948 people aged 1 to 39 years in the U.S., folate concentrations were significantly lower in individuals with major depression than in those who had never been depressed.

Results from a study of 52 men and women with major depressive disorder showed that only one of 14 subjects with low folate levels responded to antidepressant treatment compared with 17 of 38 subjects with normal folate levels.

8. Great for Colon Health

Could folate be good for your colon? A 2013 case control study linked folate intake to gene activation that alters the chances of developing colorectal cancer. [11] It’s also a testament to the importance of diet at the cellular level.

9. Reduces the Risk of Age-Related Macular Degeneration

A Harvard Medical School trial of women with a risk of age-related macular degeneration (AMD) explored the impact of B vitamin therapy (including folic acid, vitamin B6, and B12). The control group had a higher incidence of AMD than the group taking the B vitamin therapy. Researchers concluded that daily supplementation might help the fight in reducing the risk of AMD. [12]

10. Helps the Body Utilize Iron, Vitamin B12 and Amino Acids

A folate deficiency can contribute to anemia, which is a condition that develops when red blood cells are improperly formed. An important folate-dependent reaction in the body is the conversion of the methylation of deoxyuridylate to thymidylate in the formation of DNA, which is required for proper cell division. When this process is impaired, this initiates megaloblastic anemia, one of the hallmarks of folate deficiency.

Folate also helps vitamn B12 to be absorbed, so some experts are therefore concerned that high folic acid intakes might “mask” vitamin B12 deficiency until its neurological consequences become irreversible. Vitamin B12 benefits the body in many ways, including helping with nutrient absorption, energy expenditure and brain function — therefore, undiagnosed deficiency can be very risky.

11. Helps Prevent Cancer

American Journal of Clinical Nutrition reveals a decreased breast cancer risk associated with higher folate intake in postmenopausal women. Journal of Gastroenterology and Hepatology similarly finds a decreased risk of esophageal and pancreatic cancers associated with folate consumption. Biotechnic and Histochemistry shows that folic acid supplementation mitigates the toxic effects of bisphenol-A in testes.

Low blood folate levels are associated with an increased risk of cervical, breast, colon, brain and lung cancer. Epidemiologic evidence generally indicates that a high intake of folate-rich foods offers protection against the development of some common cancers, but the relationship between folic acid and cancer is complicated, as you’ve learned.

In the NIH-AARP Diet and Health Study, a cohort study of more than 525,000 people aged 50 to 71 years in the U.S., individuals with total folate intakes of 900 micrograms/day or higher had a 30 percent lower risk of developing colorectal cancer than those with intakes less than 200 micrograms/day.

On the other hand, observations in animal and human studies demonstrate that an overly abundant intake of folate among those who harbor existing foci of neoplasia might do the opposite and raise risk of certain cancers. The pharmaceutical form of the vitamin is distinct from natural forms of the vitamin and, therefore, the most protection comes from eating real foods!

12. Protects Cognitive Function and Might Help Prevent Dementia and Alzheimer’s

Most observational studies show a relationship between elevated homocysteine levels and a greater risk for Alzheimer’s disease and dementia. Some observational studies have also found correlations between low folate concentrations and poor cognitive function.

However, even though increasing folic acid through supplementing can help reduce homocysteine concentrations, this hasn’t been shown to improve cognitive function and prevent disease. A better natural Alzheimer’s treatment is to focus on obtaining plenty of nutrients, including natural folate from a variety of unprocessed whole foods.

Folate Deficiency & How to Reverse It

Folate deficiency can be a serious problem, although in most developed nations it’s not nearly as common of a nutrient deficiency as some others. According to USDA analyses of data in 2006, the National Health and Nutrition Examination Survey found that most people in the United States obtain adequate amounts of folate, although some groups are still at risk of obtaining insufficient amounts.

Mean dietary intakes of folate (including food folate and folic acid from fortified foods and supplements) range from 454 to 652 micrograms per day in U.S. adults and from 385 to 674 micrograms in children. Keep in mind that adults need about 400 micrograms daily, and children need roughly 300 micrograms.

Here are nine common signs that you might be suffering from a folate deficiency:

  1. Poor immune function; frequently getting sick
  2. Chronic low energy (including chronic fatigue syndrome)
  3. Poor digestion; issues like constipation, bloating and IBS
  4. Developmental problems during pregnancy and infancy, including stunted growth
  5. Anemia
  6. Canker sores in the mouth and a tender, swollen tongue
  7. Changes in mood, including irritability
  8. Pale skin
  9. Premature hair graying

Keep in mind that some people are at higher risks of experiencing folate deficiency than others. Groups who should be particularly careful to get enough folate naturally from their diets include:

  • Pregnant women or women looking to become pregnant
  • Breast-feeding mothers
  • Alcoholics
  • Anyone with liver disease
  • Anyone on kidney dialysis
  • Anyone taking medications for diabetes
  • Those frequently using diuretics or laxatives
  • Anyone taking methotrexate

How to Prevent Folate Deficiency: Recommended Daily Intakes

Folate is largely found in plant foods, so the best way to get adequate folate and prevent folate deficiency is to eat five or more servings of whole foods like fruits and vegetables daily. Green vegetables (nutritious Brussel sprouts, broccoli and peas, for example), especially all types of leafy greens, along with beans and citrus fruits are particularly important for preventing folate deficiency. Folate is also naturally found in some animal products, including liver and poultry.

Generally speaking, it should be pretty easy to prevent folate deficiency by eating a well-balanced diet. But studies have shown that folate absorption varies widely from person to person. There are several factors that influence how much folate someone can absorb from the foods they eat, including their levels of zinc and health of their kidneys, liver and gut.

The total body content of folate is estimated to be 10 to 30 milligrams, about half of which is stored in the liver. The remainder is found in the blood and body tissues. To test for folate deficiency, a doctor might conduct a serum folate concentration test (a value above 3 nanograms (ng)/mL indicates deficiency). However, a more reliable approach is testing erythrocyte folate concentrations, which provides a longer-term measure of folate intakes and is a better indicator of stored folate within tissues.

According to the National Institute of Health, the recommended dietary allowances (RDAs) for folate are as follows:

  • Infants and babies: 65 micrograms/day
  • Children ages 1–8: 80–150 micrograms/day
  • Teens ages 8–13: 300 micrograms/day
  • Adult men and women (above age 14): 400 micrograms/day
  • Pregnant women: 600 micrograms/day (which is about 50 percent higher than the non-pregnant women’s recommendation)
  • Women who are breast-feeding: 500 micrograms/day

Folate vs. Folic Acid: An Important Difference!

Let’s talk about folate vs. folic acid — do you know the difference between the two?

It’s estimated that about 35 percent of adults and 28 percent of all children in the United States use supplements containing folic acid. Folate and folic acid are usually used interchangeably, but they definitely have some noteworthy differences. While folate is a naturally occurring and essential vitamin, folic acid is a synthetic B vitamin found in supplements and fortified foods.

Folate is easily and naturally absorbed and utilized by the body when it’s metabolized in the small intestines. On the other hand, folic acid — which was only first introduced around the 1940s — requires the presence of a specific enzyme named dihydrofolate reductase, which is relatively rare in the body.

What’s the harm in supplementing with folic acid? Because many of us, particularly women who are of “child-bearing age,” cannot metabolize folic acid well, elevated levels of unmetabolized folic acid enter and remain in the bloodstream. Side effects of folic acid remaining in the body include changes in sex hormones, trouble concentrating, inability to sleep, mood changes and deficiencies in certain nutrients like vitamin B12.

High levels of lingering folic acid in the blood is even tied to cancer development, according to some research. Several studies have found a link between supplementing with high levels of folic acid or obtaining it from forti­­­­fied foods (like cereal grains, breads, etc.) in fostering the growth of pre-cancerous cells and tumors.

This is definitely unfortunate considering folic acid remains on the FDA’s list of mandatory food fortifications first developed in 1998. According to the U.S Department of Health and Human Services, in 1998 the FDA began requiring food manufacturers to add folic acid to enriched grain products — including all breads, cereals, flours, cornmeals, pastas, rice and other packaged goods. Other countries, including Canada, Costa Rica, Chile and South Africa, have also established mandatory folic acid fortification programs. The FDA’s fortification program was projected to increase folic acid intakes in the average American’s diet by approximately 100 micrograms/day, but the program actually increased mean folic acid intakes by almost double this amount — about 190 micrograms/day.

The USDA clams that there is a higher level of bioavailability of folic acid than that of food-found folate. At least 85 percent of folic acid is estimated to be bioavailable when taken with food, whereas only about 50 percent of folate naturally present in food is bioavailable. There are pros and cons to this, because it means folic acid can easily remain elevated, but it also might help prevent certain symptoms of deficiency.

Top 12 Folate Food Sources

Increasing your intake of natural folate-rich foods is the best way to protect yourself from deficiency along with complications of folic acid supplementation. The USDA lists the following folate levels found in natural foods:

  1. Spinach — 1 cup cooked: 262 mcg (66 percent DV)
  2. Beef Liver — 3 oz: 215 mcg (54 percent DV)
  3. Black Eyed Peas — 1 cup cooked: 210 mcg (52 percent DV)
  4. Asparagus — 8 spears: 178 mcg (44 percent DV)
  5. Broccoli — 1 cup cooked: 104 mcg (26 percent DV)
  6. Brussel Sprouts— 1 cup cooked: 156 mcg (40 percent DV)
  7. Mustard Greens— 1 cup cooked: 104 mcg (26 percent DV)
  8. Kidney Beans — 92 mcg (24 percent DV)
  9. Romaine Lettuce — 1 cup raw: 64 mg (16 percent DV)
  10. Avocado — ½ cup: 59 mcg (15 percent DV)
  11. Wheat Germ — 2 tablespoons: 40 mcg (10 percent DV)
  12. Orange — 1 medium: 29 mcg (7 percent)

How to Add More Folate to Your Diet

Folate can be found naturally in these recipes that contain folate-rich foods, such as broccoli, spinach, beans and oranges.

Interactions and Side Effects of Folate

Folate from whole food sources doesn’t pose much of a risk, but folic acid supplements can interact with several medications and aggravate health conditions as mentioned earlier. Aside from posing a risk of cancer and autoimmune problems, anyone taking Methotrexate, a medication used to treat cancer and autoimmune diseases, is at risk for compilations when taking folic acid since this medication impacts folate absorbability.

Taking antiepileptic medications used to treat epilepsy or psychiatric diseases along with folic acid supplements might cause a reduction in serum levels of these medications. The same goes for medications like Sulfasalazine used primarily to treat ulcerative colitis.

References (12)

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