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Folate
When can folate deficiency occur?
A deficiency of folate can occur when an increased need for folate is not matched by an increased intake, when dietary folate intake does not meet recommended needs, and when folate excretion increases. Medications that interfere with the metabolism of folate may also increase the need for this vitamin and risk of deficiency [1,15-19].
Medical conditions that increase the need for folate or result in increased excretion of folate include:
pregnancy and lactation (breastfeeding)
alcohol abuse
malabsorption
kidney dialysis
liver disease
certain anemias
Medications that interfere with folate utilization include:
anti-convulsant medications (such as dilantin, phenytoin and primidone)
metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
sulfasalazine (used to control inflammation associated with Crohn's disease and ulcerative colitis)
triamterene (a diuretic)
methotrexate (used for cancer and other diseases such as rheumatoid arthritis)
barbiturates (used as sedatives)
What are some common signs and symptoms of folate deficiency?
Folate deficient women who become pregnant are at greater risk of giving birth to low birth weight, premature, and/or infants with neural tube defects.
In infants and children, folate deficiency can slow overall growth rate.
In adults, a particular type of anemia can result from long term folate deficiency.
Other signs of folate deficiency are often subtle. Digestive disorders such as diarrhea, loss of appetite, and weight loss can occur, as can weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and behavioral disorders [1,20]. An elevated level of homocysteine in the blood, a risk factor for cardiovascular disease, also can result from folate deficiency.
Many of these subtle symptoms are general and can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.
Do women of childbearing age and pregnant women have a special need for folate?
Folic acid is very important for all women who may become pregnant. Adequate folate intake during the periconceptual period, the time just before and just after a woman becomes pregnant, protects against neural tube defects [21]. Neural tube defects result in malformations of the spine (spina bifida), skull, and brain (anencephaly) [10]. The risk of neural tube defects is significantly reduced when supplemental folic acid is consumed in addition to a healthful diet prior to and during the first month following conception [10,22-23]. Since January 1, 1998, when the folate food fortification program took effect, data suggest that there has been a significant reduction in neural tube birth defects [24]. Women who could become pregnant are advised to eat foods fortified with folic acid or take a folic acid supplement in addition to eating folate-rich foods to reduce the risk of some serious birth defects. For this population, researchers recommend a daily intake of 400 μg of synthetic folic acid per day from fortified foods and/or dietary supplements [10].
Who else may need extra folic acid to prevent a deficiency?
People who abuse alcohol, those taking medications that may interfere with the action of folate (including, but not limited to those listed above), individuals diagnosed with anemia from folate deficiency, and those with malabsorption, liver disease, or who are receiving kidney dialysis treatment may benefit from a folic acid supplement.
Folate deficiency has been observed in alcoholics. A 1997 review of the nutritional status of chronic alcoholics found low folate status in more than 50% of those surveyed [25]. Alcohol interferes with the absorption of folate and increases excretion of folate by the kidney. In addition, many people who abuse alcohol have poor quality diets that do not provide the recommended intake of folate [17]. Increasing folate intake through diet, or folic acid intake through fortified foods or supplements, may be beneficial to the health of alcoholics.
Anti-convulsant medications such as dilantin increase the need for folate [26-27]. Anyone taking anti-convulsants and other medications that interfere with the body's ability to use folate should consult with a medical doctor about the need to take a folic acid supplement [28-30].
Anemia is a condition that occurs when there is insufficient hemoglobin in red blood cells to carry enough oxygen to cells and tissues. It can result from a wide variety of medical problems, including folate deficiency. With folate deficiency, your body may make large red blood cells that do not contain adequate hemoglobin, the substance in red blood cells that carries oxygen to your body's cells [4]. Your physician can determine whether an anemia is associated with folate deficiency and whether supplemental folic acid is indicated.
Several medical conditions increase the risk of folic acid deficiency. Liver disease and kidney dialysis increase excretion (loss) of folic acid. Malabsorption can prevent your body from using folate in food. Medical doctors treating individuals with these disorders will evaluate the need for a folic acid supplement [1].
What are the Dietary Reference Intakes for folate?
What are some current issues and controversies about folate?
