Folate: The often overlooked B vitamin

Read Time:   |  17th August 2021

Thought folic acid was something only pregnant people need to worry about? Think again! Here's why your body needs folate and where to get it on a vegan diet.

Are folic acid and folate the same thing?

Folate (methylfolate) is the natural form of vitamin B9. Folic acid is the synthetic version found in supplements and fortified foods.

Within the body, folic acid is converted to folate.

Effectively, both perform the same function within the body. However, folate has the benefit of being found in whole foods, which contain other nutrients and beneficial fibre.

What does folate/folic acid do for the body?

From blood cell maintenance to metabolism, it is quite the all-rounder.

Its most important role is in the formation of red and white blood cells in the bone marrow and in the formation of DNA and RNA.

It is also involved in a number of metabolic processes, including energy conversion from carbohydrates.

Folate has the ability to cross the blood-brain barrier, which allows it to assist in the smooth running of the nervous system.

Alongside B12, it is also involved in the synthesis of neurotransmitters, such as serotonin and dopamine. These help to regulate emotional wellbeing.

Alongside B12, folate helps to regulate emotional wellbeing.

Alongside B12, folate helps to regulate emotional wellbeing.

Research findings

A meta-analysis (an analysis of multiple studies) found an association between low levels of folate and depression5.

Some studies have shown that folic acid supplementation, alongside medication, may be beneficial in bipolar disorder6, and major depressive disorders10.

Folate may also be beneficial in stroke and cardiovascular disease reduction.

A meta-analysis of randomised controlled trials found that folic acid supplementation was associated with a 10% reduction in stroke and a 4% reduction in overall cardiovascular disease7.

However, the effect was more prominent for those that had a low baseline level of folate, rather than those with sufficient levels.

Further research is being undertaken in these areas to come to a more definitive conclusion.

What are the symptoms of low folate?

Low folate can lead to folate deficiency anaemia (megaloblastic anaemia)4.

This causes defective, and larger than normal, red blood cells, making them harder to be transported throughout the body.

This may cause symptoms such as fatigue, headaches, heart palpitations, a sore tongue and numbness and tingling in the limbs (parathesia). It can also lead to behavioural disorders.

Folate deficiency is diagnosed with a blood test and can be treated with folic acid supplementation and/or diet.

Your GP will also check your B12 status before prescribing treatment for folate deficiency. This is because the treatment can improve certain symptoms that are associated with both folate and B12 deficiency.

This can mask serious symptoms of B12 deficiency, such as nerve damage.

Related articles:

Symptoms of folate deficiency fatigue, headaches, heart palpitations, a sore tongue and numbness and tingling in the limbs.

Symptoms of folate deficiency fatigue, headaches, heart palpitations, a sore tongue and numbness and tingling in the limbs.

Is folate and vitamin B12 the same thing?

Folate (B9) and cyanocobalamin (B12) are not the same thing, but both are B vitamins that cannot be made in the body. They are required to be consumed in the diet.

Whilst B12 can be stored in the body for a long time, folate only has a short term capacity to be stored.

Think of folate and B12 like a couple, a very cooperative couple.

One of the biggest jobs they collaborate on is making red blood cells and ensuring healthy nerve functioning.

Alongside vitamin B6, folate and B12 also control levels of homocysteine in the blood. High homocysteine levels are associated with a range of health problems including cardiovascular disease and stroke.

However, it is unclear whether high homocysteine levels are a side effect or a contributing factor.

Which folate-rich foods should we be eating and how often?

Folate is found in an abundance of foods.

Leafy green vegetables are a great source, including broccoli, spring greens, kale, Brussels sprouts and cabbage.

Other sources include asparagus, peas, chickpeas, kidney beans, brown rice, peanuts, sunflower seeds, fruits and fortified foods, such as cereal.

However, it cannot be produced in the body or stored for very long, so you should aim to be eating folate-rich foods every day. This should help you achieve the recommended daily allowance of 200 micrograms for adults.

Eating a variety of vegetables, fruits, beans, legumes and wholegrains each day should help you achieve this.

Of note, folate is a water-soluble vitamin, so a small amount may be lost if food is over-cooked, microwaved or steamed.

Alcohol can also decrease the absorption of folate.

Fortified foods such as cereal are a good source of folic acid.

Fortified foods such as cereal are a good source of folic acid.

Is folic acid just important for pregnant women?

The main reason folic acid supplementation is so important during pregnancy is because it can be difficult to obtain the increased requirements from the diet alone.

Folic acid aids the rapid growth in the fetus and can prevent neural tube defects.

In some cases, folic acid may be beneficial outside of pregnancy, but folate from foods should be enough.

Folate is important throughout all life stages and can help in growth spurts during childhood and adolescence, as well as in essential physiological functions.

Planning for a baby or already pregnant? Make sure that you supplement your diet with folic acid to help to prevent neural tube defects in the baby.

Planning for a baby or already pregnant? Make sure that you supplement your diet with folic acid to help to prevent neural tube defects in the baby.

Do we need to take folic acid supplements or can we get enough from food?

The answer to this is very much dependant on your situation. Most individuals will not need to supplement with folic acid, as a whole food plant-based diet is abundant with folate-rich foods.

However, if you are planning for a baby, or are pregnant, it is recommended that you supplement with folic acid. This will help to prevent neural tube defects in the baby.

Daily folic acid recommendation

The National Institute of Clinical Excellence (NICE) recommends 400 micrograms of folic acid each day whilst trying for a baby and for the first 12 weeks of pregnancy.

If you are at higher risk, which your GP or midwife will confirm, the dosage may be increased to 5mg per day.

If B12 deficiency has been ruled out, those with folate deficiency anaemia may benefit from folic acid supplementation.

Additionally, it may be beneficial if you have any lower gastrointestinal problems, such as coeliac disease or inflammatory bowel disease, which affect the absorption of water-soluble vitamins.

Folic acid supplementation is not suitable for everyone, so it is incredibly important to check with your GP whether it can be taken with certain medical conditions and medications.

Nutrition is a key part of giving a child a great start in life, and it’s never too early to think about it.

If you’re expecting, take a look at what foods you need to eat for a healthy pregnancy

References

  1. https://www.bda.uk.com/resource/folic-acid.html
  2. https://www.nhs.uk/medicines/folic-acid/
  3. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
  4. https://cks.nice.org.uk/topics/anaemia-b12-folate-deficiency/
  5. https://www.sciencedirect.com/science/article/pii/S0022395617305927
  6. Zheng, W., Li, W., Qi, H., Xiao, L., Sim, K., Ungvari, G.S., Lu, X-B., Huang, X., Ning, Y-P.,  and Xiang, Y-T., 2020. Adjunctive folate for major mental disorders: A systematic review. Journal of Affective Disorders, 267, 123-130.
  7. Li, Y., Huang, T., Zheng, Y., Muka, T., Troup, J., and Hu, F.A., 2016. Folic Acid Supplementation and the Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials. Journal of the American Heart Association, 5 (8).
  8. https://www.ahajournals.org/doi/full/10.1161/JAHA.116.003768
  9. Wan, Li., W., Zhang, Z., Sun, Z., He, Y., and Li, R., 2018. Methylenetetrahydrofolate reductase and psychiatric diseases. Translational Psychiatry, 8.  https://www.nature.com/articles/s41398-018-0276-6
  10. https://www.sciencedirect.com/science/article/pii/S0165032719322347

Written by

Sara Boreham

Sara Boreham

Sara is an MSc Nutrition and Behaviour student, and soon to be AfN Associate Nutritionist. She has a special interest in the benefits of plant foods and enjoys trying out new recipes. In her spare time, she likes to write children’s fiction and explore nature.

www.instagram.com/nutritionwith_sara

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