Folate

Vitamin B9 is commonly referred to as folate or folic acid.  While these two terms are used inter-changeably, they have distinctly different meanings.  

It is helpful for everyone to understand the difference between folate and folic acid, but it is essential if you have a genetic polymorphisms such as the MTHFR snp, if you are pregnant or planning on falling pregnant.   

Vitamin B9 is part of the B group of vitamins.  These water soluble vitamins are vital for our health and wellbeing.  They play a significant role in: 

  • cell health and regeneration 
  • red blood cells production
  • energy levels
  • maintaining eye function 
  • cognitive function
  • gut health and appetite 
  • nervous system function
  • hormones production
  • liver function 
  • cardiovascular health
  • muscle tone

With the exception of Vitamin B12, B Vitamins cannot be stored in our body so we must replenish our levels regularly with dietary intake or supplementation. 

Vitamin B9 is an essential nutrient: this means we must obtain it from food or supplementation as our bodies cannot make it.   We need it for many cellular functions in the body including red blood cell production, methylation and protein metabolism.  It has a crucial role in cell growth and the formation of DNA and this is why there is such a focus on B9 levels during preconception and pregnancy. 

Low levels of vitamin B9 are associated with an increased risk of several health conditions including: 

  • High homocysteine levels have been associated with an increased risk of heart disease and stroke. 
  • Low folate levels in pregnant women have been linked to birth defects that affect the brain, spinal cord, and spine.
  • Poor levels of folate are also linked to increased cancer risk. 

For these reasons, supplementing with vitamin B9 is common and many countries, including Australia, have taken the decision to add folic acid to nutrient void foods such as bread flour and cereals. 

Folic acid

Folic acid is the oxidized synthetic form of Vitamin B9.  It is more stable than folate and therefore can survive the processing when added to foods such as cereals, flour, breads, pasta, bakery items, cookies and crackers. This process is known as fortification. 

Our cells cannot utilise folic acid as such, they need to convert it to the active form, tetrahydrofolic.  This conversion takes place in the liver with the assistance of Vitamin B12 and the enzyme dihydrofolate reductase. As our liver only produces a small amount of dihydrofolate reductase, it is likely that not all folic acid consumed will be converted into the form needed by our cells.  

In addition to low dihydrofolate reductase, anyone with the MTHFR genetic snp has a further reduced capacity to convert folic acid into tetrahydrofolic.  

Any folic acid not utilised returns to the small intestine and is repeatedly reabsorbed. This can lead to Vitamin B12 deficiency, poor gut health and may mask neurological damage symptoms of which include headaches, strokes and seizures. 

Folate

Unlike folic acid, folate is the natural form of Vitamin B9.  It is processed in the small intestines into tetrahydrofolate for utilization by the cells and does not rely on dihydrofolate reductase.

It is found naturally in lots of foods including green leafy vegetable such as broccoli, Brussel sprouts, kale, spinach, cauliflower and lettuce.  It can be destroyed by heat so cooking your vegetables by lightly steaming or quickly stir frying helps retain high levels of folate.  

The problem

Our cells have folate receptors: these are gates that welcome in the active folate, tetrahydrofolic, into the cell.   Folic acid, which cannot be utilised by the cell, binds to these receptors blocking the tetrahydrofolic from entering the cell.   Therefore, I  recommended my clients limit their intake of fortified foods and obtain folate from food sources or a supplement which provides the active form.  These supplements are called “activated vitamins” and the activated B9 is called 5′-methyltetrahydrofolate or  5′-MTHF.   

How much folate do you need?   

The recommended daily intake (RDI) of folate for non-pregnant women is 400 mcg of folate each day and 500 mcg per day men.  

The RDI of folate in preconception and pregnancy is 600 mcg per day. This goes for men too, their health and folate levels have a direct impact on the health of their baby.  An example of 600 mcg of folate is: 

  • ½ a cup of cooked spinach = 105mcg
  • 6 spears of asparagus = 134 mcg
  • 1 cup of mixed lettuce = 64 mcg
  • 1  cup of broccoli = 120 mcg
  • ½ a cup of cooked pinto beans 55 mcg  
  • 2 egg = 44 mcg 
  • 1 0range = 50 mcg 
  • ½ red capsicum = 30 mcg

Other foods rich in folate are: 

  • Other leafy green vegetables, such as cabbage, kale, silver beet, cauliflower and brussels sprouts 
  • Beetroot
  • Papaya
  • Sunflower seeds 
  • Legumes 

If you are pregnant or trying to conceived then you should aim for 6 serves of these folate rich food each day.  Everyone else should aim for 4-5 serves of folate rich foods each day. 

It is also essential that you avoid, or at least minimise your intake of folic acid to allow the natural folate to be utilised by your cells.  You can do this by avoiding foods fortified such as: 

  • Breads
  • Pastries 
  • Cereals 
  • Nutritional Yeast
  • Any cakes, crackers, biscuits made with wheat or rye flour 

Many gluten free flours and gluten free products are fortified with folic acid.   It is important to check the labels.  It is a legal requirement that any fortification must be declared on the packaging, however, interestingly, it is usually labelled as folate.  We know this it is not folate; it is folic acid because folate is not stable enough to survive processing. 

Organic bread and organic flour products don’t usually have folate added, but some manufacturers will add it to the processing.  Again, if it is added it is noted on the label with the other ingredients, usually as folate.

All of the B vitamins work together:  However, Vitamin B12 and folate are especially closely related as explained above and in fact they rely on each other for activation.  B12 is essential for DNA synthesis, growth and nervous system function.  Excess consumption of folic acid combined with low dietary Vitamin B12 can easily lead to deficiency and further disruption to folate utilisation.  

Vitamin B12 is found in animal protein and products such as cheese and eggs.  People who are vegetarian or vegan need to be especially careful and consider Vitamin B12 supplementation. 

For optimal health I recommend you eat a diet high in folate rich foods, ensure you have adequate B12 levels and avoid, as much as possible, fortified foods.  

If you would like more information about folate, methylation or MTHFR please contact us to discuss or make an appointment at Elemental Health on (02) 8084 0081