Folate (Folic acid)

Folate – folic acid) – role, norms and violations

Folate (vitamin B₉) is a water-soluble vitamin essential for DNA synthesis, hematopoiesis,and the nervous system. The body does not produce folic acid, so it must come from food or supplements.

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1. The role of folate in the body

• DNA/RNA synthesis -participates in cell division (especially important for bone marrow and rapidly regenerating tissues).
• Hematopoiesis -necessary for the formation of red blood cells (prevention of megaloblastic anemia).
• Homocysteine metabolism -lowers homocysteine levels (high levels are associated with the risk of thrombosis and atherosclerosis).
• Development of the fetal nervous system -prevents neural tube defects (anencephaly, spina bifida).

Forms of vitamin B₉:

• Folic acid is a synthetic form (in supplements and fortified foods).
• Folate is a natural form (in food: greens, liver, legumes).

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2. The norm of folate in the blood

Note:

• Red blood cell folate is a more accurate indicator of long-term status (reflects 3-4-month reserves).
• In pregnant women, the lower limit of serum folate is≥ 10 nmol/l.

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3. Folate deficiency: Causes and symptoms

Causes of the deficit:

• Lack of food – a diet without greens, legumes, meat.
• Malabsorption (celiac disease, Crohn’s disease).
• Increased expenses – pregnancy, hemodialysis, oncology.
• Alcoholism -disrupts folate metabolism.
• Medications (methotrexate, anticonvulsants, oral contraceptives).

Symptoms:

• Megaloblastic anemia (weakness, pallor, shortness of breath).
• Glossitis (red ‘varnished’ tongue).
• Cognitive impairment (depression, memory loss).
• Complications of pregnancy – miscarriages, malformations of the fetus.

Laboratory signs:

• Фол Folate in serum and red blood cells.
• ↑ Homocysteine.
• Macrocytosis (MCV > 100 fl) in the UAC.

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4. Excess folate: does it happen and what is dangerous?

Overdosing on natural folate from food is almost impossible. However, an excess of synthetic folic acid (> 1000 micrograms / day) can cause:

• Mask vitamin B deficiency – improves blood tests, but doesn’t stop neurological damage.
• Increase the risk of cancer (controversial data, but with prolonged use of high doses).

Symptoms of excess:
Usually missing, but possible:

• Nausea, flatulence.
• Allergic reactions (rash, itching).

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5. Diagnosis and treatment

Analyzes:

1. Serum folate is an acute deficiency.
2. Red blood cell folate is a chronic deficiency.
3. Homocysteine (increases with B₉ or B₁₂ deficiency).
4. Vitamin B₁₂ – be sure to check with folate (their deficiencies are similar in symptoms).

Deficit management:

• Folic acid preparations(400-1000 mcg / day).
• For malabsorption – injectable forms.
• Pregnant women– 400-800 mcg/day from the moment of planning until the end of the first trimester.

Prevention:

• Foods with folate:
• Herbs (spinach, parsley).
• Liver, eggs.
• Legumes (lentils, beans).
• Avocado, citrus fruits.

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6. Examples of interpreting results

Important: Folate deficiency and B₁₂ are often combined. Do not prescribe folic acid without a B₁₂ test-this may worsen neurological symptoms!

Daily consumption rates

• Adults: 400 mcg.
• Pregnant women: 600 mcg.
• Nursing mothers: 500 mcg.

Toxicity: The upper permissible limit is 1000 mcg / day for the synthetic form (from additives).