Folate

(Folic acid, Folacin)

Folate, also referred to as folacin, is the generic name for chemical compounds that are related to folic acid. Folate is most known for its important role in the process of cell division and in the making of DNA (the genetic material of cells), however folate also assists in the manufacturing of red blood cells and in foetal development during pregnancy.

Given the important role that folate has in cell division, folate is very important in the development of a baby foetus during pregnancy. Folic acid supplements have been found to reduce the risk of serious foetal malformation and neural tube defects if taken around the time of conception. Research suggests that women who take folate supplements prior to and throughout pregnancy reduce the risk of birth defects by up to 70% and as a result most health professional recommend the use of nutritional supplements during pregnancy.

The word folate originated in 1941 from the Latin word 'Folia' (leaf) as traditionally spinach leaves were used in the preparation of folate. Folate is found in most leafy vegetables for example spinach, broccoli, cabbage and lettuce, but is also found in foods such as liver, kidney, beans, beetroot, bran, nuts and some fruits. Some textbooks suggest that there is even a little folate found in tea and beer, however expert-nutrition strongly discourages the consumption of alcohol as a means to increase folate intake during pregnancy.

Folate deficiency is arguably the most common vitamin deficiency seen in western world, however given that folate and vitamin B12 have a similar role within the body, a deficiency in vitamin B12 can often be mistaken for a deficiency in folate. Folate deficiency impairs cell division, protein synthesis and can lead to anaemia in a similar way to that seen in a vitamin B12 deficiency. Without folate, DNA synthesis slows and cells lose their ability to divide. A deficiency in folate can also increase homocysteine levels which can be toxic to the cardiovascular system increasing the risk of fatty plaque deposits in our arteries and subsequently increase the risk of heart disease and stroke.

In 2001, an article published in the Journal of the American Medical Association (JAMA) suggested that all American adults should be taking a multivitamin on a daily basis to assist in the prevention of chronic diseases. In particular, this report highlighted the lack of folate in the American diet which is known to have a protective effect against many chronic diseases and as such the use of a multivitamin supplement containing folic acid was recommended to all Americans.

Australia and New Zealand have also recently recognised that folate deficiency is a concern and are considering fortifying bread or flour as a means to reduce the incidence of the deficiency. Although there has been a report published estimating the cost associated with bread fortification to our knowledge a decision has yet to be made as to whether it will happen. In the meantime we encourage Australian and New Zealand residents to improve their diet to include folate containing foods such as those mentioned above and/or take the stance of the Americans and use supplementation.

There are a few important points to consider when taking nutritional supplements and as such there is a chapter of this website dedicated to educating people around the use of supplements.

Specifically in regards to folate supplements numerous studies have confirmed that folate supplements that also contain Vitamin B12 and vitamin B6 are the most beneficial in reducing cardiovascular risks.

Additional Possible Benefits of Folate³:

• May help to protect against heart disease, nerve damage, neural tube defects and cervical dysplasia.
• May help to prevent certain cancers, particularly cervical cancer

Another important point to consider is that given all of the recent research supporting the role of folate in reducing the incidence of disease, the Recommended Dietary Intake for folate has recently doubled and therefore if you thought a few years ago you had enough folate in your diet, by today’s recommendations you might only just be getting half. For the benefit of our readers the current recommended dietary intake for folate is summarised below.

Recommended Dietary Intake for Folate

The following recommendations have been sourced from Nutrient Reference Values for Australian and New Zealand, copyright by permission.

Please refer to the following definitions when interpreting these recommendations:

RDI-Recommended Daily Intake
The average daily intake level that is sufficient to meet the nutritional requirements of nearly all (97-98%) health individuals in a particular life stage and gender group.

AI-Adequate Intake (used when an RDI cannot be determined)
The average daily nutrient intake level based on observed or experimentally-determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate.

UL-Upper Limit of Intake
The highest average daily nutrient intake level likely to pose no adverse health effects to almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects increases.

RECOMMENDATIONS BY LIFE STAGE AND GENDER - Folate

* Not possible to establish for supplemental folic acid. Source of intake should be milk, formula and food only
** Not possible to determine, source of intake should be from food only

Source: National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Department of Health and Ageing, Canberra 2006, copyright Commonwealth of Australia reproduced by permission.

References:
1. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Department of Health and Ageing, Canberra 2006 pp 97-104.
2. Stanton R. Foods that harm, foods that heal: An A-Z guide to safe and healthy eating. Readers Digest; 2006, pp378-382.
3. Wahlqvist, M.L., et al. Australia and New Zealand: Food and Nutrition. 2nd Ed. Allen and Unwin, Sydney; 2002, pp 255-229.
4. Mann, J., Truswell, S. Essentials of Human Nutrition. Oxford Medical Publications, New York. 2000
5. Fletcher R H., Fairfield K M. Vitamins for chronic disease prevention in adults: Clinical applications. JAMA Jun 19, 2002; 287 (23): 3127-3129.
6. Report by Access Economics for the Food Standards Australia and New Zealand. Fortification of bread with folic acid. Access Economics Pty Ltd. August 2006.
7. Landgren et al. Plasma homocysteine in acute myocardial infarction: Homocysteine-lowering effect of folic acid. J Int Med 1995, 237(4): 381-388.
8. Van Den Burg M et al. Combined vitamin B6, folic acid therapy in young patients with arteriosclerosis and hyperhomocysteinemia. J Vasc Surg 1994, 20(6): 933-940.
9. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand. Department of Health and Ageing, Canberra 2006, copyright Commonwealth of Australia reproduced by permission.

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