Folinic acid (an active form of folate) has many important roles in human health including:
- making DNA
- forming red blood cells
- growth and repair of cells and tissues. (1)
Folate Deficiency
Isolated folate deficiency is rare, usually presenting alongside other nutrient deficiencies due to malnutrition, alcoholism, or a malabsorption issue. (2) A deficiency in folate can interfere with the synthesis of nucleic acids and the metabolism of amino acids, and may lead to megaloblastic anemia. (2)
Symptoms of megaloblastic anemia include:
· Weakness
· Fatigue
· Difficulty concentrating
· Irritability
· Headache
· Heart palpitations
· Shortness of breath (2)
Folate deficiency may also cause:
· Sore, shallow ulcerations on the tongue and oral mucosa
· Changes in skin, hair, or fingernail pigmentations
· Gastrointestinal symptoms
· Elevated blood concentrations of homocysteine
· Neural tube defects in the children of folate deficient women. (2)
Foods Naturally Containing Folate
Folate is naturally present in many foods including vegetables (especially leafy greens), meat, poultry, seafood, fruits, nuts, beans, peas, eggs, and grains. Foods with the highest amount of folate are spinach, liver, asparagus, and brussels sprouts. (2) Considering that only approximately 7% of adults and 5% of children eat enough vegetables, it is reasonable to be concerned about inadequate folate intake from unfortified foods. (3)
Folate and Fortification
In Australia, it is mandatory for folate to be added to all flour used to make bread. One exemption from this rule is for organic flours and breads, which do not require fortification. (1) Eating only organic bread may increase the risk for folate deficiency and increase associated health risks. (4)
Gluten Free Diet and Folate Deficiency
Eliminating foods containing gluten also increases the risk of folate deficiency due a reduction in folate-fortified flour. (4) The popularity of gluten-free diets is growing in Australia, and it is estimated that between 10-20% of Australians eat gluten-free foods. (4) There is currently insufficient evidence to recommend gluten-free diets for reducing behavioural issues in children, however, the rising prevalence of unqualified nutrition advisers on social media tend towards these types of elimination diets to treat behavioural disorders. This may lead many children diagnosed with behavioural problems to be put on a gluten-free diet at some point in time, increasing the risk of folate deficiency.
Folate Supplementation
Folate refers to the natural form of vitamin B9 which occurs in our blood and in natural foods. Supplemental folate comes in 3 different forms:
- Folic acid is the synthetic form of vitamin B9, found only in supplements (not ours).
- Follinic acid is a natural form of B9. The form we choose to use.
- Methylenetetrahydrofolate and levomefolic acid are biologically active forms of folate, meaning they don't have to "activated" in the body to affect.
References
1. Department of Health. Folate. Department of Health [Internet]. 2010 [cited February 24 2020]. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-folate-index.htm
2. National Institutes of Health. Folate Fact Sheet for Health Professionals [Internet]. 2020 [cited July 7 2020]. Available from: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
3. Australian Institute of Health and Welfare. Australia’s health 2018 [Internet]. 2018 [cited July 7 2020]. Available from: https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/fruit-and-vegetable-intake
4. Cruchet S, Lucero Y, Cornejo V. Truths, Myths and Needs of Special Diets: Attention-Deficit/Hyperactivity Disorder, Autism, Non-Celiac Gluten Sensitivity, and Vegetarianism. Annals of nutrition & metabolism. 2016;68 Suppl 1:43-50.
Written By Brittany Darling
NUTRITIONIST (BHSC), WESTERN HERBAL MEDICINE (ADV DIP),
CERT. PAEDIATRIC NUTRITION
