Folate deficiency is most often caused by a dietary insufficiency, however, folate deficiency can occur in a number of other situations. For example, alcoholism is associated with low dietary intake and diminished absorption of folate, which can lead to folate deficiency. Additionally, certain conditions such as pregnancy or cancer result in increased rates of cell division and metabolism, causing an increase in the body's demand for folate.

Folic acid deficiency can cause a specific type of anemia called macrocytic anemia, which can cause fatigue and other symptoms. Supplementation with folic acid can help reverse this condition. However, it is vital to check for a vitamin B12 deficiency as well, as this can cause the same condition. If folic acid supplementation is used, the condition will improve but may mask an underlying B12 deficiency, leading to neurological damage. So, in cases of this type of anemia it is necessary to check both folic acid and B12 levels in the blood.

Folate coenzymes are required for the metabolism of several important amino acids. The synthesis of methionine from homocysteine requires a folate coenzyme as well as a vitamin B12-dependent enzyme. Thus, folate deficiency can result in decreased synthesis of methionine and a buildup of homocysteine in the blood. Increased levels of homocysteine is an indicator for increased risk of heart disease. The results of more than 80 studies indicate that even moderately elevated levels of homocysteine in the blood increase the risk of cardiovascular disease. Most research indicates that a plasma homocysteine level of < 10 micromoles/liter is associated with a lower risk of cardiovascular disease and is a reasonable treatment goal for individuals at high risk. A simple blood test can be done to evaluate your levels of homocysteine.

Folic acid is also very important in the prevention of certain neural tube birth defects like spina bifida. The defects occur between 21 and 27 days after conception, a time when many women do not even realize they are pregnant.  For folic acid to help prevent these major birth defects, a woman needs to start taking it at least one month before she becomes pregnant and throughout her pregnancy. The dosage recommended is 800 mcg per day which is the standard amount included in most pre-natal vitamins. Fetal growth and development are characterized by widespread cell division, so adequate folate is critical for DNA and RNA synthesis.

Folic acid is famous for its role in preventing birth defects but it is currently being researched for its effects on depression. A group of researchers from Tufts University in Boston, Massachusetts found that blood levels of folate were much lower among people with depression than in people who were not depressed. Findings like these have suggested a link between low folate levels and depression. Folate, which is needed to make DNA and RNA, the building blocks of cells, is quite active in the brain and central nervous system. It affects the production of certain essential neurotransmitters such as Serotonin, Dopamine and Norepinephrine that affect mood. A study in the Journal of Clinical Psychiatry found that sufficient amounts of folate are needed for the brain to work well. Deficiencies may cause a higher risk for depression and worsen the response to antidepressant medicine. In a study published in the American Journal of Psychiatry, a group of researchers gave fluoxetine (Prozac), an SSRI,  to 213 patients with major depressive disorder. The researchers also measured blood levels of folate in all study volunteers. After eight weeks on fluoxetine, the patients with low folate levels were significantly less likely to show improvement from the drug therapy. So, folic acid supplementation may be the key for some people in successful treatment of their depression. However, simply supplementing with folic acid is not necessarily effective in treating all people with depression. It is a consideration for treatment, especially in patients that do not tolerate or respond to SSRIs or other treatments used for depression.

Deplin^® (L-methylfolate) is an orally administered medical food for use only under medical supervision for the dietary management of suboptimal folate levels in depressed patients. It comes in dosages of 7.5 mg or 15 mg of L-methylfolate. This can be prescribed by your physician if indicated for the treatment of depression.

Folic acid has to be converted in the body into it's active form, known as 5-MTHF (5-methyltetrahydrofolate or L-methylfolate). Up to 40% of adults are affected by genetic anomalies that limit the amount of folic acid converted to the active folate that helps to lower homocysteine. Most folate supplements are not the active form, which is important becausee that is the form that the body is able to utilize.

Ask us at your next visit if you are taking the right form of folate!