Folate
What does it do?
Folate, also known as vitamin B9, plays a crucial role in many important functions in the body. Folic acid is the supplement form of folate. One of its primary functions is to support healthy cell growth and division. It is essential for the formation of DNA and RNA, which are the building blocks of cells. Folate also helps to produce red blood cells and is necessary for proper brain function. Additionally, folate has been shown to support cardiovascular health by helping to lower levels of homocysteine, a compound that can contribute to heart disease when present in high levels.
How much?
The recommended daily intake for adults 19+ is 400µg of dietary folate equivalents (DFE). In pregnancy, 600 µg DFE is recommended. For most people, it is easy to reach these targets through diet alone.
Some health conditions require a much higher dose; for those taking methotrexate, 5 mg of folic acid is taken weekly four days after taking Methotrexate. To help remember this, some people use the alliteration tactic; “Methotrexate Monday; Folic acid Friday”.
Supplemental folic acid is 100% bioavailable (the extent the nutrient is available to its intended destination), from food, about 50-60% bioavailable, and folic acid fortification of food is around 85% bioavailable.
Evidence:
Supplementation of folic acid while taking methotrexate has been found to decrease the risk of side effects such as nausea, vomiting, and liver toxicity.
Safety:
It depends on where you are getting your folate from. There are no issues with high amounts of folate from food, but high levels from supplements can cause some concerns.
High amounts of folic acid can mask symptoms of B12 deficiency or make it worse.
The Upper Level in New Zealand for healthy adults is 1 mg of folic acid daily. Those on Methotrexate are not subject to this upper level.
Who might need to supplement?
Methotrexate, a common drug used in inflammatory forms of arthritis, lowers folate in the body, so doctors should prescribe a folic acid supplement to people taking methotrexate. It also helps to mitigate side effects.
For pregnant women, folate is particularly important as it can help reduce the risk of neural tube defects at birth.
If you have folate deficiency, you may experience a form of anaemia; in these cases, folic acid supplementation is required to stimulate production of red blood cells.
If you think you may need to supplement with folic acid, talk to your GP first.
Where can I get it?
From food: Dark green leafy vegetables (taro leaves, Chinese greens, turnip leaves, spinach, romaine lettuce, asparagus, Brussels sprouts, broccoli), legumes (chickpeas, lentils etc.), peanuts, sunflower seeds, fruit, fruit juices, whole grains, liver, seafood, eggs, fortified foods such as bread in Aotearoa.
Supplements: Folic acid can be prescribed in 800 µg or 5 mg doses. You can get a variety of doses over the counter at pharmacies, health stores, supermarkets and online.
