A glass of orange juice and a bowl of fortified cereal. A salad of romaine lettuce, celery, tomatoes and bell peppers. Black beans and rice. Lentil soup, collard greens, crimini mushrooms, broccoli and summer squash. If these foods have a prominent place in your diet, you’re likely to be satisfying not only your palate but your daily folate requirement.

Folate is a water-soluble B-complex vitamin occurring naturally in the above foods. Along with other B vitamins, it helps produce and maintain new cells, particularly during periods of rapid cell division such as pregnancy and infancy.

If you stay current on health matters, you know that folate is recommended for women of child-bearing age because, taken in adequate quantities just before or just after conception, it is known to decrease the risk of brain and spinal cord birth defects.

There are many other benefits to be gained from a folate-rich diet, including a reduced risk of heart attack, stroke, cancer, osteoporosis and Alzheimer’s disease.

The synthetic form of folate, folic acid, is found in supplements and foods that have been fortified. Although folic acid is absorbed more efficiently than the folate found in food, nutritionists recommend, in most cases, that you try to meet your daily folate requirements through natural sources. Foods containing folate are generally fruits, vegetables and whole grains that have many other nutrients to recommend them so you won’t go wrong by including them in your diet.

Who Needs Folate? And Why?

For most adults and children over age 14, the recommended daily allowance for folate is 400 micrograms, and this should be obtained easily by eating five or more servings of folate-rich foods. Some individuals may need more.

WOMEN OF CHIILDBEARING AGE, pregnant women and those who are breast feeding should get at least 500 micrograms of folate daily and some of this requirement may need to be met with fortified foods or supplements.

Based on knowledge regarding the role of folate in preventing birth defects, the U.S. Food and Drug Administration requires that folic acid be added to enriched breads, cereals, flours, corn meals, pastas, rice and other grain products. Since 1996, when this recommendation was put into effect, these fortified foods have become important dietary sources of folate, and the rate of neural tube birth defects has declined significantly.

Folic acid is absorbed twice as efficiently as food folate, so women in the first 30 days of pregnancy are advised to get 400 micrograms daily of folic acid from supplements and fortified foods in addition to what they get in their diet.

This can be met by eating one ounce of ready-to-eat breakfast cereal (100 to 400 micrograms), a cup of cooked enriched pasta (80 micrograms) or two slices of enriched bread (34 micrograms).

ADULTS OVER AGE 50 tend to absorb B vitamins less effectively, and they have a special need for folate for a variety of medical conditions.

Heart disease is the leading cause of death for Americans, and one of the risk factors for heart disease is an elevated blood level of the amino acid homocysteine, which damages the cells lining the artery walls, eventually leading to the development of blood clots.

Homocysteine may be elevated at least in part because of a deficiency of folate and other B vitamins, and studies have confirmed that increased consumption of folate is an effective way to decrease homocysteine levels and improve the health and function of blood vessels.

Observational studies have found that persons with high levels of folate in their diet tend to have lower blood pressure and cholesterol and a lower risk of heart attack and stroke. That folic acid supplementation can prevent heart disease has yet to be established through controlled, randomized studies, however, and the recent large NORVIT study found no benefit.

Alzheimer’s disease, Parkinson’s disease and osteoporosis are also associated with high homocysteine levels. The Baltimore Longitudinal Study of Aging found that persons getting their recommended daily allowance of folate had a 55 percent reduced risk of Alzheimer’s. Homocysteine may have a toxic effect on nerve cells, and folate can protect against this.

Colon, breast, pancreatic and other cancers have been linked to low blood levels of folate. Folate is needed for the production of DNA, the building blocks of cells, and it may help prevent the damage to DNA that often leads to cancer.

Among more than 88,000 females in the Nurses’ Health Study, the risk of colon cancer was lowest among those taking folate supplements. A large, long-term observational study found a lower risk of colon cancer among males who did not drink alcohol and consumed the recommended quantities of folate-rich foods. In the absence of an established cause/effect relationship, however, taking folic acid has not been recommended as a preventive measure.

Folate plays a key role in cells that are rapidly growing and dividing such as cancer cells. As a result, methotrexate and other drugs used to fight cancer inhibit the activity of folate. If you’re in cancer treatment or taking methotrexate for other illnesses you may need extra folate, but talk to your doctor before taking folate supplements.

Other drugs that can interfere with the body’s ability to use folate include anticonvulsants; metformin (used to treat type 2 diabetes); triamterine (a potassium-sparing diuretic); and sulfasalazine (often prescribed to patients with Chrohn’s disease and ulcerative colitis). Folate deficiency can also occur as a result of alcohol abuse, liver disease, kidney dialysis, anemia, pregnancy and breast-feeding.

Signs of folate deficiency, often subtle enough to be overlooked, include diarrhea, loss of appetite, weight loss, weakness, sore tongue, palpitations and headaches.

Too much folate (more than 1,000 micrograms), on the other hand, can be dangerous, possibly triggering a deficiency of another key vitamin, B12. Vitamin B12 deficiency is more common among adults over age 50 and, if left untreated, it can cause permanent nerve damage. Signs of too much folate include insomnia, irritability and intestinal problems.

If you think you need supplemental folate, it’s safest to talk to your doctor before visiting your local health food store. As for those folate-rich foods–from fortified cereal to romaine lettuce to lentil soup–put as many as you can fit on your daily table and enjoy good health as well as full flavor.

Michelle Herbert, PharmD, CDE
Clinical Director, Richmond Apothecaries, Inc.