What is folate and what does it do?
Our bodies need folate to make DNA and other genetic material. Folate is also needed for the body’s cells to divide. This is particularly important for people with Cystic Fibrosis to have in their diets.
How much folate do I need?
|Life Stage||Recommended Amount|
|Birth to 6 months||65 mcg DFE|
|Infants 7–12 months||80 mcg DFE|
|Children 1–3 years||150 mcg DFE|
|Children 4–8 years||200 mcg DFE|
|Children 9–13 years||300 mcg DFE|
|Teens 14–18 years||400 mcg DFE|
|Adults 19–50 years||400 mcg DFE|
|Adults 51–70 years||400 mcg DFE|
|Adults 71+ years||400 mcg DFE|
|Pregnant teens and women||600 mcg DFE|
|Breastfeeding teens and women||500 mcg DFE|
What foods provide folate?
Folate is naturally present in many foods and food companies add folic acid to other foods, including bread, cereal, and pasta. You can get recommended amounts by eating a variety of foods, including the following:
- Vegetables (especially asparagus, Brussels sprouts, and dark green leafy vegetables such as spinach and mustard greens).
- Fruits and fruit juices (especially oranges).
- Nuts, beans, and peas (such as peanuts, black-eyed peas, and kidney beans).
- Grains (including whole grains; fortified cold cereals; enriched flour products such as bread, bagels, cornmeal, and pasta; and rice).
- Folic acid is added to many grain-based products. To find out whether folic acid has been added to a food, check the product label.
Beef liver is high in folate but is also high in cholesterol, so limit the amount you eat. Only small amounts of folate are found in other animal foods like meats, poultry, seafood, eggs, and dairy products.
What kinds of folic acid dietary supplements are available?
Am I getting enough folate?
Most people get enough folate. However, certain groups of people are more likely than others to have trouble getting enough folate:
- Teen girls and women aged 14–30 years (especially before and during pregnancy).
- Non-Hispanic black women.
- People with disorders that lower nutrient absorption (such as celiac disease and inflammatory bowel disease).
- People with alcoholism.
What happens if I don’t get enough folate?
Folate deficiency is rare in the United States, but some people get barely enough. Getting too little folate can result in megaloblastic anemia, which causes weakness, fatigue, trouble concentrating, irritability, headache, heart palpitations, and shortness of breath. Folate deficiency can also cause open sores on the tongue and inside the mouth as well as changes in the color of the skin, hair, or fingernails.
Women who don’t get enough folate are at risk of having babies with neural tube defects, such as spina bifida. Folate deficiency can also increase the likelihood of having a premature or low-birth-weight baby.
What are some effects of folate on health?
Scientists are studying folate to understand how it affects health. Here are several examples of what this research has shown.
Neural tube defects
Taking folic acid regularly before becoming pregnant and during early pregnancy helps prevent neural tube defects in babies. But about half of all pregnancies are unplanned. Therefore, all women and teen girls who could become pregnant should consume 400 mcg of folic acid daily from supplements, fortified foods, or both in addition to the folate they get naturally from foods.
Since 1998, the U.S. Food and Drug Administration has required food companies to add folic acid to enriched bread, cereal, flour, cornmeal, pasta, rice, and other grain products sold in the United States. Because most people in the United States eat these foods on a regular basis, folic acid intakes have increased and the number of babies born with neural tube defects has decreased since 1998.
Preterm birth, congenital heart defects, and other birth defects
Taking folic acid might reduce the risk of having a premature baby and prevent birth defects, such as congenital heart problems. But more research is needed to understand how folic acid affects the risk of these conditions.
Folate that is found naturally in food may decrease the risk of several forms of cancer. But folate might have different effects depending on how much is taken and when. Modest amounts of folic acid taken before cancer develops might decrease cancer risk, but high doses taken after cancer (especially colorectal cancer) begins might speed up its progression. For this reason, high doses of folic acid supplements (more than the safe upper limit of 1,000 mcg) should be taken with caution, especially by people who have a history of colorectal adenomas (which sometimes turn into cancer). More research is needed to understand the roles of dietary folate and folic acid supplements in cancer risk.
Heart disease and stroke
Some scientists used to think that folic acid and other B-vitamins might reduce heart disease risk by lowering levels of homocysteine, an amino acid in the blood. But although folic acid supplements do lower blood homocysteine levels, they don’t decrease the risk of heart disease. Some studies have shown that a combination of folic acid with other B-vitamins, however, helps prevent stroke.
Dementia, cognitive function, and Alzheimer’s disease
Folic acid supplements with or without other B-vitamins do not seem to improve cognitive function, but more research on this topic is needed.
People with low blood levels of folate might be more likely to suffer from depression and might not respond as well to treatment with antidepressants as people with normal folate levels.
Folic acid supplements might make antidepressant medications more effective. But it is not clear whether these supplements help people with both normal folate levels and those with folate deficiency. More research is needed to learn about the role of folate in depression and whether folic acid supplements are helpful when used in combination with standard treatment.
Can folate be harmful?
Folate that is naturally present in food is not harmful. Folic acid in supplements and fortified foods, however, should not be consumed in amounts above the safe upper limit, unless recommended by a health care provider.
Taking large amounts of folic acid might hide a vitamin B12 deficiency. Folic acid can correct the anemia but not thenerve damage caused by vitamin B12 deficiency. This can lead to permanent damage of the brain, spinal cord, and nerves. High doses of folic acid might also increase the risk of colorectal cancer and possibly other cancers in some people.
The safe upper limits for folic acid are listed below.
|Ages||Safe Upper Limit|
|Birth to 6 months||Not established|
|Infants 7–12 months||Not established|
|Children 1–3 years||300 mcg|
|Children 4–8 years||400 mcg|
|Children 9–13 years||600 mcg|
|Teens 14–18 years||800 mcg|
Are there any interactions with folate that I should know about?
Folic acid supplements can interact with several medications. Here are some examples:
- Folic acid could interfere with methotrexate (Rheumatrex®, Trexall®) when taken to treat cancer.
- Taking anti-epileptic medications such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®), and valproate (Depacon®) could reduce blood levels of folate. Also, taking folic acid supplements could reduce blood levels of these medications.
- Taking sulfasalazine (Azulfidine®) for ulcerative colitis could reduce the body’s ability to absorb folate and cause folate deficiency.