The lowdown on folate (& folic acid): their impact to your hormonal health + fertility
Photo by Siobhan Calder
We know that females are more at risk of nutrient deficiencies that men.
If you missed the article discussing why this is, you can find it here.
Photo by Siobhan Calder
How can folate impact your health and wellbeing?
Folate
INtakes of FOLATE, its role in the body + HORMONAL HEALTH:
Folate is one of the B vitamins, B9.
In the UK, a huge 33% of women of childbearing age had a serum folate concentration (<13nmol/l) indicating deficiency (1).
And 75% of women of childbearing age had a Red Blood Cell (RBC) folate concentration below the threshold for increased risk of Neural Tube Defect (NTD)-affected pregnancies (748nmol/l) (1)
Folate is vital for proper cell division, particularly DNA synthesis (the master code inside our cells). If errors happen here, genes can be impacted which could lead to health problems.
Its role in cell division, DNA synthesis and methylation is why it is important in times of growth (hence 400mg/day is needed in anyone planning a pregnancy to avoid NTDs in the first 12 weeks), but it is also normal daily cell maintenance.
This is why it is important for anyone of child-bearing age to avoid deficiency, as it’s crucial for those first few weeks you want to be going into any pregnancy with robust levels. Folate deficiency is also associated with higher early miscarriage risk (2).
Folate deficiency can also cause a form of anaemia, Megaloblastic anaemia. This is where a lack of folate (or B12) causes the body to produce abnormally large red blood cells that cannot function properly.
Folate plays a crucial role in the synthesis of neurotransmitters such as serotonin and dopamine. These neurotransmitters are often known as our ‘feel good’ hormones. Imbalances due to deficiency can impact our mood, stress resilience, and overall mental health.
Folate can impact our hormone levels as it helps with the metabolism of estrogen, detoxifying it via methylation and regulating estrogens effect on genes.
Symptoms of folate deficiency or megaloblastic anaemia can include: fatigue, mouth ulcers, a sore, red or swollen tongue (glossitis), extreme tiredness, muscle weakness, heart palpitations, irritability, depression, confusion, or issues with memory.
B12 and folate are intimately connected in a few ways, including roles in DNA production, homocysteine (an amino acid) metabolism (which is important as a build-up of un-metabolised homocysteine is associated with health conditions including heart disease and depression). Because of this relationship, a deficiency in one can appear or exacerbate a deficiency in the other. Therefore, both should always be considered in comprehensive approach.
are folic acid and FOLATE the same?
Folate is a BIG topic. You may have noticed many supplements and awareness campaigns focus on the importance of folic acid in pre-conception. You’ll also notice some food products are fortified with folic acid (including breakfast cereals). It’s important to know folic acid and folate in are not the same.
Folate, or vitamin B9, is the naturally occurring form found in foods like leafy green vegetables, legumes, and liver. It's a general term for a group of water-soluble b-vitamins, and is also known as B9. Folic acid, on the other hand, is the synthetic form of this vitamin, often found in supplements and fortified foods.
The main difference lies in how the body metabolises these two compounds. Folate is bioavailable to the body, meaning it's ready to be used for critical functions such as DNA synthesis, cell division, and hormone regulation immediately after absorption.
Folic acid, conversely, must undergo conversion to the metabolically active 5-MTHF form before it can be used in the body. However, not everyone has the genetic ability to convert folic acid efficiently, which can potentially lead to unmetabolised folic acid in the bloodstream (3). This is due to a common genetic variant in the MTHFR gene.
Even fairly small doses (200-400mcg) of folic acid may not be completely metabolised by the time you take your next daily dose. This can also worsen as people can also be consuming folic acid in fortified foods. Therefore, high levels of unmetabolised folic acid have the potential to build in the blood stream (4). Several studies have actually found that this could be associated with adverse health effects longer-term (5).
It is estimated that around 60% of people (me included, as I’ve tested for this), have a reduced ability to utilise folic acid.
This means that many people would benefit from an ‘activated’ form of folate, such as l-methylfolate. This can be found in some higher quality prenatals and multivitamins.
The field of nutrigenomics is the integration of genetics with nutrition and lifestyle. Genetic testing, which I sometimes use in my clinic, now allows us to uncover elements of our unique genetics that can influence nutrition, such as the MTHFR gene variants.
Top food sources of folate:
Green vegetables: Vegetables like broccoli, spinach, and brussels sprouts are excellent sources of folate.
Liver: An often overlooked, yet nutrient-dense food, liver, especially chicken liver, is packed with folate. It is best to buy organic (the liver is the organ that handles toxins). If you hate the taste, there are clever ways to hide this into other dishes.
Legumes: Beans, lentils, and chickpeas are not only great folate sources but are also packed with fibre, protein, and other key nutrients.
Beetroot: This root vegetable is a wonderful folate source and also provides a host of other nutrients like manganese and potassium.
Avocados: Delicious and versatile, avocados are another excellent source of folate.
Eggs: A nutritional powerhouse, eggs supply a good amount of folate alongside high-quality protein.
Nuts and seeds: Especially walnuts and flaxseeds, provide a plant-based folate source and can easily be added to a variety of dishes.
Tip: folate is extremely sensitive to destruction by heat, fresh and minimally processed foods often have higher nutrient content. Steaming vegetables rather than boiling, can help to retain the folate content. Alongside, adding them fresh to salads.
Photo by Siobhan Calder
How do you know if you’re deficient in any nutrients?
There are two measures of blood folate:
Serum folate - this reflects recent dietary intake
Red blood cell (RBC) folate - this reflects longer term body stores and is generally considered the better measure of long term status.
A motto I use with all my clients, test don’t guess.
The best thing you can do (aside from eating a well balanced healthy diet), to ensure you aren’t deficient in any key nutrients is to test. It may not only be a waste of money to supplement without knowing levels, but it can actually do more harm than good to supplement certain nutrients without knowing your baseline levels. This is particularly true for minerals such as iron.
In my clinic, I always try to work collaboratively with a client’s GP to organise any blood tests. Sometimes more in-depth blood panels are required and I work directly with private labs for this. If you are concerned about your nutrient status, going through a stage in your life where nutrient demands change (e.g. pregnancy, TTC, menopause), or want to just find out more about the functional testing I use in my clinic; feel free to book in here for a complimentary nutrition review call where we can chat more about this.
Lastly, it’s important to be aware that…
The oral contraceptive pill can impair folate levels.
So, often women quickly come of the pill to TTC. Consider your folate levels and always ensure you have looked at supplementing the recommended 400mcg folate prior to conception. Equally, if you are supplementing folic acid and have a very high intake of fortified folic acid foods, consider whether this form is best suited to your unique metabolism of folate and genetics.