One of folate’s most important jobs is making new red blood cells, which carry oxygen to every part of your body. Without enough folate, you could become anemic, a condition caused by a lack of healthy red blood cells. Folate-deficiency anemia can make you feel drained and generally awful. The condition is usually characterized by pale skin, fatigue, moodiness, and a reduced appetite. Because anemia affects the health of your blood, it can negatively impact your entire body. Fortunately, the condition can usually be reversed with diet changes and supplements, but it’s important to get diagnosed. Anemia symptoms can mimic those of blood diseases, some liver conditions, and even other types of anemia. Unfortunately, that means that it is sometimes not diagnosed early. If left untreated, folate-deficiency anemia can cause severe and even life-threatening complications.
Folate-Deficiency Anemia Puts You at Risk of Heart Failure.
Anemia of all types, including folate-deficiency anemia, is closely associated with an increased risk for heart failure. When you don’t have as many healthy blood cells to deliver oxygen throughout your body, your tissues and organs can become deprived of oxygen. The loss of blood cells also causes blood pressure to drop. These conditions force the heart, which pushes oxygen-carrying blood out to the rest of the body, to work harder at pumping blood in an attempt to increase oxygen levels. Researchers believe that over time this extra work can cause heart muscles to weaken, which can lead to heart failure. Anemia is common in heart failure patients and is one of the best predictors of whether the patients will recover from or survive heart failure.
Low Folate Also Increases Your Risk of Heart Disease and Stroke.
In addition to its role in producing blood cells, folate is also important in preventing a potentially toxic amino acid from building up in the body. The amino acids in foods are an essential part of our diet, but not all are beneficial. Homocysteine is an amino acid that occurs naturally in your blood. You can also get it from eating red meat. Folate, along with vitamins B6 and B12, helps break down the amino acid. When levels of homocysteine are too high, it can have a damaging effect on the brain, heart, blood vessels, and bones. High homocysteine levels can damage the linings of arteries, making it harder for oxygen-carrying blood to travel from the heart to the rest of the body and increasing heart attack risk. At high enough levels, homocysteine is linked to a higher risk of heart disease, dementia, and stroke. Increasing folate intake can help keep homocysteine levels low to protect your heart and brain health.
Canker Sores in the Mouth Are a Warning Sign of Folate Deficiency.
A canker sore is a small, painful ulcer inside the mouth that results from folate deficiency. The sores are white- or yellow-colored with a swollen red border and are usually found inside the cheeks or lips, on or under the tongue, or on the gums. People usually feel pain, tingling, or burning in their mouth before the sore appears. In addition to general discomfort, canker sores can also cause fever and swollen lymph nodes. The sores usually heal on their own but can cause severe pain and other serious complications. Diets that are low in folate and other B vitamins make you more vulnerable to canker sores, as do medical conditions that interfere with the absorption of folate. If you’re prone to canker sores, you can increase folate intake through your diet or through folic acid supplements. Taking folate B12 may also be necessary to prevent or reduce canker sores.
Diets rich in folate and folic acid are linked to a decreased risk of certain types of cancer. Populations that get sufficient folate in their diet have lower rates of breast, cervical, colon, pancreatic, and stomach cancer. On the other hand, folate deficiency increases the risk of these cancers. One study found that cancer patients had a much higher rate of folate deficiency than noncancer patients. Researchers don’t know exactly how the nutrient protects against cancer. One theory is that because cancers are caused by DNA mutations that make cells behave abnormally and folate helps keep DNA healthy, the nutrient may protect DNA from cancer-causing mutations.
Your Mental Health May Suffer if You Don’t Get Enough Folate in Your Diet.
Folate deficiency can affect your mental health as well as your physical health. Folate plays an important role in producing certain neurotransmitters, the chemicals that brain cells use to communicate with one another. The vitamin is critical to the production of neurotransmitters that are involved in depression, specifically dopamine, serotonin, and norepinephrine. Some research suggests that low folate levels are more common in people with depression and that people with folate deficiency may not respond as well to treatments for depression. In fact, some doctors recommend that people with depression and folate deficiency take an activated folate supplement called L-methylfolate to boost the effects of antidepressants. L-methylfolate is an active form of folate that can be absorbed faster and more easily than folic acid.
Folate Deficiency Can Leave You Confused or Forgetful.
As we get older, our bodies go through many normal changes. A gradual decrease in folate is one of those changes. Loss of folate in our blood as we age corresponds with a decline in cognition and an increased risk of dementia. Some studies have found that folate deficiency affects our brain cells’ ability to communicate. This communication between cells is absolutely necessary for normal brain function. Without it, your ability to remember, concentrate, and make decisions will suffer. In addition, low levels of folate in the blood have been linked with an up to 68 percent increase in the risk of developing dementia. Researchers are not sure yet if folate deficiency causes cognitive decline or if cognitive decline affects folate levels. But increasing folate intake as you get older may help protect your brain regardless.
A Low-Folate Diet Can Turn Your Hair Gray Prematurely.
If you’ve noticed some stray gray hairs popping up more frequently, it might be time to reconsider your diet. Folate deficiency is associated with hair turning gray much earlier than it normally would. Melanocytes are cells that produce the pigment melanin, which gives our skin, hair, and eyes their color. As we age, melanocytes produce less melanin, causing your color to fade over time. In the case of hair, all the pigment is eventually lost, leaving the hair gray or white. Folate plays a role in hair pigmentation and strength. So, if you don’t get enough folate in your diet, you may notice changes in your hair and skin color. Of course, folate deficiency isn’t the only reason for premature graying, which can also be caused by genetics and some health conditions. But missing out on certain nutrients in your diet is one of the number one reasons that hair goes gray before its time. In addition to folate, diets that lack iron, vitamins B12 and D, and the mineral selenium are also linked to premature graying. Fortunately, graying caused by nutritional deficiencies can be reversed by increasing the intake of the missing nutrients.
You Could Be Cooking the Folate Right Out of Your Food.
Getting enough folate in your diet is as much about what foods you eat as about how you cook. Overcooking even the most nutritious, folate-packed foods will completely strip them of the vitamin. Likewise, cooking methods that use very high temperatures or a lot of water are the worst for preserving folate–and other important nutrients–in food. Both poaching (cooking in water at a lower temperature) and boiling (cooking in water at a high temperature) will result in your food losing its folate and other B vitamins. Baking, roasting, and grilling meats at high temperatures for a long time will also deplete foods of their natural folate. So what cooking methods are best for keeping your meals packed with folate? Sauteing and stir-frying, which use high cook foods at high temperatures for a very short time, can help to preserve nutrients, as can microwaving. Grilling and roasting vegetables can help them retain both flavor and folate.
Drinking Makes It Harder for Your Body to Absorb Folate.
Alcohol could be a big problem if you’re trying to increase your folate intake. Normally, your body absorbs folate directly from your food. Alcohol disturbs this process, reducing how much folate is released into the blood. Additionally, alcohol affects how well the kidney filters blood, causing the organ to absorb more folate from the blood and release it in urine. Chronic and heavy drinking is even worse for folate absorption. Heavy alcohol use can harm your gut and make it more difficult for it to absorb folate. Chronic heavy drinking also affects the liver, which stores folic acid, and may deplete levels of the nutrient. By some estimates, as many as half of people who abuse alcohol have folate deficiency.
Folate helps keep DNA stable and supports the production of new cells. So, it should come as no surprise that there is some evidence that folate may improve the number and health of your sperm population. One study found that men who took folic acid supplements had higher sperm counts, while another study found that high-folate diets were associated with a decrease in abnormal sperm. Folic acid supplements are also a proven remedy for erectile dysfunction. For women, folic acid may also boost fertility and reduce the risk of pregnancy loss. Because the birth defects caused by folate deficiency can occur before many women are even aware they are pregnant, folic acid supplements are recommended for women who are trying to conceive.
Have a Digestive Disease? You Might Be at Higher Risk for Folate Deficiency.
Anything that interferes with your body’s ability to absorb folate can lead to a deficiency. Chronic digestive diseases like Crohn’s disease and celiac disease cause inflammation or swelling in the small intestines. These conditions can seriously impair appetite and may require dietary changes, medication, or surgery to treat. Both the symptoms and the treatments of digestive disease can make it harder for nutrients to be absorbed by the small intestine. For example, surgeries to remove part of the small intestines may reduce some Crohn’s disease symptoms but can also impair folate absorption. Several studies have found that folate deficiency is much more common in adults with inflammatory bowel diseases.
Diseases aren’t the only thing that affects your body’s ability to absorb and process folate. Certain drugs can interfere with folate absorption and cause deficiency. Methotrexate is a drug that suppresses the immune system to treat inflammatory disorders like Crohn’s disease and rheumatoid arthritis. The drug keeps the body from using folate, so it is released as waste. Some seizure medications may prevent your body from absorbing folate from food, while the antibiotic trimethoprim blocks an enzyme that activates folate. People taking these drugs may be advised to take folic acid or active forms of folate to avoid deficiency.
Your Vulnerability to Folate Deficiency May Be in Your DNA.
While many people are able to absorb folate normally, people with specific genetic mutations cannot process the nutrient. MTHFR is an enzyme that converts the folate and folic acid absorbed from food and supplements into an active form. Unactivated folate can’t function in the body in the same way as activated folate. Mutations in the gene that produces MTHFR prevent it from properly activating folate. This means that the body lacks active folate, resulting in a folate deficiency. These mutations are also linked to a toxic build-up of the amino acid homocysteine, which is normally broken down by folate. People with MTHFR mutations cannot simply increase folate in their diet or take folic acid supplements because their bodies will be unable to process the nutrient in those forms. Instead, they take an already active form of folate.
Make Sure You’re Getting Enough Folate for Your Age.
Everyone needs folate, but the amount you need varies based on age, gender, and individual health. Recommended doses may also vary between countries. Pregnant women need the highest folate dose, between 400 and 800 micrograms (mcg) per day. The next highest dose is recommended for women who are breastfeeding, who may also need between 260 and 800 mcg daily. Most adults and older teens of any gender will only need between 150 and 400 mcg of folate per day, although some doctors recommend that all women of childbearing years get at least 400 mcg. Health conditions that affect your ability to process folate may require you to take a higher dose than those recommended.
Folate is found naturally in foods like leafy greens and oranges, but you can get the same benefits from folic acid, a synthetic form of folate that is found in some food and supplements. Unlike folate, folic acid is very stable at high temperatures and under pressure. Folic acid is also more easily absorbed than its natural counterpart. The body can absorb about 85 percent of folic acid compared to around 50 percent of folate. This can make folic acid a better option for restoring low folate levels and preventing folate deficiency in people who are at risk for the condition. While folate is absorbed and activated in the intestines, folic acid is converted to its active form outside of the digestive system, usually in the liver. That means it takes slightly longer for your body to metabolize folic acid, which can build up in the body, potentially causing health problems. Drinking orange juice and taking other B vitamin or vitamin C supplements in combination with folic acid can help your body process folic acid faster.
In the 1990s, the U.S. became the first country to fortify foods with folic acid to ensure that the population, especially women of childbearing age, were consuming enough of the nutrient. In the decades since dozens of countries implemented similar folic acid fortification initiatives. The initiatives, which included all cereal grain products, substantially increased folate intake across all age groups. Some of the foods that are typically fortified with folic acid include flour, bread, pasta, rice, and breakfast cereals. Folate deficiency used to be far more common worldwide and still is in some countries. However, improved diets and the introduction of fortified foods have dramatically reduced folate deficiency and related health issues. A study conducted two years after U.S. folate fortification began found that reports of low folate had decreased by almost 97 percent.
Leafy Greens, Fruits, Nuts, and Legumes Are Excellent Natural Sources of Folate.
So, what should you be adding to your diet to up your folate intake? Fortunately, there are many delicious foods that arenaturally rich in folate. Dried legumes, such as lentils, beans, and chickpeas, pack the biggest folate punch per serving. One serving of these foods contains up to 90 percent of the daily recommended intake for most adults and 60 percent for pregnant women. But remember that these values only apply to legumes that are cooked from dried. Canned legumes have less than half the folate of dried legumes. Green leafy vegetables like Brussels sprouts, asparagus, spinach, broccoli, and kale are another excellent source of folateâas long as they’re not overcooked. One serving of beef liver will provide you with around half of your daily recommended folate, while beets provide about 37 percent. Some fruits that are high in folate include avocado, pomegranates, citrus, and papayas.
Where Do We Find This Stuff? Here Are Our Sources: