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folate in fortified cereal
The B vitamin folate, also called folic acid, is a water-soluble vitamin. Water-soluble vitamins are stored in the body in very limited amounts and are excreted through the urine. Therefore, it is a good idea to have them in your daily diet. Folate is considered a crucial vitamin before and during pregnancy. Research has shown that folate deficiencies during pregnancy can lead to neural tube birth defects in babies.

Functions

Folate's functions include:

  • Helping amino acid metabolism and conversion
  • Producing and maintaining new cells
  • Making DNA and RNA, the building blocks of cells
  • Preventing changes to DNA that may lead to cancer
  • Making red blood cells, preventing anemia
  • Assisting in the creation of neurotransmitters (chemicals that regulate sleep, pain, and mood)
Recommended Intake:
Age Group (in Years)Recommended Dietary Allowance
FemalesMales
1 - 3150 mcg150 mcg
4 - 8200 mcg200 mcg
9 - 13300 mcg300 mcg
14 - 18400 mcg400 mcg
Pregnancy, 14 - 18600 mcgn/a
Lactation, 14 - 18500 mcgn/a
19+400 mcg400 mcg
Pregnancy, 19+600 mcgn/a
Lactation, 19+500 mcgn/a

mcg=microgram

Folate Deficiency

Folate deficiency is a common vitamin deficiency. It can occur for a variety of reasons, including:

  • Need is increased, as with pregnancy
  • Dietary intake is lacking
  • Body is excreting more than usual
  • Medications interfering with the body's ability to use folate include:
    • Anti-convulsant mediations
    • Metformin
    • Sulfasalazine
    • Triamterene
    • Methotrexate
    • Barbituates

Signs or symptoms of folate deficiency include:

  • Megaloblastic anemia
  • Irritability, hostility
  • Weakness
  • Weight loss
  • Apathy, forgetfulness
  • Anorexia, loss of appetite
  • Sore tongue, glossitis (inflammation of tongue)
  • Headache
  • Heart palpitations
  • Paranoid behavior
  • Diarrhea
Too Much Folate

Large doses of folate can cause symptoms of vitamin B12 deficiency to appear. Vitamin B12 deficiency is common in older adults. Although folate supplementation will alleviate the anemia caused by the B12 deficiency, the nervous system damage caused by the B12 deficiency will continue. This is why it is important that you talk to your doctor before you take a folate supplement. It may be necessary for you to take vitamin B12 supplements along with the folate.

There is no upper limit for ingesting folate found naturally in foods. However, there are tolerable upper intake levels for folate consumed from fortified foods and supplements:

AgeMicrograms (mcg) per day
1-3 years300 mcg
4-8 years400 mcg
9-13 years600 mcg
14-18 years800 mcg
Pregnant or nursing women up to 18 years800 mcg
19 years and older1,000 mcg
Pregnant or nursing women 19 years and older1,000 mcg
Major Food Sources

There is a variety of foods that contain folate. Some foods, like cereal, rice, and flour, are fortified with folate. Here is a list of major food sources and their folate content.

FoodServing Size Folate Content
(mcg)
Chicken liver, simmered3.5 ounces770
Fortified breakfast cereal3/4 cup 100-400
(check Nutrition Facts label)
Soy flour1 cup260
Beef liver, braised3 ounces215
Chickpeas, cooked1 cup282
Pinto beans, cooked1 cup291
Spinach, boiled1 cup263
Lima beans, cooked1 cup156
Papaya1 medium112
Avocado1 ounce25
Wheat germ, toasted1/4 cup100
Asparagus, boiled1 cup243
Orange juice, fresh8 fluid ounces74
Spinach, raw1 cup58
Whole wheat flour1 cup53
Green peas, boiled1/2 cup50
White rice, long-grain1/2 cup45
Orange, navel1 medium44
Peanuts, dry roasted1 ounce41
Wheat flour, whole grain1 cup53
Broccoli, boiled1 spear40
Tomatoes, sun-dried1 cup32
Tomato juice, canned1 cup49
Peanut butter, crunchy2 tablespoons30
Banana1 cup30
Cashews, dry roasted1 ounce20
Bread, whole wheat1 slice14
Health Implications
Populations at Risk of Folate Deficiency

The following populations may be at risk of folate deficiency and may require a supplement:

  • Pregnant women—Folate is critical for the production and maintenance of new cells. This is especially important during pregnancy—a period of rapid cell division.
  • People who consume excessive amounts of alcohol—Alcohol interferes with the absorption of folate and increases excretion by the kidneys. In addition, many alcoholics tend to have diets low in essential nutrients, like folate.
  • People on certain medications—Certain medications can interfere with the body's ability to use folate. Check with your doctor about supplementation if you are on medication that may affect your folate levels.
  • People with inflammatory bowel diseases—Malabsorption of folate can occur with inflammatory bowel diseases.
  • The elderly—Many elderly have low blood levels of folate, which can occur from low intake of the vitamin or problems with absorption.
Birth Defects

In 1991, a landmark study found a relationship between folate and birth defects. Subsequent research has supported the finding that adequate folate intake during the period before and just after conception protects against a number of neural tube defects, including spina bifida and anencephaly.

The crucial period is before and very early after conception—a time when most women do not know they are pregnant. Therefore, the recommendation is that all women of childbearing age make sure they have a folate intake of at least 400 mcg.

Tips for Increasing Your Folate Intake:

To help increase your intake of folate:

  • Spread a little avocado on your sandwich in place of mayonnaise.
  • Drink a glass of orange juice or tomato juice in the morning.
  • Add spinach to your scrambled eggs.
  • Slice a banana on top of your breakfast cereal.
  • Sprinkle some toasted wheat germ on top of pasta or a stir-fry.
  • Throw some chickpeas or kidney beans into a salad.
  • If you take a vitamin supplement, make sure it contains folate.

RESOURCES:

Choose My Plate.gov—US Department of Agriculture
http://choosemyplate.gov

Eat Right.org—Academy of Nutrition and Dietetics
http://www.eatright.org

CANADIAN RESOURCES:

Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Duyff RL. The American Dietetic Association's Complete Food & Nutrition Guide. 3rd ed. Hoboken, NJ: John Wiley and Sons, Inc.; 2006.

Folate. Office of Dietary Supplements, National Institutes of Health website. Available at: http://ods.od.nih.gov/factsheets/Folate-HealthProfessional. Updated December 14, 2012. Accessed March 6, 2014.

Folate, DFE (µg) content of selected foods per common measure, sorted by nutrient content. USDA national nutritional database for standard reference, release 25. US Department of Agriculture website. Available at: https://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/SR25/nutrlist/sr25w435.pdf. Accessed March 6, 2014.

Folate deficiency. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated January 16, 2013. Accessed March 6, 2014.

Folic acid. EBSCO DynaMed website. Available at: http://ebscohost.com/dynamed. Updated October 28, 2013. Accessed March 6, 2014.

Garrison R, Somer E. The Nutrition Desk Reference. New Canaan, CT: Keats Publishing; 1995.



Last reviewed March 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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