Vitamin B9 - Folate

Question 1

Vitamin B9 - Folate

Answer 1

• Vitamin B9 (folate) is named to reflect its main source, ‘foliage’.
• The active form of folate in the body is THF (tetrahydrofolate), and its methylated derivatives. As part of an enzyme complex, folate is active in numerous metabolic reactions.
• Folic acid is a synthetic supplement or fortification form and is not found in nature. Folinic acid and levomefolic acid are also synthetic forms of this vitamin. These synthetic forms can be dangerous (discussed shortly), so should be avoided.

Question 2

Vitamin B9 - Folate: Food Sources

Answer 2

Leafy greens, asparagus, avocado, Brussel sprouts, legumes, citrus fruit (especially oranges) and liver.

Question 3

Vitamin B9 - Bioavailability and Absorption

Answer 3

• Absorption requires adequate pancreatic enzymes . After absorption, a methyl group ( CH3) is added to folate and in this form, it is delivered to body cells.
• Without the vitamin B12 enzyme which removes the methyl group, folate becomes trapped inside cells in its methyl form (5 methyl THF), unavailable to perform its main functions (DNA synthesis and cell growth) a metabolic situation called the ‘folate trap’.
• Losses occur from processing & cooking foods. Main storage site is the liver (50%). Some folate is recycled in the liver and reabsorbed. The microbiota produce some B9, but absorption/use is not known.

Question 4

Vitamin B9 Forms and Adverse Effects

Answer 4

• Dietary Folate Equivalents (DFE) have been developed because bioavailability of folate varies in food compared to supplements. 1mcg of natural folate = 1 DFE.
• Folic acid is considered 1.7 x more available than dietary folate, which is problematic in that it is less regulated and so absorption is uncontrolled in the body. An adverse effect of high folic acid supplementation is nausea.
• Where supplementation of B9 is indicated, it is advisable to recommend the methylated form of folate

Question 5

Vitamin B9 - Folate: Roles

Answer 5

Cardiovascular Health
Red Blood Cell formation
Embryo Health

Question 6

Vitamin B9 - Cardiovascular Health - Functions

Answer 6

• Methylation of homocysteine to methionine.

Question 7

Vitamin B9 - Cardiovascular Health - Therapeutic Uses

Answer 7

• Atherosclerosis
• Alzheimer’s
- Consume at least 300mcg per day of dietary folate

Question 8

Vitamin B9 - RBC Formation - Functions

Answer 8

• Required for erythrocyte synthesis. Without this, they are large & immature

Question 9

Vitamin B9 - RBC Formation - Therapeutic Uses

Answer 9

• Anaemia (B9 deficiency induced)

Question 10

Vitamin B9 - Embryo Health - Functions

Answer 10

• Required for the healthy development of the neural tube

Question 11

Vitamin B9 - Embryo Health - Therapeutic Uses

Answer 11

• Prevents spina bifida ( 600mcg/day)

Question 12

Vitamin B9 - Deficiency Signs and Symptoms

Answer 12

Deficiency signs and symptoms:
• Affecting rapidly dividing cell types; skin, GIT and blood cells
• Skin and digestive issues, megaloblastic anaemia (severe deficiency)

Question 13

Vitamin B9 - Deficiency Factors

Answer 13

Factors related to deficiency:
• Alcoholism, OCP, diuretic and aspirin use. GIT disorders, diets low in green leafy vegetables and old age. Those on methotrexate and anticonvulsants should consult their GP regarding vitamin B9 use.

Question 14

Vitamin B9 - Safety Considerations

Answer 14

• Naturally occurring folate is considered safe to use.
• Folic acid supplements mask the megaloblastic anaemia of vitamin B12 deficiency and may hasten the development of irreversible nerve damage. B12 testing can combat this.
• People with an MTHFR polymorphism may be more susceptible to issues arising from supplementation with folic acid (or that in fortified foods). Active forms of the vitamin ONLY should be recommended to clients.
• Folic acid supplements have the most drug interactions of all vitamins; check rigorously.