Vitamin: Vitamin B9 – Folate

Question 1

Vitamin B9 – Folate

Answer 1

Vitamine B9 (folate) Is named to reflect its main source, ‘foliage’.
* The active form of folate in the body is THF (tetrahydrofolate), and it’s 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, so should be avoided
Foliage = folium ‘leaf’ (Latin)

Question 2

Food sources

Answer 2

• Leafy greens
• Asparagus
• Avocado
• Brussels sprouts
• Legumes
• Citrus fruits (Especially oranges)
• Liver

Question 3

Absorption and bioavailability

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’
• Main storage site is in the liver (50%). Some folate is recycled in the liver and reabsorbed. The microbiotia produce some B9, but absorption/use is not known.

Question 4

Food prep

Answer 4

• Losses occur from processing/cooking foods.

Question 5

B9 forms and adverse effect

Answer 5

• Dietary folate equivalents (DFE) have been developed because bio-availability of folate varies in food compared to supplements. 1 mcg 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 effects of high folic acid supplementation is nausea.
• Where supplementation of B9 is indicated, it is advisable to recommend the methylated form of folate

Question 6

Cardiovascular health: functions and therapeutic uses

Answer 6

• Functions:
  o Methylation of Homocysteine to methionine.
  o Watch this video:
  http://www.youtube.com/watch?v=x1DzCeo7QK8
• Therapeutic uses:
  o Atherosclerosis
  o Alzheimer’s
  (Consume at least 300 mcg per day of dietary folate)

Question 7

Formation of red blood cells: functions and therapeutic uses

Answer 7

• Functions:
  o Required for erythrocyte synthesis. Without this, they are large and immature
• Therapeutic uses:
  o Anaemia (B9 deficiency induced)

Question 8

Embryo health: functions and therapeutic uses

Answer 8

• Functions:
  o Required for the healthy development of the neural tube
• Therapeutic uses:
  o Prevents Spina bifida (600 mcg / day)

Question 9

Deficiency signs and symptoms

Answer 9

• Affecting rapidly dividing cell type; Skin, GIT and blood cells
• Skin and Digestive issues
• Megaloblastic anaemia (severe deficiency)

Question 10

Factors related to deficiency

Answer 10

• Alcoholism
• OCP
• Diuretic and aspirin use
• GIT Disorders
• Diets low in green leafy vegetables
• Old age
• Those on methotrexate and anticonvulsants should consult their GP regarding vitamin B9 use

Question 11

Dosage for conception

Answer 11

• Preconception and conception of care: 600 mcg / day beginning prior to conception helps avoid neural tube defects

Question 12

Safety considerations

Answer 12

• 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 thing combat this.
• People with 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 rigourously

Question 13

B9 folate functions

Answer 13

Cardiovascular health
Embryo health
Formation of red blood cells