Why is Folate Important for Young Adults?

Folate is the natural form of vitamin B9, is water-soluble and naturally found in many foods. As a critical vitamin, it has been added to foods and sold as a supplement in the form known as folic acid. In January 1998, the U.S. Food and Drug Administration required food manufacturers to add folic acid to our food supply in an effort to decrease neural tube defects. Common foods such as cereals, pasta, breads, rice, and additional grain products have added folic acid. This mandatory program has increased the average folic acid intake by about 100 mcg/day in the United States.

The importance of Folate is very clear. Besides its critical function in prevention of neural tube defects, folate is crucial for:

1. Cell Growth and Division: Folate is essential for the synthesis of nucleotides, the building blocks of DNA and RNA. Therefore, it plays a critical role in cell division and tissue growth. This is particularly important during periods of rapid growth, such as pregnancy and infancy.
2. Red Blood Cell Formation: Folate is involved in the production of red blood cells (RBCs) in the bone marrow. A deficiency in folate can lead to a type of anemia called megaloblastic anemia, leading to symptoms like fatigue and weakness.
3. DNA Methylation: Folate is a co-factor in the methylation cycle, which is involved in the regulation of gene expression. Methylation is a process by which a methyl group is added to DNA, affecting gene activity without changing the DNA sequence. Proper DNA methylation is essential for normal cellular function and development.
4. Heart Health: Folate plays a role in breaking down an amino acid called homocysteine. Elevated levels of homocysteine have been associated with an increased risk of cardiovascular disease. Folate, along with vitamins B6 and B12, helps to convert homocysteine into other substances, potentially reducing the risk of heart disease.
5. Mood Regulation: Folate plays an important role in mood regulation and mental health. Adequate folate intake has been associated with a reduced risk of depression, and improved cognition.

Because of folate’s importance, there is a Recommended Dietary Allowance. The Recommended Dietary Allowance for folate is listed as micrograms (mcg) of dietary folate equivalents (DFE). Men and women ages 19 years and older consider consuming 400 mcg DFE. Pregnant and lactating women require 600 mcg DFE and 500 mcg DFE, respectively. People who regularly drink alcohol should aim for at least 600 mcg DFE of folate daily since alcohol can impair its absorption.

Folate deficiency is relatively rare in the United States. With the abundance of adequate foods containing folate, complemented with folic acid fortification, folate deficiency is not commonly found. Young adults, however, should be aware of certain instances where folate deficiency may play a role.

• Alcoholism: Alcohol interferes with the absorption of folate and speeds the rate that folate breaks down and is excreted from the body. People with alcoholism also tend to eat poor-quality diets low in folate-containing foods.
• Pregnancy: The need for folate increases during pregnancy as it plays a role in the development of cells in the fetus.
• Intestinal surgeries or digestive disorders that cause malabsorption: Celiac disease and inflammatory bowel disease can decrease the absorption of folate. Surgeries involving the digestive organs or that reduce the normal level of stomach acid may also interfere with absorption.
• Genetic variants: People carrying a variant of the gene MTHFR cannot convert folate to its active form to be used by the body.
• Folate receptor autoantibodies: Recently, a set of autoantibodies targeting folate receptor alpha (blocking/binding autoantibodies) have been identified. Folate receptor alpha is one of the major active transporters of folate into the cell. Folate receptor autoantibodies attack this receptor and render it dysfunctional, causing impairment in the transport of folate (especially in the brain). Ultimately this may mean that not enough folate is being transported into the brain and the choroid plexus. In these instances, several cognitive and neurological symptoms may occur. Young adults who have been diagnosed with autism spectrum disorder or depression have tested positive for these autoantibodies. This condition has been termed cerebral folate deficiency syndrome. Folate receptor autoantibodies may be detected with the use of a test known as FRAT^®.