Folate is essential for for cell growth and replication. It helps breakdown homocysteine, an amino acid that may damage the inner walls of arteries which increases the risk of stroke or heart attack. In pregnancy, Folate helps in the prevention of birth defects and aids in the development of the central nervous system of the fetus.
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10 to 12 hours fasting
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3 days prior: Discontinue all nonessential medications and dietary supplements. If not possible, specify the list of medications and supplements the patient is taking.
Patient preparation
Also known as folate, folic acid. Around 30-50% of which are found in the mitochondria.
This is essential for metabolic activities for cell growth and replication. It is serves as a cofactor in the synthesis of thymidylate, purines and methionine, and other methylation reactions1.
Signs and Symptoms of Deficiency or Toxicity
Severe deficiency leads to megaloblastic anemia. Signs and symptoms of which are fatigue, weakness, and shortness of breath2.
Folate deficiency normally occurs with other nutritional deficiencies. The most common cause of inadequate dietary intake. Other causes are secondary causes such as liver disease, hemolytic disorders, malignancies, and rare inborn errors of metabolism3. People who are at risk to folate deficiency are people with alcohol dependence, women of reproductive age, pregnant women, and those with malabsorptive disorders3.
Toxicity of water-soluble vitamins is unlikely2 and is excreted in the urine4, 5.
Biomarker and Methods of Analysis
SERUM FOLATE
Serum folate is more reproducible and faster to perform than red cell folate; it is influenced by fewer analytical variables and provides an assessment of folate status that may be superior to red cell folate6.
Supplementation Guide
Routine folic acid supplementation is recommended from at least a month before conception and throughout the first 1 weeks of pregnancy to reduce neural tube defect in baby. Dosing recommendation is 500 micrograms per day. Meanwhile, women with chronic hemolytic conditions including beta thalassemia should be provided with a higher dose of folic acid of 5 mg per day7
Following are UL per age group8.
- In children:
- 1-3 y.o.:30 mcg DFE
- 4-8 y.o. 400 mcg DFE
- 9-13 y.o.: 600 mcg DFE
- 14-18 y.o.: 800 mcg DFE
- In adults, 19 years and older, 1000 mcg DFE
- Among pregnant/lactating women:
- 14-18 y.o.: 800 mcg DFE
- 19 and older, 1000 mcg DFE
High intakes of folic acid may mask vitamin B12 deficiency3.
Folic acid may possibly interact with anticonvulsants, barbiturates, methotrexate, and pyrimethamine9.
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Folate is widely found in food especially in dark green leafy vegetables. Fruits and fruit juices, nuts, beans, dairy products, poultry and meat, eggs, seafood, and grains. The richest source of folate are spinach, liver, yeast, and brussel sprouts3.
(2) Higdon J, Drake VJ, Delage B. (July 2015). Micronutrient Information Center. Biotin.Retrieved from http://lpi.oregonstate.edu/mic/vitamins/folate
(3) Office of Dietary Supplements-National Institutes of Health. Folate. Dietary supplement Fact Sheet. Retrived from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
(4) Mayo Clinic Medical Laboratories. (n.d.) Test Catalog. Vtamin B12 and Folate, Serum. Retrieved from https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9156
(5) Sriram K and Lonchyna VA. Micronutrient supplementation in adult nutrition therapy: Practical considerations. Journal of Parenteral and Enteral Nutrition 2009; 33(5): 548-562.
(6) Bralley, J.A., Lord, R.S. (2012). Laboratory Evaluations for Integrative and Functional Medicine. 2nd ed. Duluth, Ga: Metametrix Institute.
(7) The Royal Women’s Hospital. (May 15, 2017). Guideline. Folate in Pregnancy. Retrived from https://thewomens.r.worldssl.net/images/uploads/downloadable-records/clinical-guidelines/folate-in-pregnancy_150517.pdf
(8) Philippine Dietary Reference Intakes. 2015. Department of Science Technology-Food and Nutrition Research Institute.
(9) Mayo Clinic Staff. (October 24, 2017). Folate (folic acid). Retrieved from https://www.mayoclinic.org/drugs-supplements-folate/art-20364625
