Folic acid. If pregnancy is the first thing that comes to your mind when you hear these words, public health campaigns all over the world have been successful. Low folic acid levels are linked to birth defects of the brain, spine and the spinal column known as neural tube defects.
Given that it’s a nutrient, one might think it would be easy enough to regulate folic acid levels. But, unlike other well-recognized risk factors of birth defects, such as the age of the mother and drinking or smoking during pregnancy, the one element that controls folic acid levels appears to be out of our hands.
That is genetics! Inheriting changes in two genes, MTHFR and MTHFD1 can control the levels of folate in our bodies.
Folate is essential
Folate or folic acid is a B vitamin (B9) involved in the production and maintenance of cells, and building DNA and amino acids. It’s essential for the production of red blood cells and white blood cells. Folate is also responsible for preventing changes to the DNA that can cause cancer.
Once absorbed, folate is converted into several different forms by our bodies. This processing involves an array of different enzymes. The MTHFR and MTHFD1 genes encode two of these enzymes. Variants (small changes in the DNA) in these genes influence folic acid levels.
The MTHFD1 gene
The MTHFD1 gene encodes a tri-functional folate-converting enzyme. People with a variant of this gene, called rs2236225 A, produce an enzyme that is much less efficient at converting folate.
The resulting low folate levels are linked to a higher risk of birth defects, second trimester pregnancy loss and placental abruption, when the placenta separates from the body before the baby is born.
MTHFR variants
Those with a variant of MTHFR also make an enzyme that is much less active. People with one defective copy of MTHFR can process about 65% of the folate they ingest. Those with two defective copies process only about 30%.
The effects of this MTHFR variant reach far beyond pregnancy-associated risks. Low folate levels can also lead to the buildup of homocysteine. Elevated homocysteine levels are a risk factor for many other conditions, such as coronary artery disease, schizophrenia and autism.
Symptoms of folate deficiency
Folic acid may appear to be more relevant to adult women (particularly during pregnancy), but it is also essential in children and male adults. Folate deficiency also causes megaloblastic anemia, characterized by large abnormal red blood cells.
Early symptoms of folate deficiency include fatigue, irritability, heart palpitations, headaches, trouble concentrating and shortness of breath. Isolated folate deficiency is usually rare. It often occurs together with other nutrient deficiencies, especially vitamin B12 deficiency, suggesting that your diet may be to blame.
Eggs, fish, legumes, and leafy green vegetables are great sources of folate. Refer to the end of the article for food sources with folate and recommended dietary allowances.
Folic acid toxicity
It’s hard to take in too much folate from food. But, folic acid toxicity is a concern if you are taking a supplement or eating a lot of fortified foods. Digestive problems, nausea, loss of appetite, bloating, unpleasant taste in the mouth, sleep disturbance and depression are some of the more moderate symptoms of folate toxicity.
There can also be serious side effects. These include psychotic behavior, numbness, trouble concentrating, confusion and even seizures. Large doses of folic acid can also permanently damage the nervous system.
These adverse effects can be avoided by limiting your intake to the recommended upper limit of 1000 mcg a day for adults. Tolerable upper limits for other age groups are shown at the end of this article.
Considering genetics
Folic acid helps protect us from cardiovascular disease and mental disorders, like schizophrenia and Alzheimer’s. But, loading up on folic acid without considering your genetic background is not such a good idea.
According to a recent study, giving extra folic acid to mice with the MTHFD1 variant increased the incidence of birth defects. It’s entirely possible that this finding may not be directly applicable to people. However, it tells us that genetics can dictate the benefits of folic acid.
Genetic variants of MTHFR and MTHFD1 are included in the DNA Nutrition Test. Don’t take a chance with your wellbeing, or risk the health of your unborn baby. Consider finding out which MTHFR and MTHFD1 variants you have, before heading out to the nutrition store.
Recommended dietary allowances for folate
Recommended dietary allowances are listed as micrograms of dietary folate equivalents (mcg DFE) to take into account the higher bioavailability of folic acid than that of food folate.
1 mcg of food folate is equal to 1 mcg DFE, but only 0.5-0.6 mcg of fortified foods or dietary supplements is required to achieve the same 1 mcg DFE.
Adequate intake shown for infants from birth to 12 months is equivalent to the mean intake of folate in healthy, breastfed infants.
| Age | Male | Female | Pregnancy | Lactation |
|---|---|---|---|---|
| 0–6 months | 65 mcg DFE | 65 mcg DFE | ||
| 7–12 months | 80 mcg DFE | 80 mcg DFE | ||
| 1–3 years | 150 mcg DFE | 150 mcg DFE | ||
| 4–8 years | 200 mcg DFE | 200 mcg DFE | ||
| 9–13 years | 300 mcg DFE | 300 mcg DFE | ||
| 14+ years | 400 mcg DFE | 400 mcg DFE | 600 mcg DFE | 500 mcg DFE |
Selected foods sources of folate and folic acid
The Daily Value (DV) for folate is 400 mcg for adults and children age 4 and older. The U.S. Food and Drug Administration (FDA) developed DV, so you can compare the nutrient contents of products within the context of a total diet.
| Food | mcg DFE per serving | Percent DV |
|---|---|---|
| Beef liver, braised, 3 ounces | 215 | 54 |
| Spinach, boiled, ½ cup | 131 | 33 |
| Black-eyed peas (cowpeas), boiled, ½ cup | 105 | 26 |
| Breakfast cereals, fortified with 25% of the DV* | 100 | 25 |
| Rice, white, medium-grain, cooked, ½ cup* | 90 | 23 |
| Asparagus, boiled, 4 spears | 89 | 22 |
| Spaghetti, cooked, enriched, ½ cup* | 83 | 21 |
| Brussels sprouts, frozen, boiled, ½ cup | 78 | 20 |
| Lettuce, romaine, shredded, 1 cup | 64 | 16 |
| Avocado, raw, sliced, ½ cup | 59 | 15 |
| Spinach, raw, 1 cup | 58 | 15 |
| Broccoli, chopped, frozen, cooked, ½ cup | 52 | 13 |
| Mustard greens, chopped, frozen, boiled, ½ cup | 52 | 13 |
| Green peas, frozen, boiled, ½ cup | 47 | 12 |
| Kidney beans, canned, ½ cup | 46 | 12 |
| Bread, white, 1 slice* | 43 | 11 |
| Peanuts, dry roasted, 1 ounce | 41 | 10 |
| Wheat germ, 2 tablespoons | 40 | 10 |
| Tomato juice, canned, ¾ cup | 36 | 9 |
| Crab, Dungeness, 3 ounces | 36 | 9 |
| Orange juice, ¾ cup | 35 | 9 |
| Turnip greens, frozen, boiled, ½ cup | 32 | 8 |
| Orange, fresh, 1 small | 29 | 7 |
| Papaya, raw, cubed, ½ cup | 27 | 7 |
| Banana, 1 medium | 24 | 6 |
| Yeast, baker’s, ¼ teaspoon | 23 | 6 |
| Egg, whole, hard-boiled, 1 large | 22 | 6 |
| Vegetarian baked beans, canned, ½ cup | 15 | 4 |
| Cantaloupe, raw, 1 wedge | 14 | 4 |
| Fish, halibut, cooked, 3 ounces | 12 | 3 |
| Milk, 1% fat, 1 cup | 12 | 3 |
| Ground beef, 85% lean, cooked, 3 ounces | 7 | 2 |
| Chicken breast, roasted, ½ breast | 3 |
*Fortified with folic acid as part of the folate fortification program.
Tolerable upper intake levels for folic acid
These upper limits apply to folic acid – the synthetic form of folate available in dietary supplements and fortified foods. Breast milk, formula and food should be the only sources of folate for infants.
These upper limits do not apply to individuals taking high doses of folic acid under medical supervision.
| Age | Male | Female |
|---|---|---|
| 0–12 months | Not possible to establish | Not possible to establish |
| 1–3 years | 300 mcg | 300 mcg |
| 4–8 years | 400 mcg | 400 mcg |
| 9–13 years | 600 mcg | 600 mcg |
| 14–18 years | 800 mcg | 800 mcg |
| 19+ years | 1,000 mcg | 1,000 mcg |
Recommended dietary allowances, food sources and tolerable upper limits are obtained from the Folate Dietary Supplement Fact Sheet (National Institutes of Health).
