What are some of the common causes?
Folate or folic acid (Vitamin B9) is a vitamin that is mainly found in leafy green vegetables, nuts, seeds, and citrus fruits. It is also added to fortified foods such as cereals. Both folate and folic acid are different types of vitamin B9. Folate comes from natural food sources while folic acid is a synthetic version of the vitamin found in fortified foods and vitamin B9 supplements. Vitamin B9 plays an important role in the production of new blood cells, DNA synthesis, and during pregnancy for brain and spinal cord development. It also helps to keep skin, hair, and nails healthy.
A deficiency in Folic acid can lead to anaemia, neural tube defects, increased homocysteine levels, inflamed tongue (the cells in the tongue mucosa divide rapidly, so old cells cannot be replaced as quickly in the presence of a folate deficiency), shortness of breath, pale skin, felling lethargic, fatigue.
Causes of B9 deficiency include a decreased dietary intake of folate, an increased demand by the body; for example during pregnancy, as a result of impaired absorption (because of the effects of certain medication or chronic alcohol consumption), and in cases of inflammatory bowel disease. The RDA is around 400 mcg, however this is higher during pregnancy.
The Science bit
Folate acid found in food sources such as fortified cereal, citrus fruits and leafy greens is in the form of polyglutamate (chains of the amino acid, Glutamic acid). This form is soluble in water but not lipids. Because the cells in the gastrointestinal tract have a lipid membrane, the polyglutamate cannot be absorbed. For absorption to happen, enzymes released by the jejunum break down the polyglutamate to monoglutamate. As monogultamate is smaller, it passes into entrocytes and converted to tetrahydrofolic acid (THF). In the cell, THF joins a methyl group and becomes CH3-THF which passes through the enterocyte and into the blood. In the blood some of the CH3-THF is used by cells, while some travels to the liver and is stored for ~ 3 months
Folic acid is important to synthesis DNA precursors. On cells surface there are folate protein transporters that carry the CH3-THF inside the cell. Inside the cell, the methyl group (CH3) is converted to B12 (methylcobalamin). The free THF joins with another methylene group (from serine – an amino acid within cells). Further cellular reactions take place and thymidine is produced as the end result. Thymidine is a nucleotide used to build DNA. (This part is the same cellular process that occurs with Cobalamin). the methyl group of the methylcobalamin transfers to homocysteine which then converts it to methionine which in turn reduces homocysteine levels. High levels of homocysteine (an amino acid) are linked to arterial damage and heart disease.
When cell division is affected by folate deficiency, red and white blood cells in the bone marrow are affected. In terms of red blood cells, the bone marrow produces macrocytes (large mature cells instead of small mature cells). These macrocytes are destroyed in the spleen which causes anaemia. The bone marrow responds to the decrease in red blood cells by releasing more cells to compensate for the cells destroyed by the spleen, but these compensating bone marrow red cell precursors are not properly developed and are termed megaloblasts which results in macrocytic megaloblast anaemia. Severe folate deficiency can also affect white blood production and development of platelet precursors. When RBCs, WBCs, and platelets are affected, it is termed pancytopenia.
Folic acid also plays a very important role in preventing neural tube defects during fetal development. It closes the anterior and posterior neurotube which is important for the Central Nervous System Development. **osmosis.org
Testing
Looking for folate testing in Ireland? You can get tested for folate deficiency with a blood test.
You can now get tested for folate levels at Gastrolife. The testing kit is designed to be performed as a home test and sent back to the laboratory for analysis. The laboratory performing the analysis is fully accredited by ISO15189 International Standard for Medical Laboratories
