Introduction: The importance of folic acid
Folic acid, the synthetic form of folate (vitamin B9), is a crucial nutrient for many bodily functions. It plays a vital role in cell growth, DNA synthesis, and red blood cell formation. A deficiency can lead to a type of anemia called megaloblastic anemia, which causes fatigue, weakness, and other health issues. To effectively prevent or treat a deficiency, it is essential to understand the primary reasons what causes folic acid to be low.
Dietary deficiencies
The most straightforward and common cause of low folic acid is inadequate dietary intake. Our bodies cannot produce folate, so we must obtain it from our food. When our diet lacks sufficient folate-rich foods, our body's stores can become depleted within weeks.
- Insufficient consumption: Many people simply do not eat enough fruits, vegetables, and fortified grains. The standard American diet, often high in processed foods, is typically low in natural folate.
- Overcooking food: Folate is a water-soluble vitamin that is sensitive to heat. Excessive boiling or prolonged cooking can destroy a significant portion of the folate content in vegetables.
- Poor food choices: A restrictive or unbalanced diet, due to socioeconomic factors or personal preferences, can lead to limited dietary diversity and low folate intake.
Medical conditions affecting absorption
Even with a folate-rich diet, certain health issues can interfere with the body's ability to absorb and utilize the nutrient.
Gastrointestinal diseases
- Celiac disease: An autoimmune disorder where consuming gluten damages the small intestine lining, which is responsible for nutrient absorption.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease and ulcerative colitis cause chronic inflammation, impairing nutrient uptake.
- Tropical sprue: A condition found in tropical regions that damages the small intestine, leading to malabsorption.
- Surgical resection: Procedures involving the removal of parts of the small intestine, such as bariatric surgery, can reduce the area available for absorption.
Other health issues
- Kidney dialysis: Patients undergoing dialysis often lose water-soluble vitamins, including folate, during the procedure.
- Chronic hemolytic anemia: This condition involves the premature destruction of red blood cells, which increases the body's demand for folate to produce new cells.
Impact of certain medications
Some medications can interfere with folate metabolism, either by blocking its absorption or increasing its excretion.
Common medications known to interfere with folate
- Methotrexate: A potent folate antagonist used to treat cancer, autoimmune diseases, and arthritis.
- Anticonvulsants: Drugs like phenytoin (Dilantin) and phenobarbital can interfere with folate absorption and metabolism.
- Sulfasalazine: Used for IBD and rheumatoid arthritis, this medication can impair folate absorption.
- Trimethoprim: An antibiotic that works by blocking a key enzyme in the folate pathway.
Genetic factors
Genetic variations can affect the body's ability to convert folate into its active, usable form.
MTHFR gene mutation
A common genetic variation, particularly the C677T variant of the methylenetetrahydrofolate reductase (MTHFR) gene, can lead to impaired folate metabolism. Individuals with this mutation have a reduced ability to convert dietary folate into its active form, 5-methyltetrahydrofolate (5-MTHF), which can contribute to low folate levels.
Lifestyle and other risk factors
Chronic alcohol abuse
Excessive and long-term alcohol consumption is a significant cause of folate deficiency. Alcohol interferes with the absorption of folate, increases its excretion through the kidneys, and impairs its storage in the liver.
Pregnancy and lactation
During pregnancy, the body's demand for folate increases significantly to support fetal development and rapid cell division. Inadequate intake during this period can lead to serious birth defects, such as neural tube defects.
High cellular turnover
Besides pregnancy, other conditions that involve rapid cell growth, like chronic hemolytic anemia and certain cancers, increase the body's need for folate.
Comparison: Folate vs. Folic Acid
To better understand the issue, it is helpful to differentiate between folate and folic acid.
| Feature | Folate | Folic Acid |
|---|---|---|
| Source | Naturally occurring in foods like spinach, beans, and citrus fruits. | Synthetic form of vitamin B9 used in supplements and fortified foods. |
| Absorption | Requires conversion by enzymes in the digestive system. | More efficiently absorbed by the body, especially on an empty stomach. |
| Metabolism | Converted to its active form (5-MTHF) via several enzymatic steps. | Requires a specific enzyme (dihydrofolate reductase) for conversion. |
| Risks | No significant risk of high intake from food alone. | High, unmetabolized levels can accumulate in the blood, potentially masking a vitamin B12 deficiency. |
What to do if you have low folic acid
If you suspect you have low folic acid, the first step is to consult a healthcare professional. They can perform a simple blood test to confirm a deficiency. Based on the cause and severity, they may recommend a treatment plan, which could include:
- Dietary changes: Increasing your intake of folate-rich foods such as dark leafy greens, legumes, and fortified cereals.
- Supplements: Taking a folic acid supplement, which is often recommended for pregnant women and those with severe deficiencies.
- Addressing the underlying cause: Treating any medical condition, such as celiac disease, that is preventing proper absorption.
For more information on folate and its role in health, you can refer to the National Institutes of Health fact sheet.
Conclusion
Low folic acid levels can result from a complex interplay of dietary, medical, genetic, and lifestyle factors. While poor diet is a common culprit, malabsorption issues, medications, and genetic predispositions can also play a significant role. By working with a healthcare provider to identify the specific cause, individuals can effectively manage their folic acid levels and prevent potential health complications. Paying attention to what you eat and staying informed about potential risk factors is key to maintaining healthy folate levels.
