Folate deficiency

Folate deficiency is having an insufficient amount of a specific type of water-soluble vitamin, vitamin B12, in the blood stream. Folate deficiency is more commonly known as anaemia, where the number of red blood cells are undersupplied, thus causing an atypically low quantity of hemoglobin in each red blood cell. Hemoglobin is an essential protein molecule that uses red blood cells to transport oxygen from the lungs to the cell tissues. Folate and vitamin B12 are two primary elements required for DNA synthesis and methylation, where a methyl group replaces a hydrogen atom in DNA to regulate gene development and disease control.

Folic acid is strongly associated with folic deficiency and its many related diseases, such as ulcerative colitis (a bowel disease that creates sores in the colon), liver disease, and kidney failure. It is able to naturally supplement the lack of hemoglobin in the blood stream. Folate is a naturally occurring vitamin in food, while folic acid is a more synthetic form of the vitamin. Folic acid is added to cold cereals, flour, bread, pasta, and many other bakery items, while folate is prevalent in leafy vegetables, meat, fruits, and natural fruit juices. The increase of folic acid can alleviate folate deficiency, allowing the bowels to absorb nutrients properly and regularly.

Pregnant women may use the vitamin to prevent miscarriages and birth defects, and folic acid can be used for colon cancer, cervical cancer, and stroke prevention. It may lower the risk for heart disease by moderating homocysteine levels in the blood, given that higher homocysteine levels have the capacity to damage arteries and increase the possibility for heart disease and other cardiovascular diseases.

Background

One of the major causes of folate deficiency is a low dietary uptake, or poor absorption, of vitamin B12-rich foods, such as leafy vegetables. An inadequate dietary intake of vitamin B12 or folate is common in poorer populations, certain vegetarian groups, vegans, and the elderly, where the abnormal absorption of the vitamin is caused by gastric atrophy or the shrinkage and weakening of the stomach muscles. Folate absorption can be adversely affected by intestinal disease, infection, and certain medications.

The Recommended Dietary Allowance (RDA) for folate is 2.4 to 2.8 (g/day for adults, with specific values based on gender and physical stature. In the United States, the average vitamin B12 intake from food, not considering additional vitamin supplements, is 5 (g/day for men and 3.5 (g/day for women. It is important to understand the metabolism of vitamin B12 and the rate of vitamin depletion in the body. The depletion rate depends largely on the initial vitamin B12 amount stored in the body and the absorption efficiency is affected by the diet and reabsorption from bile. The body normally stores approximately 1 to 3 mg of folate and a vitamin turnover of 0.1% occurs per day. Folate deficiency occurs for folate amounts below 300 (g. For a lack of continuous folate intake, an amount of 1- to 3-mg of stored folate can provide the body’s nutritional needs for three to six years. Continuous consumption of vitamin B12 or folate-rich foods, normal absorption, and adequate amounts of stored folate can minimize folate deficiency and its symptoms for at least twenty-five years.

Topic Today

Vegans and lacto-ovo vegetarians, as well as octogenarians, have a greater risk for folate deficiency. The majority of the cases in the vegan-affected group comprise infants born to or breastfed by vegan mothers. In adolescence, vegans who had been fed a mostly macrobiotic diet, composed mainly of local grains and local vegetables, had a higher risk of folate depletion even after adapting to a more omnivorous diet later in life. The extent of consistently lower folate intakes during the early childhood and adolescent years is still somewhat uncertain. However, approximately half of the excreted and reabsorbed bile passes primarily through enterohepatic circulation, where the biliary (or bile-related) acids transfer between the liver and the bile. Typically, it takes twenty to thirty years for vegans to deplete stored vitamin B12. On the other hand, individuals who begin with the normal omnivorous diet and acquire a vegan lifestyle later in life show faster signs of folate deficiency, typically in only six years.

Lacto-ovo vegetarians, on the other hand, eat vegetables, eggs, and dairy products but do not consider meat as part of the regular diet. Studies have shown that lacto-ovo vegetarians have a higher risk of folate deficiency than omnivores. This challenges the customary belief that only vegans, who do not eat any animal-sourced foods are vulnerable to folate deficiency. In fact, people who avoid eating meat and only eat smaller amounts of animal-sourced foods, such as lacto-ovo vegetarians, are also capable having inadequate vitamin B12 supplies in the body.

Conversely, malabsorption and atrophic gastritis (chronic inflammation of the stomach mucus) are more common in the elderly. Vitamin B12 or folate depletion intensifies more rapidly for the abnormal absorption of folate compared to low dietary intake of folate. Typically, folate deficiency symptoms develop within two to five years, especially in the presence of intestinal abnormalities. Folate malabsorption is triggered by the low release of vitamins from food. Although the recirculation of blood may still be normal, the amount of folate reabsorbed by the liver is lower. Malabsorption of folate can be caused by gastric atrophy (common in the elderly) and pernicious anemia (an autoimmune disorder where autoantibodies kill stomach cells).

Folate or vitamin B12 deficiency is also predominant in developing countries and impoverished populations. Disadvantaged populations are more prone to folate deficiency because of the higher costs and unavailability of an adequate diet, or of dietary restrictions based in cultural or religious beliefs. These situations are common in some countries in Latin America, Asia, and Africa. About 60% of urban India was reported to have folate values lower than 150 pg/mL, and in Nepal, more than half of pregnant women had insufficient levels of vitamin B12.

Bibliography

Allen, Lindsay H. "Causes of Vitamin B12 and Folate Deficiency." Food and Nutrition Bulletin 29.2 (2008): S20–S34. Print.

"Anemia: For Patients." Hematology.org. American Society of Hematology, n.d. Web. 7 Jan. 2016. http://www.hematology.org/Patients/Anemia/.

Combs, Gerald F. The Vitamins: Fundamental Aspects in Nutrition and Health. 4th ed. London: Elsevier, 2012. Print.

"Folate Deficiency." MedlinePlus. U.S. National Library of Medicine, 20 Sept. 2013. Web. 7 Jan. 2016.

Herbert, Victor. "Experimental Nutritional Folate Deficiency in Man." Transactions of the Association of American Physicians 75 (1962): 307. Print.

Hooper, Martyn. Living with Pernicious Anaemia and Vitamin B12 Deficiency. London: Hammersmith, 2013. Print.

Oh, R., and David L. Brown. "Vitamin B12 Deficiency." American Family Physician 67.5 (2003): 979. Print.

Tucker, K. L., et al. "Plasma Vitamin B-12 Concentrations Relate to Intake Source in the Framingham Offspring Study." American Journal of Clinical Nutrition 71.2 (2000): 514–22. Print.