1. Folate: Vitamin B-9 By: Abby Stanley

2. Overview  Difference between folate and folic acid  Dietary folate equivalents  Sources  RDA and Upper Limits

3. Overview  Absorption, Transportation and Storage  Functions  Deficiency  Research: Current and Future Application  Evidence Analysis Library

4. General Information  Water-soluble vitamin  Member of the B-vitamin family  Comes from Latin word “folium”  Formerly known as Folicin  Naturally present in some foods, added to others and available as dietary supplement  Forms coenzyme Tetrahydrofolic acid (THFA)

5. Folate vs. Folic Acid Folate  Refers to forms found naturally in foods  Polyglutamate Folic Acid  Synthetic form, found in supplements and fortified foods  Fully oxidized form of the vitamin  Monoglutamate

6. Bioavailability  Degree to which the amount of an ingested nutrient is absorbed and is available to the body.  The bioavailability of Folate depends on the source and other factors while taking it in.  Dietary Folate vs Synthetic Folic Acid  Taken with food/fortified food vs On empty stomach Absorbed and available to the body Folic Acid on Empty Stomach 100% Folic Acid + Food 85% Dietary Folate 50%

7. Dietary Folate Equivalents 1 DFE 1 mcg dietary folate 0.6 mcg folic acid w/ food 0.5 mcg folic acid on empty stomach  The RDA for folate is expressed using DFEs.  Reflects the higher bioavailability of folic acid than dietary folate  Example: If Daily Intake is  Dietary Folate=100 mcg  Folic Acid= 340 mcg  DFE=100 + (340 x 1.7)  =100 + 578  =678 mcg Dietary Folate (mcg) Folic Acid (mcg) x 1.7 DFE

8.  400 mcg DFE Men  400 mcg DFE  Capable of becoming pregnant should come from both dietary folate and synthetic folic acid Women  600 mcg DFE  400 mcg from folic acid  200 mcg from dietary folate Pregnant Women RDA’s

9. Sources Foods  Common Sources  Fortified bread and cereal products  Orange juice & citrus fruits  Green veggies  Largest Bioavailability  Liver  Legumes  Leafy greens Dietary Supplements  Stand alone, Multivitamins, prenatal vitamins, and in supplements containing other B- complex vitamins

10. Sources Food Processing can destroy 50-90% of available folate!

11. Folic Acid Fortification  In 1998 the FDA began requiring manufacturers to add folic acid to enriched breads, cereals, pasta, rice and other grain products.  Projected to increase folic acid intake by 100 mcg/day, but actually increased it by about 190 mcg/day.  Other Countries also have established folic acid fortification programs  Canada, Costa Rica, Chile, South Africa

12. Folic Acid Fortification

13. Cereals with Folic Acid General Mills Chex (multi- bran & wheat) Fiber One Raisin Bran Total Kashi Honey Toasted Oat Warm Cinnamon Oat Oat Flakes & Blueberry Clusters Kellogg’s All-Bran Low-fat granola Product 19 Mueslix Smart Start Special K Original Malt-O-Meal Crispy Rice Mini Spooners (AF) Quaker Oats Cap’n Crunch (AF) Corn Bran Crunch Honey Graham Oh!s King Vitamin Life (SF) Oatmeal Squares (AF) Quisp Multigrain Crisps The Following cereals contain 100% of the Daily Value of folic acid per serving. Is your cereal on the list?

14. Upper Limits  No UL for dietary folate because absorption is limited  UL for synthetic folic acid is 1000 mcg for adults  FDA limits amount of folic acid in non-prescription supplements to 400 mcg  Over-the-counter, prenatal supplements can contain 800 mcg  Health Risks  Masks B-12 deficiency, which leads to neurological damage  New studies show it may accelerate development of preneoplastic lesions  areas that proceed development of tumors

15. Chemical Structure  Consists of 3 parts:  Pteridine  Para-aminobenzoic acid (PABA)  Glutamate  Monoglutamate  Only one glutamate molecule attached  Folic acid  Polyglutamate  Multiple glutamate molecules attached  Dietary folate

16. Folate in the Body  Absorption  Folate polyglutamates must be broken down to monoglutamate form  By enzymes called “folate conjugases”  Mono form is actively transported across intestinal wall  Large doses of supplemental folic acid can be absorbed here by passive diffusion  Mono travels from intestine to portal vein to liver  Storage and Transportation  It is either stored in the liver  Or released into blood for delivery to cells  Once in cell it is converted back to polyglutamate form, which traps it there

17. Functions Synthesis and maintenance of new cells (RBC) Function in metabolic pathways DNA synthesis Amino acid metabolism

18. Folate & B12 The Folate “Trap” B12

19. Deficiency: How is it measured? Serum Folate Indicator  >3 ng/mL adequate folate status  Sensitive to dietary folate intake  Might not reflect long term status Erythrocyte Folate Concentration  >140 ng/mL adequate folate status  Research shows higher values better for preventing neural tube defects  Reflects long term status

20. Deficiency: At Risk Groups  People with alcohol dependence  Women of childbearing age  Pregnant women  People with malabsorptive disorders

21. Deficiency  Results from:  Low intake  Malabsorption  Increased requirement  Compromised utilization  Certain medication use  Excessive exertion Megaloblastic anemia Increased size of circulating RBC Megaloblastic changes in bone marrow & other rapidly dividing cells Increased blood concentration of homocysteine Structure change of certain WBC Defective DNA synthesis Decreased red cell folate Decreased blood folate concentration Steps in Folate Deficiency

22. Deficiency  Symptoms  Open sores on tongue and mouth  Change of color in skin, hair and fingernails  Effects of Deficiency  Megaloblastic anemia  Weakness & fatigue  Trouble concentrating  Irratibility  Headache  Heart palpitations  Shortness of breath  Neural tube defects in pregnancy  Spina bifida

24. Research: Current Application  Currently research shows that folate status in women who are pregnant or capable of becoming pregnant significantly effects outcome of NTD in pregnancy.  Science suggests folic acid use could reduce NTD by 50-90%  Applied through the folate fortification program and well as the increased RDA for pregnant women

25. Research: Evidence Analysis Library  Before & after study of patients with heart failure  Sample size=14, 12 males, 2 females  Given 0.8 mcg folate, 3 mcg pyridoxine, 0.5 mcg B12  Period of 6 weeks  Results  May result in beneficial outcomes for patients  Possible benefits: decreased homocysteine levels,arterial blood pressure and improvements in left ventricular volume and life scores For the patient with heart failure, is there evidence to suggest that supplementing with folate and or B12 provides beneficial outcomes?

26. Research: Future Application  Cancer  Studies suggest inverse relationship b/w folate status and risk of various cancers  Research is mixed and depends on how much is taken and when  Modest amount, before cancer development, decrease risk; high doses, after development, speed progression  Cognitive Function  Correlations between low serum folate concentrations and poor cognitive function and higher risk of dementia and Alzheimer's disease  BUT when used folic acid supplementation as treatment for these conditions was shown to have no effect

27. Research: Future Application  Depression  Research shows that folate does play a role in depression  Those with Low folate levels are more likely to suffer from depression and may not respond to treatment with antidepressants as well  Folic acid supplements might make antidepressant med. More effective  Pre-term birth and congenital heart defects  Folic acid supplementation shown to lengthen mean gestational age, lowering risk of pre term birth  Also, suggests a link between folic acid and multivitamin use and a lower risk of heart defect in newborns

28. Case Study  Sarah  27 year old. Female  Pregnant with her first child  Has read a lot of information talking about folate in relation to pregnancy  She is extremely worried that she is not getting enough folate in her diet and she is looking for help.  What is the RDA of folate for sarah? General and Specific.  If Sarah came to you looking for ways to increase her intake, what would you suggest?  Sarah wants to know why folate is so important during pregnancy, what would you tell her?  Should she have been monitoring her folate intake before becoming pregnant?

29. Review http://www.youtube.com/watch?v=AZLudkA0q z4

30. Sources