Folic Acid

What it is

Folic acid, also known as folate or vitamin B9, is a vital nutrient that plays a crucial role in many bodily functions. It's a water-soluble vitamin, meaning your body doesn't store large amounts of it, so regular intake through diet is important. Folic acid is the synthetic form found in supplements and fortified foods, while folate is the natural form found in many foods. For simplicity, we'll often use "folic acid" to refer to this nutrient in general.

Think of folic acid as a key ingredient for building and repairing. It's essential for making DNA, the genetic material in all your cells, and for the production of red blood cells, which carry oxygen around your body. It also plays a part in cell growth and development, particularly during periods of rapid growth like pregnancy and infancy.

Why it matters

The levels of folic acid in your blood are measured to give an indication of your nutritional status and how well your body is utilising this vitamin. Adequate folic acid levels are important for overall health.

One of the most well-known roles of folic acid is in preventing neural tube defects in unborn babies. These are serious birth defects of the brain and spine that can occur very early in pregnancy, sometimes before a woman even knows she's pregnant. This is why folic acid supplementation is often recommended for women planning a pregnancy.

Beyond pregnancy, sufficient folic acid is important for maintaining healthy red blood cells. Low levels can lead to a type of anaemia called megaloblastic anaemia, where the red blood cells are larger than normal and don't function as effectively, potentially leading to fatigue and weakness. Folic acid also contributes to normal psychological function and can help reduce tiredness and fatigue.

What can cause it to be high or low

A blood test for folic acid typically measures its concentration in your serum (the liquid part of your blood). The normal range in the UK is generally between 3.8 and 26.8 nmol/l, though this can vary slightly between laboratories.

Low Folic Acid Levels (Below 3.8 nmol/l):

• Dietary Deficiency: Not eating enough foods rich in folate, such as leafy green vegetables, legumes, and fortified cereals.
• Malabsorption Issues: Conditions that affect the gut's ability to absorb nutrients, like coeliac disease or Crohn's disease.
• Increased Demand: Pregnancy, breastfeeding, or conditions causing rapid cell turnover (like certain blood disorders) can increase the body's need for folic acid.
• Alcohol Abuse: Excessive alcohol consumption can interfere with folic acid absorption and metabolism.
• Certain Medications: Some medications can interfere with folic acid levels.

High Folic Acid Levels (Above 26.8 nmol/l):

It's less common for folic acid levels to be significantly high, and often, very high levels might indicate that you've recently taken a folic acid supplement or eaten a meal heavily fortified with it. In some rare cases, persistently very high levels might be associated with certain medical conditions or treatments, and this would be something to explore with your doctor.

Lifestyle factors that may help

Maintaining healthy folic acid levels can often be supported through dietary choices and lifestyle adjustments.

• Dietary Intake: Focusing on a balanced diet rich in natural sources of folate is key. This includes plenty of leafy green vegetables like spinach, kale, and Brussels sprouts. Lentils, beans, peas, and fortified breakfast cereals are also good sources.
• Supplementation: For certain individuals, particularly those planning a pregnancy or with specific dietary restrictions, folic acid supplements can be very beneficial. This is a topic best discussed with your GP.
• Limiting Alcohol: If you consume alcohol, doing so in moderation can help your body absorb and utilise nutrients, including folic acid, more effectively.

Questions to discuss with your GP

If you have concerns about your folic acid levels, or if you've received a blood test result that falls outside the normal range, it's always a good idea to have a conversation with your GP. Here are some questions you might consider discussing:

• What does my folic acid level mean in the context of my overall health?
• Are there any specific dietary changes you would recommend to help maintain healthy folic acid levels?
• Given my personal circumstances, would taking a folic acid supplement be beneficial for me?
• Could any of the medications I'm currently taking be affecting my folic acid levels?
• Are there any other tests that might be helpful to understand why my folic acid levels are what they are?