optimal folate levels

                              Folic acid deficiency in the elderly,

                                 optimal folate levels

Folate   (Folic Acid)

Folate is a type of vitamin B9, which is a water-soluble vitamin. Folate and vitamin B12 work together, folate is necessary for the formation of RBC (Red blood cells) and nerve function. Folate is a water-soluble vitamin. It helps the body to restore cells, and formation of DNA and RNA. Lack of folate and B12 causes anaemia, which we call macrocytic anaemia.

Normalization of folate is very important for fetal development. The major problem of folate deficiency is in pregnancy, because of folate deficiency can cause neural tube defects, like spine Bifida  (Incomplete closure of the vertebrae and membranes of the spinal cord) and anencephaly (Absence of the main portion of the brain)  the fetus.

Folate levels must be normal in the body, its deficiency also affects the skin, nail, hair and muscles.

Causes of folate deficiency

Folate deficiency is a clinical condition, because of the low level of folate. Most people are folate deficient because of the unbalancing diet, especially they eat junk and processed foods a lot, and didn't eat enough green leafy vegetables, fruits, pulses, nuts and seeds.

We should confirm the megaloblastic anaemia of folate deficiency from vitamin B-12 deficiency by the finding of a normal vitamin B 12  level and a decreased red blood cell folate or serum folate level. In megaloblastic anaemia, physical growth slows down.

Mostly folate deficiency is caused by increased demand for folate through pregnancy or sickle cell disease. The most common reasons for folate deficiency are:

• Poor diet, if someone not eating folate-rich foods like leafy green vegetables, beans, citrus fruits, rice and fortified cereals. Folate deficiency anaemia can occur because of a poor diet.

•   Pregnancy,  Folate requirements are increased in pregnancy because fetus uses quality levels of folate and received from mother.

• Consumption of excess alcohol,   Alcoholic persons decreased folic acid absorption is rarely seen, since absorption occurs from the entire gastrointestinal tract, alcohol increases folate excretion through the urine.

• Old age, inadequate food intake in old age is the biggest reason for folate deficiency.  

• Medications, Drugs such as phenytoin, trimethoprim-sulfamethoxazole, methotrexate or sulfasalazine, carbamazepine may interfere with its absorption. Folic acid absorption is poor in some patients with vitamin B,, deficiency because of mucosal disruption from that missing nutrient.

• Diseases, that affect absorption in the gastrointestinal tract can cause folate deficiency, diseases such as celiac disease, several kinds of cancers, kidney problem especially when requiring dialysis etc.

Symptoms of folate deficiency

 The features are like those of vitamin B,, deficiency because of anaemia and megaloblastic changes in the mucosa. Although, there are none of the neurologic abnormalities related to vitamin B,, deficiency. Patients with folate deficiency have the following signs and symptoms, 

• Weakness  

• Pale look    

• Chest  pain  

• Diarrhoea 

• Nausea 

• Difficulty in-breath and swallowing   

• Dizziness  

• Canker sores  

• Low Red blood cells (RBC ) and platelet.

Folate deficiency  side effects and complications 

If someone is folate deficient, so it should be treated by a doctor, as folate deficiency seems to be a minor problem, but its deficiency can lead to many dangerous complications. Some complications that can be caused by folate deficiency are listed below,

• Heart problems  

• Stroke     

• Hypothyroidism   

• Hair loss  

• Lead to anaemia & leukopenia 

•  Premature or low birth weight 

• Infertility 

Laboratory  investigations 

Folate normal value for adults is 2-20 ng/mL. 5-21 ng /mL is for children and for infants  14-51 ng/mL,(Serum normal optimal folate levels 7.2 to 17.ng/mL)..... Megaloblastic anaemia is identical to anaemia resulting from vitamin B,, deficiency. A red blood cell folate  level of < 150 ng/mL (< 340 nmol/L) is diagnostic of folate deficiency. 

The red blood cell folate level is preferred over the serum folate level because the former reflect body stores over the life span of the red blood cell, while the latter reflects immediate labile serum levels rather than body stores. 

Usually, the serum vitamin B 12 level is normal and should always be measured when folate deficiency is suspected. In some instances, folate deficiency is a consequence of the gastrointestinal mucosal disturbances from vitamin B-12  deficiency.

Bone marrow is sometimes studied to determine folate deficiency. 

Dietary options 

A folate deficiency is usually easy to curable with oral supplements. Folate supplements amazingly decrease the risk of congenital heart defects. Folate is present in most fruits and vegetables, and daily requirements of 50-100 mcg are mostly met in the diet. 

If you eat a proper diet on a daily basis, you will never suffer from folate deficiency, and in that case, medicine will not be needed. The following foods can help reduce folate deficiency, 

• Citrus fruits 

• Eggs 

• Leafy green vegetables  

• Broccoli  

• Peas 

•  Avocado 

• Nuts 

• Beef liver  

• Milk

Treatment of folate deficiency 

Total body stores of folate are about  5 mg, enough to supply requirements for 2-3 months. The woman who wants to conceive should start taking folate supplements before they conceive, because it protects the baby against diseases and birth defects .400 mg to 600 mg of folate should be taken daily during or before pregnancy, especially in the first trimester.

Folate deficient should receive supplementation with 1 mg daily of folate. The response is similar to that seen in the treatment of vitamin B,, deficiency, with rapid improvement and a sense of well-being, reticulocytosis in 5-7 days, and total correction of hematologic abnormalities within 2 months.

Large doses of folic acid may produce hematologic responses in cases of vitamin B,, deficiency, but will allow neurologic damage to progress, hence the importance of knowing the vitamin B 12 status in suspected folic acid deficiency.

Remember that folate acid medications should never be taken without doctor's advice as it can have many harmful side effects, such as skin rashes, poor appetite, nausea, breathing problems, etc.