Spotlight on vitamin B9, the artist also known as folate (oh, and folic acid. Too many names...).

Better known as folate, or folic acid (which is this vitamin in its synthetic form), vitamin B9 appears prominently in millions of tacky tube adverts featuring overjoyed-looking pregnant women, and as you might have guessed is mostly known for its role during pregnancy. This is chiefly thanks to its role helping to close an embryo’s neural tubes, and in aiding the body in the business of making new cells – both crucial during reproduction and pregnancy.

But it’s not just important if you’ve a bun in the oven. Besides its role here, the mighty B9 also has a key part to play in helping the body recycle and produce proteins, maintain healthy liver function, ensure DNA replication goes according to plan, and aid the production of red blood cells. In short, it’s an essential vitamin for us all.

What's the story?

One of the few vitamins where a woman played a starring role in its discovery, folate was originally called 'Will’s factor' after Lucy Wills, an enterprising young British doctor working with anaemic pregnant women in Mumbai. Suspecting that poor diet could be contributing to their condition, she discovered that the humble marmite spread (rich in yeast and B-vitamins) could cure her patient’s symptoms, and the rest as they say, was history.

Interestingly (well, if you’re a history nerd like me…), it became known as folate in around 1941 from the Latin word ‘folium’, roughly translated as ‘leaf’, thanks to the fact it was first isolated from spinach leaves.

Why is it so important for those up the duff?

Without sufficient amounts of folate, there’s less activity in cells when it comes to the process of methylation, which can lead to changes in gene expression. The full detail behind the biochemistry underpinning folate’s role in closing embryonic neural tubes is actually pretty hazy, and not fully understood, but what is known is that without enough folate in the diet neural tube defects (such as spina bifida) can occur in newborns.

Although many people do take folic acid when pregnant, it’s actually most critical in the very earliest stages of pregnancy, before and during the first 6 weeks of gestation. Unfortunately, this is before most women even know they’re pregnant; according to recent statistics, only an estimated 55% of pregnancies in the UK are planned. Yep. Can you see the problem here? As such, the FSA recommends all women of childbearing age obtain adequate amounts of folate via a supplement, so if you’re actively trying for a wee bairn definitely make sure you’re getting enough of this vitamin.

The great fortification debate

But the big problem with supplementation is that these messages tend to be received by those in the population who are already pretty health conscious (and so probably less likely to actually need a supplement). SACN cites a 2014 study looking at what proportion of women took a folic acid supplement, and found only 43% of mothers in the most economically deprived areas in the UK did so, compared to 70% of women in the UK’s least deprived areas.

As a result, there’s an argument for making fortification of flour with folate mandatory, so that everyday staples like bread can bump up women’s daily intake of folate without them having to do much differently. And this tactic has form. In the USA, all enriched grain products are legally required to contain folic acid in an attempt to prevent birth defects, and to make sure child-bearing women consume enough B9. Since 1998 when the FDA brought this law in, the rate of neural tube defects in the US has dropped by an impressive 25-50%.

As a result, the tricky issue of whether the UK should follow suit continues to rear its floury head. As recently as August 2017 the UK government debated the issue after a request from the Scottish Food Standards Agency. Although SACN (the government nutrition bods) have repeatedly recommended mandatory fortification of products with folic acid in the UK, the Scottish request was turned down, as it was seen as too tricky to enact on a Scotland only basis.

Why do we need to be careful with folate?

Although it may seem like a no brainer to some, as with many of the vitamins, their interconnectedness and admirable complexity means that it’s not all that straightforward. Although the evidence thus far is fairly inconclusive, uncertainties still exist around whether folate is a potential cancer risk (it’s unlikely, but can’t be ruled out completely).

Moreover, folate’s close relationship with vitamin B12 poses other problems. B12 is a sort of ‘frenemy’ of folate (B9), where both rely on the other for activation. Folate needs B12 in order to convert folate in the diet into its active form. Similarly, the intriguing sounding ‘folate trap’ describes the situation whereby deficiencies of B12 and folate co-exist together, with folate masking B12 deficiencies. This means that high doses of folate can potentially hide the warning signs of vitamin B12 deficiency.

This is a particular problem given our aging population, as vitamin B12 deficiencies are not only relatively common amongst the elderly, but can also cause irreversible neurological affects. As a result, fortifying products to target one group of individuals (pregnant ladies), could have an adverse effect on those eating the same products, but who are not in fact pregnant ladies (like the elderly).

Ok, but how much do I need and how do I get it from my diet?

Adult women and men aged 19 and beyond (including 50+ year olds) need 200 μg per day.

Pregnant women and those actively trying for a baby need an additional 100 μg a day, although most reliable sources recommend taking a supplement of 400 ug, due to ‘conclusive evidence’ that taking this amount in the run-up to conception and during the first trimester can prevent the majority of neural tube defects. Unless you eat at least copious portions of fruit and veg every day, it can be hard to obtain enough folate when pregnant which is why a supplement is recommended.

Folate has a lot in common with its sibling vitamin C when it comes to eating your way to the RDA. Foods rich in folate include citrus fruit such as kiwi and oranges, eggs, peanuts, green leafy veg and cruciferous vegetables like broccoli and sprouts. Seafood, chickpeas, wholegrains, and milk products (cheese, milk etc) are also good sources of this vitamin.

Take a look at the recipe store for ideas of how to integrate these foods into your diet, from this summery Crayfish salad with sundried tomato and lime, to Stirfried kale with quinoa, orange and pecans, or this more wintery chickpea and aubergine curry recipe.

REFERENCES

British Nutrition Foundation (2016) Nutrition Requirements.  Available here [last accessed 5th August 2017].

Pitkin, R.M. (2007) Folate and neural tube defects. The American Journal of Clinical Nutrition. 85 (1). Available here.

Price, C. (2016) The Vitamin Complex. London, Oneworld Publications, pp. 258-9.

Van Raaij, J., de Groot. L.C., (2011) Pregnancy and Lactation. In: Lanham-New, S.A, Mcdonald, I.A., and Roche, H.M., (eds) Nutrition and Metabolism, Second edition. Chichester, John Wiley & Sons, chp. 6.

Other references can be linked to in the body of this blog.