Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food. Folic acid is the synthetic form of this vitamin that is found in supplements and fortified foods. Folate is necessary for the production and maintenance of new cells and is especially important during periods of rapid cell division and growth such as infancy and pregnancy. Folate is needed to make DNA and RNA, the building blocks of cells. It also helps prevent changes to DNA that may lead to cancer. Both adults and children need folate to make normal red blood cells and prevent anemia.
A deficiency of folate can occur when your need for folate is increased, when dietary intake of folate is inadequate, and when your body excretes more folate than usual. Medications that interfere with your body’s ability to use folate may also increase the need for this vitamin. Some situations that increase the need for folate in children include liver disease, and some types of anemia.
Loss of appetite
Sore mouth and tongue
If a blood test detects large red blood cells in people who have anemia or who are undernourished, doctors should measure the folate level in a blood sample. A low level indicates a deficiency. Doctors should also measure the vitamin B12 level to rule out vitamin B12 deficiency because this deficiency can also result in anemia and large red blood cells.
Women with folate deficiency who become pregnant are more likely to give birth to low-birth-weight and premature infants, and infants with neural tube defects, which are malformations of the spine, skull, and/or brain. Folate deficiency can slow growth rate in infants and children. Advanced folate deficiency can lead to anemia in adults.
Folic acid is available in most multivitamins, as a folic acid-only supplement, and in some foods.
Dietary sources include leafy greens such as spinach and turnip greens, dry beans and peas, fortified cereals and grain products, and some fruits and vegetables. Most breakfast cereals are fortified with folic acid.
Since 1998, food manufacturers in the US have been required to add folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products. These regulations were specifically targeted to reduce the risk of neural tube birth defects in newborns. Since the folic acid fortification program took effect, fortified foods have become a major source of folic acid in the American diet. Synthetic folic acid that is added to fortified foods and dietary supplements has a simpler chemical structure than the natural form of folate, and is absorbed more easily by the body. After digestion and absorption however, the two forms are identical and function in exactly the same manner.