Folate: essential vitamins for health and longevity

What are folates and why are they necessary for the body?

Folates are the common name for a group of substances derived from vitamin B9. Their name comes from the Latin word "leaf," and this is no coincidence: leafy vegetables such as spinach and cabbage are among the best sources of folic acid.

They participate in vital metabolic processes:

• they regulate blood formation and promote the formation of red blood cells;
• they protect against oncological diseases;
• they maintain the health of blood vessels and prevent atherosclerosis;
• they are necessary for the synthesis and repair of DNA;
• they promote tissue regeneration, including muscle tissues.

The role of folates is particularly important during pregnancy: an adequate level of vitamin B9 reduces the risk of congenital anomalies in the fetus, premature birth, and neural tube development disorders.

What role in women? Which women particularly need it?

• Women considering pregnancy: taking folates before conception is necessary for the proper development of the neural tube in the fetus. We have discussed the issue of folic acid for women in more detail on our blog.
• Pregnant women: their folate needs increase; a deficiency can lead to congenital anomalies, anemia, and complications.
• Women suffering from gynecological and endocrine diseases: folic acid is particularly necessary in cases of PCOS, endometriosis, fibroids, and hypothyroidism.
• Women experiencing fertility issues or miscarriages: a deficiency in folates affects implantation and placental development and increases homocysteine levels.
• Women with an MTHFR gene mutation: they need active forms of folate (5-MTHF), as regular folic acid is not absorbed.
• When taking hormonal medications: contraceptives, ovulation stimulants, and HRT can reduce folate levels.
• In cases of chronic stress: folates participate in the synthesis of serotonin and dopamine, and their deficiency can worsen depression and anxiety.

What role in men? Importance, benefits, and recommendations

Although folic acid is traditionally associated with women's health, its importance for the male body is also extremely significant. Vitamin B9 plays a key role in male fertility, metabolism, and cardiovascular system function.

Benefits of folates for men:

• They help improve sperm quality: an adequate level of folates reduces the risk of DNA mutations in sperm and increases the chances of conception;
• They support heart and vascular health by lowering homocysteine levels;
• They influence mood and energy levels by participating in neurotransmitter synthesis;
• They play a role in the prevention of oncological diseases and age-related degenerative changes.

Which men particularly need it?

• Men suffering from fertility issues;
• When preparing for conception (with their partner);
• In cases of chronic stress, fatigue, depressive states;
• In cases of heart and vascular diseases;
• In cases of MTHFR gene mutation or when taking metformin, antacids, or blood pressure-reducing medications.

It is recommended to have your folate and homocysteine levels analyzed, especially if you are considering having a child or suffer from a chronic illness. In case of deficiency, the 5-MTHF form (active methyl folate) is preferable, especially in cases of genetic particularities in metabolism. We have discussed the issue of folic acid for men in more detail: importance, benefits, and recommendations on our blog.

Folate deficiency: symptoms and consequences

Symptoms:

• headaches and fatigue;
• depression and increased anxiety;
• edema and varicose veins;
• anemia, complicated pregnancy, or miscarriage.

A low folate level can be a marker of cancer risk as well as the risk of cardiovascular diseases and diabetes. In case of suspected deficiency, it is necessary to consult a doctor and undergo tests.

How to check folate levels in the body

There are two types of laboratory tests:

1. Serum folate blood test
   • fasting, excluding vitamin intake at least 24 hours before;
   • norms: 3-17 ng/ml (may vary by laboratory);
   • may be distorted by taking dietary supplements.
2. Folates in erythrocytes
   • more accurately reflects the level of the last 2 to 3 months;
   • norms: 140-628 ng/ml;
   • useful in case of suspected chronic deficiency.

Additionally, it is possible to check the level of homocysteine, which is often elevated in cases of deficiency in B9, B6, and B12. These tests are particularly relevant in cases of pregnancy planning, infertility, chronic fatigue, and contraceptive use.

How to normalize folate levels

Folates are found in:

• asparagus, broccoli, avocado;
• cabbage, spinach, beets;
• liver, legumes, nuts, seeds;
• rye bread, strawberries, eggs.

However, in cases of MTHFR gene mutation or gastrointestinal and thyroid problems, absorption from food may be difficult. It is important to distinguish:

• Folates — natural forms of vitamin B9 present in food, partially active.
• Folic acid — synthetic form, must be converted in the liver to an active form, 5-MTHF.
• 5-MTHF — already active form, absorbable without additional enzymes, recommended in cases of MTHFR gene mutations.

If synthetic folic acid is not absorbed, it can accumulate as "uncleaved folate," providing no benefit.

Folic acid was synthesized in 1945 and has since been considered the "vitamin of motherhood and beauty." It promotes the growth of new cells, strengthens skin, hair, and nails. Maintaining an optimal level of folates is important at all stages of a woman's life.

Folates and IVF with egg donation, IVF with double donation

Folates play a key role in preparing the endometrium and ensuring the successful implantation of the embryo, especially in assisted reproductive technology (ART) programs such as IVF with egg donation or IVF with double donation.

Even if the egg or sperm comes from a donor, preparing the woman's body, including her hormonal balance, immune status, and follicular cycle, is essential for achieving pregnancy and its proper course.

Why are folates important in the context of IVF with donation?

• they promote the formation of a healthy endometrium for implantation;
• they reduce homocysteine levels, which can disrupt the vascular network of the placenta;
• they participate in cell division and DNA synthesis, ensuring the complete development of the embryo;
• they are necessary for regulating immune reactions and protecting against thrombophilias.

It is particularly important for patients undergoing an IVF with egg donation program to monitor their folate levels and, if necessary, take active forms (5-MTHF), especially in cases of genetic mutations in the folate cycle (e.g., MTHFR). This helps increase the chances of successful implantation and reduce the risks of complications during the first trimester of pregnancy.

References used:

Kaldygulova L. et al. Biological Role of Folic Acid in Pregnancy and Possible Therapeutic Application for the Prevention of Preeclampsia. Bio Medicines, 2023; 11 (2): p. 272.

Green T. J. et al. Effect of continued folic acid supplementation beyond the first trimester on child cognitive development: a randomized controlled trial. BMC Medicine, 2019; 17: article 1432.