Folate, Pregnancy and Hyperhomocysteinemia


Folate and Pregnancy

What is folate ?
Folate (or folic acid) is a vitamin essential for growth and good health. The body cannot make folate, so it must be obtained from foods and supplements.
Folate is the proper term for the vitamin as it is found naturally in foods. However, the term "folic acid", which is the term for the vitamin as it is found in supplements, is more familiar.

Why is fotale important ?
Folate is necessary for the formation and development of new and normal tissue. New tissus forms at a rapid pace during pregnancy, and the body's need for folate nearly doubles.

Folate can help protect an unborn baby against birth defects of the neural tube. When the neural tube, which develops into the spinal cord, fails to close at the top, the baby is born without a brain. This is known as anencephaly, and the baby dies soon after birth. If the neural tube does not close further down, the delicate nerves of the spinal cord are left exposed and paralysis may result. This is called spina bifida.

How much folate do I need ?
Because as many as 50% of pregnancies are unplanned, it is recommended that all women of childbearing age have an adequate daily intake of folate.
The 1989 Recommended Dietary Allowances (RDA) set folate intake levels of 180 micrograms daily for the adult woman, 200 micrograms for the adult man, and 400 micrograms during pregnancy.
Since then, research established the connection between babies born with neural tube defects and an inadequate concentration of folate in the mother's blood at or around the time of conception.
The 1997-98 Dietary Reference Intakes (DRI), developped to expand the Reccomended Dietary Allowances, have set folate intake of 400 micrograms for adult women. Further, in view of the evidence linking folate with neural tube defects, it is recommended that all women capable of becoming pregnant consume 400 micrograms of synthetic acid from supplements and/or fortified foods in addition to the intake of food folate from a variety diet.
Milligrams (mg) and micrograms (mcg) are the most common units of measurement. Four tenths (0.4) mg equals 400 mcg.

Can I consume too much folate or folic acid ?
There is no evidence of toxicity from dietary sources of folate. In other words, eating foods rich in folate on a daily basis has no known harmful effects. Care should be taken, however, to keep total daily folic acid (supplements) consumption under 1 milligram because the effects of high intake are not well known and may complicate the diagnosis of vitamin B 12 deficiency.

Can folate be destroyed?
Some nutrients are more prone than others to loss or destruction. As much as 50% of folate may be destroyed during preparation, food processing, and storage. Canned pinto beans, for example, contain one-half the folate of boiled pinto beans.
For best retention of folate and other nutrients, follow these simple guidelines of food preparation:
· Avoid cutting foods into small pieces prioir to cooking
· Avoid overcooking
· Steam, boil, or simmer using the minimum amount of water
This practice will help preserve not only folate, but all water-soluble nutrients which are likely to be discarded in the cooking water.
· Serve fruits and vegetables raw whenever possible.


Hyperhomocysteinemia:

What you are NOT eating could hurt you.
Heart disease is the number one killer in this country, claiming 500,000 lives every year. Factors such as cigarette smoking, high blood pressure and cholesterol, physical inactivity, age, stress, hereditary factors, diabetes and being a male contribute to an increased risk of heart disease. However, many heart attacks occur in people without any of these riks factors.

Recent studies point to a new risk factor. Homocysteine, an amino acid and a basic unit of protein, appears to be implicated in 10 to 15 percent of heart disease cases. A 1992 study of over 14,000 male physicians found that those with the highest levels of homocysteine had more than three times the risk of heart disease. Homocysteine, like cholesterol, has an important role in forming and maintaining tissues, but abnormally high levels of it in the blood can injure blood vessels.

Foods rich in folate, B 12 and B 6 help keep homocysteine at safe levels. In other words, when B-vitamins are provided, the homocysteine levels may decrease. Conversely, low levels of blood folate are consistently related to high levels of homocysteine. Folate (also known as folic acid) seems to have a greater clearing effect on homocysteine levels than B 6, B 12 or both vitamins combined. Some people may be more prone to homocysteine buildup and may consequently need more B-Vitamins.
Although we cannot yet conclude that folate (or all 3 B-vitamins) will definitely prevent heart disease, we can conclude based on the present evidence that it is advisable to increase your intake of B-vitamins, and especially of folate.

How much folate do I need?
The 1989 Recommended Dietary Allowances (RDA) set daily folate intake levels of 180 micrograms for the adult woman, 200 micrograms for the adults man, and 400 micrograms during pregnancy.
The 1997-98 Dietary Reference Intakes or DRI (developed to expand the Recommended Dietary Allowances) sets folate intake at 400 micrograms for adult men and women.

Why should I be concerned with increasing folate intake?
The highest concentrations of folate are found in plant food sources such as lentils, beans and chickpeas, followed by some green leafy vegetables and fruits. Under Food and Drug Administration (FDA) rules, effective January 1, 1998, grain products such as breads, macaroni, rice, corn meal, and enriched flours are required to be fortified with folic acid. According to one estimate, six daily servings of enriched grains foods will total around 320 micrograms of folate.

FOLATE IN COMMON FOODS

Legumes Folate
(1/2 cup, boiled) (micrograms)
lentils 179
pinto beans 147
chickpeas (garbanzo beans) 141
kidney beans 115
pinto beans, canned 72
split beans 64
kidney beans, canned 63

Leafy green vegetables
(1/2 cup)
spinach, frozen, boiled 102
romaine lettuce, raw, shredded 38

Other vegetables
(boiled)
asparagus, 6 spears 88
medium artichoke 61
cauliflower pieces, frozen boiled, ½ cup 37

Meats
(3 ounces)
extra lean ground beef, baked 8
½ chicken breast, boneless, roasted 3

Fruits
orange juice from concentrate, 6 oz 82
avocado, 1/2 (3 oz) 57
orange, large 56
blackberries, unsweetened, frozen, ½ cup 26
banana, one medium 23
cantaloupe, medium, 1/8 12
pineapple chuncks, ½ cup 6

Whole grain products
General Mills Total, ¾ cup (30 g) 400
Kellog's All-Bran, ½ cup (3 0g) 90
Toasted wheat germ, ¼ cup (30 g) 100
Fortified instant oats, 1/3 cup dry
(30 g) or ¾ cup cooked 90
whole wheat bread, 1 slice 14


Source: SDA Nutrient Database for Standard Reference, Release 13 (November 1999)