Understand your Folate (folic acid) and RBC Folate Blood Test Results…

This page helps you to understand blood test results for Folate and RBC Folate and gives you the reference range to determine if your lab test results mean that you have high, low or normal Folate D levels. 

We outline the risk factors associated with both raised and lower folate levels.

Reference Ranges for folate/folic acid(Sign up to see ranges for RBC Folate):

Measurement unit Metric Optimal Risk
US Conventional Units ug/L or mcg /L or ng/m 3-20 < 3 or > 20
Standard International Units ug/L or mcg /L or ng/m 3-20 < 3 or > 20
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What is Folate

Folate is a B-vitamin (B9) that is naturally present in many foods. A synthetic form of folate, called folic acid, is used in dietary supplements and fortified foods [84].

There are 2 main tests to assess folate levels, serum folate and RBC folate and there is some debate as to which one is preferable. Some suggest that serum folate is cheaper and faster to perform than red cell folate, and is influenced by fewer analytical variables and provides an assessment of folate status that may be superior to red cell folate [85].   However there are others that prefer RBC folate as it is a more stable measure of folate.  This is because folate levels in the liquid portion of blood (serum) can vary based on a person’s recent diet.

A Reduction in the activity of the MTHFR gene affects people’s ability to turn folic acid into methyfolate, the active form of folate which is required for methylation. This genetic defect is thought to be present in varying degrees in up to 30% of the world’s population, although the frequency varies widely between different ethnic populations [86].  This has been one of the key findings to date from the human genome project.  People with this defect should not be supplementing with folic acid but should instead use folinic acid of methylfolate [86].

It is important to note that people with MTHFR gene defects may show as having normal folate levels on both blood tests but could be deficient in the active form of folate leaving them open to the risk factors below. A genetic test can determine if the defect is present and if so, to what extent.

http://mthfr.net/ is an excellent resource for further information on this topic

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Function of Folate

Folate is used by the body to produce methylfolate which is required to start the methylation cycle. The Methylation Cycle is a biochemical pathway that manages or contributes to a wide range of crucial bodily functions, including:

  • Detoxification
  • Immune function
  • Maintaining DNA
  • Energy production
  • Mood balancing
  • Controlling inflammation [87]

All these processes help the body respond to environmental stressors, to detoxify, and to adapt and rebuild. Therefore folate is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body’s genetic material, and is especially important when cells and tissues are growing rapidly, such as in infancy, adolescence, and pregnancy. Folate also works closely with vitamin B12 to help make red blood cells and help iron work properly in the body [88].

Folate works with vitamins B6 and B12 and other nutrients to control blood levels of the amino acid homocysteine. High levels of homocysteine are associated with heart disease, however researchers are not sure whether homocysteine is a cause of heart disease or just a marker that indicates someone may have heart disease [88].

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Risk factors associated with Folate

Cardiovascular disease – An elevated homocysteine level has been associated with an increased risk of cardiovascular disease. Folate and other B vitamins are involved in homocysteine metabolism and researchers have hypothesized that they reduce cardiovascular disease risk by lowering homocysteine levels [84].

Dementia, cognitive function, and Alzheimer’s disease – Most observational studies show positive associations between elevated homocysteine levels and the incidence of both Alzheimer’s disease and dementia. Some, but not all, observational studies have also found correlations between low serum folate concentrations and both poor cognitive function and higher risk of dementia and Alzheimer’s disease [84].

Depression – Low folate status has been linked to depression and poor response to antidepressants. In an ethnically diverse population study in the United States, folate concentrations were significantly lower in individuals with major depression than in those who had never been depressed. Results from a study of men and women with major depressive disorder showed that only 1 of 14 subjects with low serum folate levels responded to antidepressant treatment compared with almost 1 in 2 subjects with normal folate levels [84].

Cancer – Several epidemiological studies have suggested an inverse association between folate status and the risk of colorectal, lung, pancreatic, esophageal, stomach, cervical, ovarian, breast, and other cancers [84]. However, research has not established the precise nature of folate’s effect on carcinogenesis.

Neural tube defects (NTD’s) – NTDs result in malformations of the spine (spina bifida), skull, and brain (anencephaly). They are the most common major congenital malformations of the central nervous system and result from a failure of the neural tube to close at either the upper or lower end during days 21 to 28 after conception. The incidence of NTDs varies from 0.5 to 4.0 per 1,000 births in North America. Rates of spina bifida and anencephaly (the two most common types of NTDs) are highest among Hispanic women and lowest among African American and Asian women [84].

Due to its role in the synthesis of DNA and other critical cell components, folate is especially important during phases of rapid cell growth [84].

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Notable variations by demographic group

Prevalence of the MTHFR gene defect which affects folate metabolism varies widely across demographic groups. Mexican, Chinese and Italian populations have some of the highest rates of MTHFR.  This translates into high instances of neural tube defects in both Mexican and Chinese populations, but not in Italians suggesting that diet and lifestyle factors have a key role to play as in mediating the genetic tendency [86].

Take a moment to Register for our 30 day Free trial to view Recommendations to Improve your numbers for each of your biomarkers

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Diet to improve Folate

Folate is found naturally in a wide variety of foods, including vegetables (especially dark green leafy vegetables), fruits, nuts, beans, peas, dairy products, poultry and meat, eggs, seafood, and grains. Spinach, liver, yeast, asparagus, and Brussels sprouts are among the foods with the highest levels of folate.

Many countries have mandatory folic acid fortification programs which requires manufacturers to add folic acid to enriched breads, cereals, flours, pastas, rice, and other grain products [84].

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Supplements for Folate

Folic acid is available in multivitamins and prenatal vitamins, in supplements containing other B-complex vitamins, and as a stand-alone supplement.

For an estimated 30% of the world’s population, a reduction in the activity of the MTHFR gene affects people’s ability to turn folic acid into methyfolate, the active form of folate which is required for methylation. Therefore rather than using folic acid, it is preferable to supplement with the less commonly used forms of B9, folinic acid of methylfolate [86].

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Exercise to improve Folate

The B-vitamins are necessary in the energy-producing pathways of the body, and for the repair of damaged cells. Individuals with poor or marginal nutritional status for a B-vitamin may have decreased ability to perform exercise at high intensities, and should correct deficiencies before participating in intense training.

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Sleep for Folate

Swedish researchers have shown that reduced sleep, even for one night can have a negative impact of the body’s methylation cycle (for which folate is required). If your blood tests show you to be deficient in folate or you have a mutation of the mthfr gene then it is particularly important to get good quality sleep and in the right amount.