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Dx Folate Deficiency Treatment:

Folate Deficiency (B9)

The Merck Manual Home Edition
"Folate (folic acid), with vitamin B12, is necessary for the formation of normal red blood cells and the synthesis of DNA (deoxyribonucleic acid), which is the genetic material of cells. Folate is also necessary for normal development of a fetus's nervous system. A low intake of folate may increase the risk of bone fractures in older adults. Folate supplementation does not seem to improve cognitive function in older adults.
In the United States and Canada, folate is added to enrich foods made from grains. Folate in supplements or in enriched foods is easier for the body to absorb than the folate that occurs naturally in food.

Folate Deficiency
Not eating enough raw leafy vegetables and citrus fruits can cause folate deficiency.
*Anemia can develop, causing fatigue, paleness, irritability, shortness of breath, and dizziness.
*A severe deficiency may result in a red and sore tongue, a reduced sense of taste, weight loss, depression, tingling or loss of sensation in the hands and feet, muscle weakness, loss of reflexes, difficulty walking, confusion, and dementia.
*If a pregnant woman has folate deficiency, her infant may have a birth defect of the spinal cord or brain.

The diagnosis is based on blood tests.
*There is anemia and the red cells are enlarged. This can be also caused from B12 deficiency.
*Folate (B9 blood level), B12 blood levels.
*Homocysteine (B9, B12 and BMG deficiency).

*Poor diet: diabetes (metformin), alcoholism
*Poor absorption: GI distress, celiac
*Medications: Anticonvulsants (dilantin and phenobarbital), ulcerative colitis (sulfasalazine), methotrexate, triamterene, urinary antibiotic (trimethoprim-sulfamethoxazole)

Folate supplements taken by mouth usually correct the deficiency. Because the body stores only a small amount of folate, a diet lacking in folate leads to a deficiency within a few months. Folate deficiency is common because many people do not eat enough raw leafy vegetables or citrus fruits. Also, prolonged cooking destroys much of the folate in food.

Women who are pregnant or breastfeeding and people undergoing dialysis may develop this deficiency because their need for folate is increased. Folate deficiency causes an anemia similar to that due to vitamin B12 deficiency.

Anemia develops gradually and may be more severe than symptoms suggest. Fatigue may be the first symptom. In addition to the general symptoms of anemia (such as paleness, irritability, shortness of breath, and dizziness), folate deficiency, if severe, may result in a red and sore tongue, a reduced sense of taste, weight loss, and depression. If a pregnant woman has folate deficiency, her infant may have a birth defect of the spinal cord or brain (neural tube defect). [Editor] A cerebral folate deficiency (CFD) disease in infants is now being recognized and associated with folate-alpha antibodies n the mother causing infantile autism, neurological defects and spastic ataxia.

Prevention and Treatment
As a preventive measure, people who are taking drugs that interfere with the absorption or metabolism of folate should take a folate supplement (0.8 to 1mg daily is recommended by the CDC). Women who are pregnant or who could become pregnant should take folate supplements to reduce the risk of having an infant with a birth defect, mainly neural tube defects. Women who have had a baby with a neural tube defect are often prescribed higher doses of folate. FOLATE in high doses of 3mg can reduce the risk of severe congenital heart defects by 40% says Gideon Koren, M.D. in OB.GYN.NEWS October 2015 page 16.

Folate supplements do not protect against coronary artery disease or stroke. Their role in reducing the risk of various cancers is unclear. Taking daily doses of a folate supplement by mouth effectively treats the deficiency.

Medications Used in Treatment:
1. folic acid
2. leucovorin: usually reserved for patients on methotrexate and chemotherapy. Can be given by injection.
3. L-methylfolate: l-methylfolate

*[Editor] About one-third of the Editor's patients have elevated homocysteine which shows a diffuse B vitamin deficiency. When the B vitamins are replaced in adequate amounts, starting with 2 capsules twice daily for 30 days, the laboratory tests improve. These individuals then continue with one capsule daily. The Editor uses Biotics® B12®/folate and Homocysteine Resist® to correct the blood levels successfully. The Editor supports a normal homocysteine value at less than 7; lower than what is considered by the laboratory at 'normal.' Folate and B12 long-term use appeared to improve the cognitive function of healthy older people with high homocysteine levels, taking a vitamin supplement to treat a risk factor of aging should make the decision easier.
*[Editor] A large percentage of the population suffering from depression (and schizophrenia) have a genetic deficiency and are unable to make folate unless they take 15mg of L-methylfolate(LMF) daily. LMF is available both as prescription and over-the-counter.

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