Folate - Serum

Introduction

Folate (Vitamin B9) is a water-soluble vitamin essential for DNA synthesis, methylation, and red blood cell formation. Serum folate measurement offers an early snapshot of folate status, guiding timely interventions before tissue stores become depleted.

Background on Folate

Folate acts as a coenzyme in single-carbon transfers during DNA and amino acid synthesis. Dietary sources include leafy greens, legumes, citrus fruits, and organ meats. After intestinal absorption, folate is stored in the liver and released into circulation.

Serum Folate Measurement and Ranges

Serum folate reflects recent intake and is reported in ng/mL (nmol/L).

• Standard Range: 5.5–27.0 ng/mL (12.5–61.2 nmol/L)
  
• Optimal Range: 15.0–27.0 ng/mL (34.0–61.2 nmol/L)
  
• Deficiency Threshold: <3.0 ng/mL indicates clinical deficiency
  
  

Clinical Implications of Folate Deficiency

Low serum folate impairs DNA synthesis, leading to:

• Megaloblastic Anemia: Characterized by large, immature red blood cells and reduced survival.
  
• Neurological and Cognitive Effects: Mood disturbances, cognitive decline, and elevated Homocysteine, a risk factor for vascular dysfunction.
  
• Pregnancy Risks: Insufficient folate raises risk of neural tube defects in the fetus.
  
  

Populations at Risk

Serum folate testing is recommended for:

• Pregnant women and women planning pregnancy
  
• Individuals with malabsorption (e.g., celiac disease, Crohn’s disease)
  
• Chronic alcohol users
  
• Patients on medications that deplete folate (see below)
  
• Those with unexplained macrocytic anemia or abnormal CBC
  
  

Increased Folate Requirements

• Pregnancy: Supports rapid fetal and placental growth
  
• Hemolytic Anemia & Cancer: Heightened folate turnover
  
• Chronic Inflammation: May demand additional folate for repair processes
  
  

Factors Affecting Serum Folate Levels

Interfering Factors

• Chronic alcoholism impairs folate uptake and release.
  
• Gastrointestinal surgeries or diseases reduce absorption.
  
  

Drug Associations

• Decrease Folate: Antiepileptics (phenytoin, phenobarbital), methotrexate, metformin, proton pump inhibitors, oral contraceptives, antimalarials, chloramphenicol, erythromycin, tetracyclines
  
• Bind Folate: Antacids, H2 blockers
  
  

Dietary Sources and Supplementation

• Natural Foods: Spinach, lentils, asparagus, oranges
  
• Fortified Foods & Supplements: Folic acid (must be converted to active folate in the body)
  
• Monitoring: Ensure adequate intake, particularly when dietary sources are limited
  
  

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner in Florida facilitates identification of cellular-level and molecular imbalances underlying folate-related disorders. By integrating evidence-based allopathic therapies with IV therapy medical care services—where nutrient repletion is often prioritized—we offer a regenerative, preventive framework to rebuild resilience and optimize wellness. Call (904) 799-2531 or schedule online to request your personalized folate assessment.

Further Reading

1. Pfeiffer CM, Caudill SP, Gunter EW, Osterloh JD, Sampson EJ. “Biochemical indicators of B vitamin status in the US population: NHANES 1999–2000.” American Journal of Clinical Nutrition. 2007;85(5):1327–1336. PubMed
   
2. Kelly P, McPartlin J, Scott JM, Weir DG. “Unmetabolized folic acid in serum: relationship to folic acid intake.” American Journal of Clinical Nutrition. 1997;66(4):1249–1253. PubMed
   
3. Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL. “Maternal red cell folate status and neural tube defects in Ireland.” QJM: An International Journal of Medicine. 2009;102(4):251–255. PubMed
4. O’Leary F, Allman‐Farinelli M, Samman S. “Dietary and cellular folate status: impact on homocysteine and DNA damage.” Critical Reviews in Food Science and Nutrition. 2011;51(3):198–212. PubMed