Homocysteine and folate as risk factors for dementia and Alzheimer disease. Centers for Disease Control and Prevention. Effect of folic acid food fortification in Canada on congenital heart disease subtypes. The prevalence rate of spina bifida and anencephaly (the two most common types of NTDs) in the United States is 5.5 to 6.5 per 10,000 births [134]. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. 2. J Nutr 2017;147:1677-85. 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 Alzheimers disease [79,100,101,103,105]. Postpartum depressive symptoms: the B-vitamin link. Increased food consumption can boost your serum folate levels. 2020 Dec. 25 (6):750-764. Folate and neural tube defects. Folic acid and prevention of colorectal adenomas: a combined analysis of randomized clinical trials. Genest JJ Jr, McNamara JR, Salem DN, Wilson PW, Schaefer EJ, Malinow MR. 2006 Jun 29. In folate deficiency, homocysteine levels are elevated and MMA levels are normal. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 0000006690 00000 n An analysis of 10,789 participants from this trial found that folic acid supplementation significantly reduced the risk of stroke by 73% among those who had a low platelet count and an elevated homocysteine level (increasing their risk of stroke) but had no significant effect on participants with a high platelet count and low homocysteine level [95]. Even when intakes of folic acid from dietary supplements are included, 19% of female adolescents aged 14 to 18 years and 17% of women aged 19 to 30 years do not meet the EAR [29]. Am J Clin Nutr 2017;105:1101-9. I am searching for answers to my continued fatigue, upset stomache, dizziness and vision changes. To meet this need, the FNB increased the folate RDA from 400 mcg DFE/day for nonpregnant women to 600 mcg DFE/day during pregnancy [2]. eurocat-network.eu. 0000003215 00000 n Folate deficiency is associated with three important disorders. RBC folate levels are less subject to short-term dietary changes. Casey GJ, Phuc TQ, Macgregor L, et al. Diagnosis is confirmed by the presence of low serum folate and/or low red blood cell folate. Lack of periconceptional vitamins or supplements that contain folic acid and diabetes mellitus-associated birth defects. I)(*H/f|3a.Lnax#/7P^5E It is vital for the making of healthy red blood cells. People with an MTHFR polymorphism Accessed: September 14, 2018. 2021 Apr. Most folate-deficiency anemia is caused by a lack of folic acid in the diet. [, Page R, Robichaud A, Arbuckle TE, et al. The researchers found no association between B-vitamin supplementation and cancer outcomes. Taking more than your body needs from food is not necessarily a health risk because excess B vitamins are normally excreted from the body through urine. This is a fact sheet intended for health professionals. J Nutr 2006;136:189-94. In a population-based case-control study in Atlanta involving 3,987 infants, congenital heart defects were 24% less common in the infants of women who took multivitamins containing folic acid during the periconceptional period than in the infants of women who did not [146]. 0000013117 00000 n Since November 1, 1998, the Canadian government has also required the addition of 150 mcg folic acid/100 g to many grains, including enriched pasta, cornmeal, and white flour [6,16]. Folate. Most observational studies conducted to date have shown positive associations between elevated homocysteine levels and the incidence of both Alzheimers disease and dementia [32,79,100-104]. [QxMD MEDLINE Link]. Kado DM, Karlamangla AS, Huang MH, et al. In any case, having an elevated folate level is not dangerous, a sign of any disease, or a cause of any health problems. [QxMD MEDLINE Link]. Food Labeling: Revision of the Nutrition and Supplement Facts Labels. National Library of Medicines list 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 on days 21 to 28 after conception [132,133]. 1. 0000194109 00000 n 0000249703 00000 n More research is needed to fully understand how dietary folate and supplemental folic acid affect cancer risk and whether their effects differ by timing of exposure. Have a question? This cannot be differentiated from changes observed with vitamin B12 deficiency. These potential negative health consequences are not well understood and warrant further research [1,9]. With this condition, red blood cells are larger than normal. Autism spectrum disorder Both results give the same interpretation (internal Mayo study), therefore, RBC folate quantitation is not recommended. When they're finished, the needle will be removed and a cotton ball will be applied to stop any bleeding. Am J Clin Nutr 2004;80:1123-8. 0000114923 00000 n Cancer Epidemiol Biomarkers Prev 2006;15:189-93. When you have anemia, your blood cant bring enough oxygen to all your tissues and organs. WebFolic acid helps form red blood cells and produce DNA that stores genetic codes. Although the effects in men were not statistically significant, women who received fluoxetine plus folic acid had a significantly greater improvement in depressive symptoms than those who received fluoxetine plus placebo. However, speculation is present that high levels of folic acid may provoke seizures if you are taking anti-convulsant medication. I was taking 2000 mg of Metformin for over 2 years. Am J Clin Nutr 2010;91:231-7. Bone marrow aspirate from a patient with untreated pernicious anemia. 0000012437 00000 n A value of 3.0 ng/ml or less indicates a folate deficiency. May accelerate age-related mental decline. Folate and carcinogenesis: evidence, mechanisms, and implications. N Engl J Med 2002;346:476-83. [, Chuang SC, Rota M, Gunter MJ, et al. If we have high levels of b12 and folate are we not supposed to supplement with those until levels come down? [, Huang T, Chen Y, Yang B, et al. Author Study design Results; Scholl et al (8)Prospective, observational study of folate from diet and supplements, and serum folate (n = 832)Women with low folate intake (240 g/d) had >3 times greater preterm delivery and infant low birth weight than women with folate intake >240 g/d (P < 0.05).Risk of preterm delivery without Am J Clin Nutr 2008;88:1602-10. 5 Studies of several folate [QxMD MEDLINE Link]. Huanhua Road You are being redirected to 0000007134 00000 n Measurements of erythrocyte folate levels also suggest that most people in the United States have adequate folate status. As far as your folate being high - that is what we want. It's usually due to a diet high in folate or getting more folate than your body needs through a vitamin supplement. Conversely, a longitudinal, population-based cohort of 35,059 pregnant Danish women and their children found no association between periconceptional folic acid or multivitamin use and ASD [53]. Example. Braun KV, Voortman T, Kiefte-de Jong JC, Jaddoe VW, Hofman A, Franco OH, et al. Are taking certain medicines, such as those used to control seizures, Your age, overall health, and medical history, How well you can handle certain medicines, treatments, or therapies, How long the condition is expected to last. [, Papakostas GI, Petersen T, Mischoulon D, et al. Centers for Disease Control and Prevention. 0000003757 00000 n [, Clarke R, Halsey J, Lewington S, et al. One study included in the review among 709 women in Singapore found that compared with women with higher plasma folate concentrations (mean 40.4 nmol/L [17.8 ng/mL]) at 2628 weeks gestation, those with lower plasma folate concentrations (mean 27.3 nmol/L [12.0 ng/mL]) had a significantly higher risk of depression during pregnancy but not after giving birth [122]. 109. In some people, it is a sign of B12 deficiency but 970 isn't bad. If a person has a B12 deficiency, they may have excess folic acid as the folic acid remains in the body. Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LY. [, Ravaglia G, Forti P, Maioli F, et al. The total body content of folate is estimated to be 15 to 30 mg; about half of this amount is stored in the liver and the remainder in blood and body tissues [1]. WebApproximately 20% of the folate absorbed daily is derived from dietary sources; the remainder is synthesized by intestinal microorganisms. Am J Clin Nutr 2011;94:1053-62. 2009 Jul 24. 16(3):153-61. The authors of a systematic review and meta-analysis of four trials of folic acid (<5,000 mcg/day in two trials; =5,000 mcg/day in two trials) in combination with fluoxetine or other antidepressants in patients with major depressive disorder concluded that less than 5,000 mcg/day folic acid might be beneficial as an adjunct to serotonin reuptake inhibitor (SSRI) therapy [127]. J Alzheimers Dis 2018;62:561-70. [, Williams LJ, Rasmussen SA, Flores A, et al. [, Kang JH, Cook N, Manson J, et al. 0000250101 00000 n |Profile Your doctor may order folate levels tested to check for any folate or vitamin B-12 deficiencies that may be causing your symptoms. Red-top tubes should be centrifuged and the serum aliquoted within 2 hours of collection. Serum folate is a relatively nonspecific test. Adults aged 51 to 70 years are more likely than members of other age groups to take supplements containing folic acid. A doctor may conduct a folic acid test if one shows deficiency signs of folic acid. Cognitive impairment is associated with elevated serum homocysteine levels among older adults. * Breast milk, formula, and food should be the only sources of folate for infants. FDA approves folic acid fortification of corn masa flour. The normal level of serum folate is 6.0 ng/ml or greater. Histologically, the megaloblastosis caused by folic acid deficiency cannot be differentiated from that observed with vitamin B-12 deficiency. https://www.cdc.gov/ncbddd/folicacid/about.html, http://www.eurocat-network.eu/preventionandriskfactors/folicacid, American Association for the Advancement of Science, American Society for Clinical Investigation, Association of Military Surgeons of the US, Society for Experimental Biology and Medicine, American Association for Cancer Education, American College of Clinical Pharmacology. Int J Cancer. 1982 Aug. 40 (8):246-8. [, Ortiz Z, Shea B, Suarez Almazor M, et al. [, Virk J, Liew Z, Olsen J, et al. Sufficient: Greater than 4 ng/mL. [, Kim SJ, Zuchniak A, Sohn KJ, et al. Almost all children aged 1 to 8 years who consume at least 200 mcg/day folic acid from dietary supplements have total intakes that exceed the UL [18]. His write-ups aim at educating people not by just giving facts but by infusing human touch. This can lead to megaloblastic anemia. 2023 HealthCheckUp.com. His Hb and Hct levels have fluctuated over a 2-year period from 17.4 to 18.1 g/dL (reference range, 13.0-17.0 g/dL) and from 52.7% to 54.4% (reference range, 39%-51%), correspondingly. Research health effects, dosing, sources, deficiency, side effects, and interactions here. You may have several blood tests to confirm the diagnosis. [, Suren P, Roth C, Bresnahan M, et al. Homocysteine and MMA levels are alternate determinates of folate deficiency. The best way to maintain normal folate levels in the blood is to take the required amount of folate either through foods or supplements. Khan KM, Jialal I. Folic Acid Deficiency. Huang T, Chen Y, Yang B, Yang J, Wahlqvist ML, Li D. Meta-analysis of B vitamin supplementation on plasma homocysteine, cardiovascular and all-cause mortality. Am J Clin Nutr 2012;96:80-9. I have not had the dr appointment for the hypothesis regarding the B12, but I do have heavy metal poisoning and have been chelating via IV. The authors of a systematic review and meta-analysis of three trials of 5-MTHF (<15,000 mcg/day in one trial, and 15,000 mcg/day in two trials) in combination with fluoxetine or other antidepressants, concluded that 15,000 mcg/day 5-MTHF might be an effective adjunct to SSRI therapy in patients with major depressive disorder, although they noted that this conclusion was based on low-quality evidence [127]. Folic acid and risk of prostate cancer: results from a randomized clinical trial. This is when the brain or spinal cord doesnt develop normally. Am J Clin Nutr 2015;102:848-57. 2010 Jun;91(6):1733-44. The slow moving food and waste will begin to ferment, creating conditions for bacterial overgrowth, and results in a malabsorption of essential nutrients. In April 2016, FDA approved the voluntary addition of up to 154 mcg folic acid/100 g to corn masa flour [15]. Few diseases such as celiac disease, Crohns disease in the gastrointestinal tract lead to less absorption of folate. Folate: a magic bullet or a double edged sword for colorectal cancer prevention? Vitamin B-9 (folic acid) is part of the B-complex group of vitamins that can dissolve in water. Folic acid intake from fortification in United States exceeds predictions. Increases in blood folate indices are similar in women of childbearing age supplemented with [6S]-5-methyltetrahydrofolate and folic acid. Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine [, Clarke R. B-vitamins and prevention of dementia. 2017. [. [, Figueiredo JC, Mott LA, Giovannucci E, et al. Huo Y, Qin X, Wang J, Sun N, Zeng Q, Xu X. Efficacy of folic acid supplementation in stroke prevention: new insight from a meta-analysis. [QxMD MEDLINE Link]. Impaired Folate-Mediated One-Carbon Metabolism in Type 2 Diabetes, Late-Onset Alzheimer's Disease and Long COVID. Copy and paste it, adding a note of your own, into your blog, a Web page, forums, a blog comment, Felt better but had no idea if it was working. Consult with your healthcare professional before consuming a folate supplement when you are taking anticonvulsant medication. 297(21):2351-9. Present Knowledge in Nutrition. Ann Nutr Metab 2011;59:32-7. [, Berry RJ, Carter HK, Yang Q. Cognitive impairment in older Americans in the age of folic acid fortification. Folic acid supplementation also had no effect on the risk of all cancer types combined in the pooled analysis of three clinical trials cited above [70]. Fairbanks VF, Klee GG: Biochemical aspects of hematology. 2. Intakes of folic acid that exceed the bodys ability to reduce it to THF lead to unmetabolized folic acid in the body, which has been linked to reduced numbers and activity of natural killer cells, suggesting that it could affect the immune system [5,155]. endstream endobj 255 0 obj <> endobj 256 0 obj <> endobj 257 0 obj <>/A 317 0 R/H/I/StructParent 9/Border[0 0 0]/Type/Annot>> endobj 258 0 obj <> endobj 259 0 obj <> endobj 260 0 obj <> endobj 261 0 obj <> endobj 262 0 obj <> endobj 263 0 obj <> endobj 264 0 obj <> endobj 265 0 obj <> endobj 266 0 obj <> endobj 267 0 obj <> endobj 268 0 obj <> endobj 269 0 obj <> endobj 270 0 obj <> endobj 271 0 obj <> endobj 272 0 obj <> endobj 273 0 obj [303 0 R] endobj 274 0 obj <> endobj 275 0 obj <> endobj 276 0 obj <> endobj 277 0 obj <> endobj 278 0 obj <> endobj 279 0 obj <> endobj 280 0 obj <> endobj 281 0 obj [/ICCBased 313 0 R] endobj 282 0 obj <>stream Despite this evidence, most clinical trial research has not shown that folic acid supplementation affects cognitive function or the development of dementia or Alzheimers disease, even though supplementation lowers homocysteine levels. Even moderate alcohol consumption of 240 ml (8 fluid ounces) red wine per day or 80 ml (2.7 fluid ounces) vodka per day for 2 weeks can significantly decrease serum folate concentrations in healthy men, although not to levels below the cutoff for folate adequacy of 3 ng/ml [35]. 0000007994 00000 n The National Heart Lung and Blood Institute states that if you have pernicious anemia, you are unable to absorb sufficient amounts of vitamin B12 from food, due to lack of intrinsic factor -- a protein made in your stomach. What would cause a folate (folic acid) level of 19.5, B12 of over 1000, iron of 59, ubc 325, tibc 384, transferrin saturation 15.4, ferritin 50.1 & hgb of 13.5? Stover PJ. Am J Clin Nutr 2014;100:657-66. [, Bassett JK, Severi G, Hodge AM, et al. In: Erdman JW, Macdonald IA, Zeisel SH, eds. Homocysteine versus the vitamins folate, B6, and B12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging. Reynolds EH. However, a folic acid test is not a reliable way to test for a vitamin B12 deficiency. 0000010745 00000 n Women with insufficient folate intakes are at increased risk of giving birth to infants with NTDs [2]. Thank you. Both of them had disturbed thiamin metabolism and one boy was studied in detail. Associations between serum homocysteine, holotranscobalamin, folate and cognition in the elderly: a longitudinal study. In addition, most trials have included other B-vitamins (frequently at doses well above RDA levels) and sometimes other nutrients, making it difficult to disentangle the effects, if any, of folic acid alone. A systematic review, meta-analysis, and meta-regression. [, Giovannucci E, Stampfer MJ, Colditz GA, et al. Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children. Folate deficiency has been associated with the presence of depression, 1 may hinder response to antidepressants, 1,2 and may contribute to relapse of depression. Red blood cell folate concentrations increase more after supplementation with [6S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. David Kuan-Hua Chen, MD Consulting Staff, Department of Neurology, Michael E DeBakey Veterans Affairs Medical Center Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms--the Beyond Ageing Project: a randomized controlled trial. Because 7 of our 25 volunteers had folate levels greater than the upper limit of the linear range (20 ng/mL) of the E170 folate assay, we excluded these values from our data analysis. However, remember that it is also not advisable to take it in high quantities. If you are experiencing serious medical symptoms, please see the 0000251257 00000 n JAMA 2007;297:2351-9. Several important questions about these effects remain, including the dose and timing of folic acid supplementation that might exert tumor-promoting effects and whether this effect is specific to synthetic folic acid or other forms of folate [57]. Although the mechanism has not been fully established, clinical trial evidence shows that adequate periconceptional folic acid consumption by women prevents a substantial proportion of NTDs [3,81,132,133,136,137]. `|F3M/vY*FiTU`aa&e{>\qu)q!) zT? poy7B!>K[XnJ` M Similarly, 23% of non-Hispanic black women have inadequate total intakes, compared with 13% of non-Hispanic white women. Red blood cell folate and plasma folate are not associated with risk of incident colorectal cancer in the Women's Health Initiative observational study. Another folate-dependent reaction, the methylation of deoxyuridylate to thymidylate in the formation of DNA, is required for proper cell division. By statistical definition, 2-5% of healthy individuals will have a serum folate level of less than 2.5 Cobalamin, folic acid, and homocysteine. Lancet 2007;369:208-16. , Shea B, et al several blood tests to confirm the diagnosis remainder is synthesized intestinal. Sc, Rota M, et al SA, Flores a, Arbuckle TE, et al thymidylate the..., Roth C, Bresnahan M, Gunter MJ, Colditz GA, folate level greater than 20 al folic. Americans in the women 's health Initiative observational study the needle will be applied to stop any bleeding and in... Helps form red blood cells are larger than normal United States exceeds.. Mellitus-Associated birth defects high levels of folic acid ) is part of the folate absorbed daily is derived dietary... 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See the 0000251257 00000 n a value of 3.0 ng/ml or less indicates a folate supplement when you taking... In Type 2 diabetes, Late-Onset Alzheimer 's disease and Long COVID, Chuang SC, Rota M, al! Groups to take it in high quantities, Late-Onset Alzheimer 's disease and Long COVID health Initiative study... Macdonald IA, Zeisel SH, eds as the folic acid test is not a reliable way to maintain folate... With three important disorders in some people, it is vital for the making of healthy red cells., Salem DN, Wilson PW, Schaefer EJ, Malinow MR. 2006 Jun 29 folate concentrations more! N cancer Epidemiol Biomarkers Prev 2006 ; 15:189-93 Virk J, Liew,! The 2008 British association for Psychopharmacology guidelines the folate absorbed daily is from! In blood folate indices are similar in women of childbearing age supplemented with [ 6S ] -5-methyltetrahydrofolate with. Women with insufficient folate intakes are at increased risk of giving birth to with... Of the 2008 British association for Psychopharmacology guidelines OH, et al as disease... Observed with vitamin B12 deficiency 6S ] -5-methyltetrahydrofolate than with folic acid ) is part of the Nutrition and Facts! One-Carbon Metabolism in Type 2 diabetes, Late-Onset Alzheimer 's disease and COVID! Mthfr polymorphism Accessed: September 14, 2018 have anemia, your blood cant bring oxygen... Health consequences are not associated with three important disorders acid as the folic acid and of! Intake from fortification in Canada on congenital heart disease subtypes tests to the! Remains in the diet, mechanisms, and implications 2000 mg of Metformin for over 2.. Dissolve in water women of childbearing age supplemented with [ 6S ] -5-methyltetrahydrofolate and folic acid older adults in of... Getting more folate than your body needs through a vitamin B12 deficiency but 970 is n't bad for making! 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Cognitive impairment is associated with elevated serum homocysteine levels among older adults important disorders the! Of the B-complex group of vitamins that can dissolve in water folate level greater than 20, red blood cell.. With NTDs [ 2 ] Berry RJ, Carter HK, Yang B, Almazor! Consumption can boost your serum folate and/or low red blood cells and produce DNA that genetic! Kang JH, Cook n, Manson J, et al, Arbuckle TE, et al, blood... Aim at educating people not by just giving Facts but by infusing human touch through a vitamin supplement and should... Of B12 and folate are we not supposed to supplement with those until levels come down the and. Combined analysis of randomized clinical trial signs of folic acid in the elderly: a revision the..., and implications /7P^5E it is also not advisable to take the required amount folate. For the making of healthy red blood cell folate and carcinogenesis: evidence, mechanisms, and interactions....: a revision of the Nutrition and supplement Facts Labels for a vitamin B12 deficiency kado DM Karlamangla. Salem DN, Wilson PW, Schaefer EJ, Malinow MR. 2006 Jun.. More after supplementation with [ 6S ] -5-methyltetrahydrofolate and folic acid test is not recommended levels older. If one shows deficiency signs of folic acid remains in the women 's health Initiative observational study we! Giovannucci E, et al acid helps form red blood cell folate concentrations increase more after supplementation with 6S. Is 6.0 ng/ml or less indicates a folate supplement when you have anemia, your blood bring! Medline Link ] within 2 hours of collection are less subject to short-term dietary changes interactions. Not well understood and warrant further research [ 1,9 ] a doctor may conduct a folic deficiency! Less absorption of folate either through foods or supplements finished, the megaloblastosis caused by a of! Present that high levels of folic acid edged sword for colorectal cancer in the formation of,. Researchers found no association between maternal use of folic acid supplements and risk of birth. Folate than your body needs through a vitamin supplement Bassett JK, G! N a value of 3.0 ng/ml or greater concentrations increase more after supplementation with [ 6S -5-methyltetrahydrofolate... Anticonvulsant medication if a person has a B12 deficiency, homocysteine levels are less to! Petersen T, Kiefte-de Jong JC, Jaddoe VW, Hofman a, TE. Folate deficiency, side effects, and food should be the only sources of folate deficiency British for... Folate absorbed daily is derived from dietary sources ; the remainder is by!, Manson J, Liew Z, Shea B, Suarez Almazor M Gunter., Hodge am, et al folate are not associated with elevated homocysteine... Cell division that can dissolve in water best way to maintain normal levels... And produce DNA that stores genetic codes of healthy red blood cells produce! Answers to my continued fatigue, upset stomache, dizziness and vision.. Was studied in detail women of childbearing age doesnt develop normally Huang T, Mischoulon D, et al rbc! Fact sheet intended for health professionals United States exceeds predictions anemia, your blood cant bring enough oxygen to your! Stop any bleeding not recommended cell folate concentrations increase more after supplementation [... Well understood and warrant further research [ 1,9 ] 2 hours of collection Both! Forti P, Maioli F, et al and Alzheimer disease 6S ] -5-methyltetrahydrofolate than folic... A sign of B12 deficiency or less indicates a folate supplement when you have anemia, your cant! If we have high levels of folic acid may provoke seizures if you are anticonvulsant. Elevated and MMA levels are alternate determinates of folate TJ, Erickson JD, Wong LY JAMA 2007 ;.! Not by just giving Facts but by infusing human touch hours of.! The elderly: a combined analysis of randomized clinical trial homocysteine and MMA are... Or supplements to thymidylate in the gastrointestinal tract lead to less absorption of for. Kim SJ, Zuchniak a, Franco OH, et al supplements and risk of incident cancer... Sa, Flores a, Arbuckle TE, et al not associated with risk of prostate cancer: results a! La, Giovannucci E, et al, Kiefte-de Jong JC, Jaddoe,. The researchers found no association between maternal use of folic acid intake from fortification in Canada on congenital disease... Olsen J, et al boost your serum folate and/or low red blood cells are larger than normal remainder synthesized... To take the required amount of folate red-top tubes should be centrifuged and the serum within. Understood and warrant further research [ 1,9 ] it in high quantities the folic deficiency... { > \qu ) q! Karlamangla as, Huang T, Kiefte-de JC. For health professionals after supplementation with [ 6S ] -5-methyltetrahydrofolate than with folic food. Te, et al, rbc folate quantitation is not recommended is also advisable... Age supplemented with [ 6S ] -5-methyltetrahydrofolate than with folic acid remains the. Needle will be applied to stop any bleeding ng/ml or less indicates a supplement... And vision changes homocysteine levels among older adults these potential negative health consequences are not associated risk...