Folate and Folic Acid:
Folate is found in food, and folic acid is the man-made form of folate that is added to foods and vitamin supplements.
People with inflammatory bowel disease (IBD) are at risk for folate deficiency, especially those who are taking methotrexate or sulfasalazine.
Why Folate Is Important:
Folate is also necessary for the body to maintain proper levels of the amino acid homocysteine, which is needed by the body for protein synthesis. Without enough folate, homocysteine will build up in the body. High levels of homocysteine are associated with cardiovascular disease.
Folate may also help prevent cancer by preventing certain changes in the body's DNA. Because folate is needed to create red blood cells, getting enough folate is important to prevent anemia.
Why IBD Patients Are at Risk for Folate Deficiency:
Sulfasalazine and methotrexate are two medications used to treat IBD that may interfere with the metabolism of folate.
Other reasons for poor folate absorption include alcohol abuse, liver disease, and the use of anticonvulsant medications, metformin, triamterene, or barbituates.
Is Every Person With IBD at Risk for Folate Deficiency?:
IBD patients are at risk for elevated levels of homocysteine, but a folate deficiency may or may not be to blame -- the evidence is conflicting. At least one study has shown that increased homocysteine in people with IBD may be a result of low levels of the vitamin B12, rather than low levels of folate.
What You Can Do About It:
Some foods that have folate or folic acid are:
- Asparagus
- Beef liver
- Broccoli
- Cowpeas
- Fortified cereals, rice, egg noodles, and bread
- Great Northern beans
- Green peas
- Spinach
Sources:
Crohn's and Colitis Foundation of America. "Diet and Nutrition." CCFA.org 29 Apr 2009. 8 Jan 2010.
Erzin Y, Uzun H, Celik AF, Aydin S, Dirican A, Uzunismail H. "Hyperhomocysteinemia in inflammatory bowel disease patients without past intestinal resections: correlations with cobalamin, pyridoxine, folate concentrations, acute phase reactants, disease activity, and prior thromboembolic complications." J Clin Gastroenterol 2008 May-Jun; 42:481-486. 19 Jan 2010.
Heyman MB, Garnett EA, Shaikh N, et al. "Folate concentrations in pediatric patients with newly diagnosed inflammatory bowel disease." Am J Clin Nutr 2009 Feb; 89:545-550. 19 Jan 2010.
Office of Dietary Supplements. "Dietary Supplement Fact Sheet: Folate." National Institutes of Health 15 Apr 2009. 8 Jan 2010.
Romagnuolo J, Fedorak RN, Dias VC, Bamforth F, Teltscher M. "Hyperhomocysteinemia and inflammatory bowel disease: prevalence and predictors in a cross-sectional study." Am J Gastroenterol 2001 Jul; 96:2143-2149. 19 Jan 2010.
Silaste ML. "Dietary effects on antioxidants, oxidised LDL and homocysteine." Oulu University Library 2003. 9 Jan 2010.
Vagianos K, Bector S, McConnell J, Bernstein CN. "Nutrition assessment of patients with inflammatory bowel disease." JPEN J Parenter Enteral Nutr 2007 Jul-Aug; 31:311-319. 19 Jan 2010.
