Vitamin B9 aka Folate: Newborns may have neural tub defects at birth if Moms overlook Folate.

Vitamin B9, also known as vitamin M, folate, or folic acid, is one of the 9 water soluble vitamins. Although it is best known with the birth defects (Neural tube defects), folate is also responsible for other conditions, such as infertility, miscarriage, depression, and anemia (remember it’s one angle of the triangle B6-B9-B12 that works with iron to maintain healthy red blood cells).

I took the first nutrition class in 2009 as one of the science selective while I just declared English Rhetorical Writing as my (first) major. Back then, folate was like a whole foreign language to me, because I just could not grasp how deficiency in folate BEFORE PREGNANCY could cause horrible neural tube defects. Since then, I have known better; thanks to many research articles and subsequent courses of biology and medical nutrition courses. And, today I would like to share what I did not know back then-about folate.

1/ Functions of folate:

First: Folate is critical nutrient among child-bearing aged women, because the deficiency caused neural tube defects.

“Neural tube defects” include many conditions. In this article, I will write about just 2 which are spina bifida and anencephaly.

spina bifida

This picture depicts a newborn with spina bifida. It’s the condition in which the newborn’s spinal cord is failed to close completely. Its Latin name is literally split spine as you see in the picture. Usually medical experts can cite the list of causes of a certain disease. However, spina bifida is more complex than a fact sheet. It can be caused by genetics and environmental factors, such as family history of neural tube defects or deficiency of folate in mothers.

Anyway, what happens in pregnancy that has anything to do with spina bifida? When the woman conceives a child, most of the time she does not know she’s pregnant until 5-6 weeks later (that is if she’s wondering why she’s missing a period). The spinal cord, unfortunately, is formed and complete by 28 days since the moment she’s conceived (back in anatomy class, we learned that conception occurred within 30 minutes after sex). So…it means that the woman with folate deficiency can be carrying a child with spina bifida even before she learns about her pregnancy. At that time, the damage has been done. Doctors can do (or not) something about it, depending on how severe the condition is. If they can do something about, usually it’s involved surgery on your newborn (after birth) or fetus (before birth).


In this picture, you’re seeing a fetus with anencephaly which means missing parts of the brain or skull. It’s also one of many neural tube defects. Well, the neural tube (forming the brain and the spinal cord) is the first thing appeared after conception, and if it’s defected, the condition can be seen anywhere on that length of the tube. If it’s the end, you see something like spina bifida. If the defects happens in the upper part of the tube, you see anencephaly as in this picture.

Newborns with spina bifida have much higher survival rate, provided that medical intervention is prompt. However, those born with anencephaly are usually fated to die (within 1 year after birth). According to the Center of Disease Control,  1 out of 4859 newborns will be born with anencephaly annually in the United States.

Of course, folate deficiency before conception is not the only risk factor. Smoking and drinking before and during pregnancy are also well known to cause damages to the fetuses. When you do all of the three: not having enough folate, drinking alcohol, and smoking, your offspring may be affected by these neural tube defects.

Second: Folate helps making neurotransmitters.

Neurotransmitters are workers of the communication center of the brain. If we don’t produce enough of these, the communication is not going well. As you imagine, the reason we can avoid that dog dashing out on the street, pick our nose, or sipping coffee is all thanks to the communication process of the brain. When the communication line is dropped, the brain can’t give and receive signals from and to organs: things are shutting down-literally (the extreme case of that is…brain death). Of course, that is extreme. However,  people with mild depression, ADHD, and other disorders may be that way because something is not right with neurotransmitters or the synthesis of neurotransmitters.

And, folate helps make the communication happen smoothly.

Third: People who consume dietary folate and vitamin B6 have less heart attacks than those who do not.

Usually, patients with cardiovascular diseases have high levels of homocysteine whose elevated blood levels can cause osteoporosis (porous bones) and atherosclerosis (narrowing of the blood vessels). Folate is not a treatment for such conditions. Also, individuals may respond differently to the same treatment (folate). However, it is true that folate has the ability to lower homocysteine level.

Fourth: Folate participates in the Folic acid cycle

The folic acid cycle is the means of our body to filter and breakdown homocysteine. If homocysteine is not brokendown, it will show up in the blood which overtime causes the elevated homocysteine. This is the pathway how folate can help lower heart attacks in people with cardiovascular diseases.

Fifth: Folate, together with vitamin B6, vitamin B12, and iron, participates in red blood cell synthesis.

Anemia can occur if we suffer deficiency of any of the four for a long term.

2/ Recommended daily intake (microgram per day)

  • 0-6 months old: 65 mcg/day
  • 7-12 months old: 80 mcg/day
  • 1-3 years old: 150 mcg/day
  • 4-9 years old: 200 mcg/day
  • 9-13 years old: 300 mcg/day
  • 14 years and older: 400 mcg/day
  • Pregnant woman: 500 mcg/day
  • Lactating women: 500 mcg/day

3/ Overdose? DO NOT consume more than 1000 mcg/day

Yes you can overdose folate which may mask vitamin B12 deficiency. It’s recommended not to consume more than 1000 mcg/day from both supplement and dietary folate. Toxicity of DIETARY FOLATE has never been reported. However, the same statement is not applied for folate supplement.

4/ Deficiency: signs and symptoms

So you have already known deficiency of folate can cause neural tube defects, miscarriage, abortion, infertility, depression, higher risks of heart attacks, and anemia. But…what can you do before things are carried too far? There are certain signs and symptoms that you should be able to spot and address before you have to pay too high a cost.

  • Gray hair (unrelated to aging process)
  • Pain in the bones particularly hip bones, wrist bones or long bones of the legs and arms (osteoporosis).
  • Inflammation of the tongue (glossitis )
  • Gastrointestinal disorders: diarrhea, indigestion, painful bloating
  • Slow growth (in children)
  • Mood swings/mood disorders
  • Mild depression

5/ Who’s at risk of folate deficiency?

  • Women on oral contraceptive pills have greater risk of folate deficiency (remember 40% of women on OCP suffer vitamin B6 deficiency)
  • People on seizure drugs also have greater risk of folate deficiency because the drugs block the absorption of certain vitamins such as vitamin B6, folate, and others
  • People with kidney failure
  • People with liver diseases
  • Alcoholics
  • People with poor digestive system (can’t produce enough juicy matters to breakdown and absorb nutrients)

Frankly, most Americans would suffer folate deficiency if folate was not added to their breakfast cereals and other packaged foods. There is very small percent of Americans consume enough folate from natural whole foods.

6/ How to retain the most folate from natural food source?

Vitamin B9 or folate is very readily lost to major types of food processing methods: canning, heat, water/washing, and prolonged cooking time.

Therefore, the best strategy is to minimize cooking time as much as possible. Steaming is better than boiling because you prevent the vitamin loss into water. By boiling, you just destroy anywhere between 25-50% the original content of vitamin B9. Usually cooking time at 205 Celcius (325 F) for 30-40 minutes can take away 40-50% of folate.

Last thing you ever want to do is to purchased canned veggies and beans or seadfoods because the vitamin B9 and biotin in canned products are only 20% of the original amounts. Canning process strips 80% of folate and biotin. So, keep this in mind when you go shopping next time.

7/ Foods rich in folate

1) Spinach


200 g of spinach provides 45 calories, 70% folate, 30% vitamin B6 45% iron, 28% vitamin E, 44% magnesium, 16% vitamin B1, 34% vitamin B2, 26% potassium, 24% calcium, and lots of vitamin K. However, folks with history of kidney stones or taking blood thinning medications should avoid eating too much vitamin K. More info will be available in the blogs about vitamin K and osteoporosis.

2)  Turnip greens

cải xanh

A portion of 150 g of sauteed turnip greens provides 44% folate, 16% vitamin B6,  19% vitamin E, 61% vitamin A, 21% calcium, and about 700% vitamin K.

3) Broccoli


A portion of 150 g steamed or raw broccoli provides 40% folate, 16% vitamin B6, 15% vitamin B5, 13% vitamin B2, 14% vitamin E, 11% vitamin A, and 238% vitamin K. If you consume it raw, the same amount also adds 130% vitamin C.

4) Beets


Every 150-g portion contains 30% folate, 12% potassium, and 5% iron.

5) Bok choy:


A portion of 200 g provides 20% folate, 18% vitamin B6, 18% calcium, 12% iron, 21% potassium, 46% vitamin A, and 70% vitamin K.

6) Cauliflower


Cauliflowers are one of rare vegetables with omega-3. A portion of 150 g sauteed or steamed cauliflower contains 17% folate, 15% vitamin B5, 14% vitamin B6, 23% vitamin K, and 11% omega-3

7) Black beans:


One of the most nutrient dense beans is black beans: a portion of 170 g cooked black beans provide 64% folate, 20% iron, 35% vitamin B1, 30% magnesium 280% molybdenum, and 15 g protein. I don’t like beans dishes- I mean the Vietnamese don’t eat beans the way folks in South America do. We used beans as ingredients for desserts. So yeah we add sugar, sticky rice, coconut milk etc… to our beans and make such concoctions desserts. Well, I grew up eating beans as desserts. Now, I have had to learn to eat….just boiled beans without sugar. Sometimes I throw in a slice of bacon in my boiled beans and awkwardly call it “bean soup”

8) Brussels sprouts


These miniature cabbage looking cuties taste awesome when sauteed with red onions-one of my favorite dishes (for meat lovers: one or two slices of bacon are fine as long as it helps you enjoy the food without causing much health problem).

A portion of 150 g of sauteed or steamed brussels sprouts provides 21% folate, 15% vitamin B6, 240% vitamin K, 13% potassium, 13% vitamin B1, and 10% omega-3.

9) Papaya

A portion of 275 g papaya contains 120 calories, 26% folate, 224% vitamin C, 14% magnesium, 15% vitamin A, and 14% potassium. It’s a healthy source for vitamin C besides the well known oranges. Actually if you compare oranges and papaya, you’ll see that papaya is more nutrient dense and less calories per weight than oranges.

10) Avocado:


This fruit recently has made it to one of the healthiest foods on the face of earth. Let’s look at its nutritional profile: 150g raw edible portion contains 240 calories, 30% folate, 23% vitamin B6, 42% vitamin B5, 35% vitamin K, 21% vitamin E, 21% potassium, and 20% vitamin C. It does have a bunch of saturated from fat, but its chemistry is different than the saturated fat from animal. You can enjoy this high calorie fruit by adjusting your menu for the day: if you do add one avocado to your menu, then be mindful about other animal sources and cooking oil for the entire day.

11) Green peas:


This famous legume provies 24% folate, 20% vitamin B6, 13% iron, 12% potassium, 43% vitamin K, 28% vitamin C, 18% vitamin B3, 17% vitamin B2, and 16% zinc per 150 g portion.

12) Asparagus


A portion of 180 g cooked asparagus provides a whooping 67% daily value of folate, 24% vitamin B1, 19% vitamin B2, 12% vitamin B3, 12% potassium, 100% vitamin K, 18% vitamin E, 18% vitamin C, 10% iron, and 9% zinc

13) Romaine Lettuce:


A portion of 100 g of romaine lettuce provides only 18 calories, but tons of nutrients: 32% folate, 45% vitamin A, 110% vitamin K, 13% molybdenum, 7% potassium, 6% biotin, 6% vitamin B1, and a little of other nutrients.

14) Lentils:


A portion of 200 g cooked lentils provides 230 calories, 90% folate, 21% vitamin B6, 37% iron, 28% vitamin B1, 25% vitamin B5, 23% zinc,  21% potassium, 330% molybdenum, and 63% daily value of fiber.

15) Garbanzo beans:


A portion of 165 g cooked chickpeas provides 269 calories, 70% folate, 25% iron 23% zinc, and 50% fiber.

16) Kidney beans:


A cup of 180 g of cooked kidney beans provides 225 calories, 55% folate, 23% vitamin B1, 22% iron, 20% potassium, 19% magnesium, 45% fiber, and 35% phosphorus.

17) Green beans


A cup of 125 cooked green beans provides 44 calories, 10% folate, 16% vitamin C, and 22% vitamin K.

18) Parsley:


Every 30-g portion of FRESH AND RAW parsley contains 12% folate, 10% iron, 54% vitamin C, 14% vitamin A, and over 500% vitamin K…all that for just 11 calories. Amazing dense source of iron for little calories.

Last time I visited Vietnam, I saw many American restaurant chains: Starbucks, Dunkin Donuts, Baskin Robins, and more. The reasons people in the U.S go there may be different than Vietnamese do: Americans go there because it’s CHEAP and convenient whereas the Vietnamese go there because it’s EXPENSIVE and a symbol of COOLNESS. Jesus. “Cool.” I can’t digest that “cool” word. And I remember I felt disappointed. I hope Vietnam will not fall into the toll of obesity and metabolic syndromes like the U.S now faces: 2/3 of the population is classified as either obese or overweight. I know what it is and the effect of the biochemistry of the food on our brain chemistry… but, God, I still have a hard time understanding why we spend dollars on gadgets, transportation means, houses, and clothes, but yet we put trash and toxics in our mouth. Don’t we need a healthy body to lead a joyful and productive life?

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