Vitamin B9 - How Can Vitamin B9 (Folate) Help Your Child?

Vitamin B9, also called folate or folic acid, is water-soluble and is one of the eight B nutrients. There are vitamin B9 foods, and they also commonly supplement food sources using a crystalline form of folic acid. Folate is also commonly sold as a vitamin or supplement using the same crystalline form of folic acid, and this structure can actually be better retained over that from folate food sources. The difference between folate and folic acid is that folate is the natural form of vitamin B9 in food and folic acid is the synthetic form.

What does vitamin B9 do? Vitamin B9 has been found to assist with framing DNA and RNA and is associated with protein digestion. It has a vital job in breaking down homocysteine, an amino acid in the body that can have negative outcomes if it is present in excess of what is necessary. Additionally, vitamin B9 is known to help the body make red platelets and aid in the body’s metabolic functions, both of which have many preventative health benefits. It is involved in cell replication, and it is especially important to have a sufficient intake of vitamin B9 during times of child brain development, such as fetal development during pregnancy and throughout development as a child.

A folate deficiency can lead to child heart disease, embryonic and neural tube defects, hyperhomocysteinemia (elevated homocysteine levels), megaloblastic anemia, leukocytopenia and thrombocytopenia. Folate deficiency is also tied to increased risk for cancer, child depression and cognitive impairment. (1)(2)(3)

How Does Vitamin B9 Function in Your Child's Body?

Folate is essential for several metabolic pathways, including DNA replication, repair, and methylation, and in the synthesis of nucleotides, amino acids, and some vitamins. Its involvement in these vital functions make it imperative that children get an adequate amount of folate in their diet in order to be safeguarded from various disorders and diseases. Supplementing a child’s diet with folate can prevent folate deficiency symptoms, however it is always suggested that attention is first given to including healthy sources of vitamins in a child’s diet. When significant deficiency is suspected, a prescribed supplement might be taken with the guidance of a medical professional.

Folate is primarily absorbed in the duodenum and jejunum, which are both in the small intestine of your body. It is absorbed at the surface level of the cell and transported through means, such as the brush border membrane of the proximal intestine. Research has shown that the colon produces ample bacteria that synthesize folate, indicating that folate might be endogenously created in the human body. Bacteria in the proximal small intestine also produce folate that accompanies dietary sources of this vitamin. (4)

When vitamin B9 enters the body from synthetic sources (i.e. folic acid), it is absorbed directly into the bloodstream which leads to more efficient uptake. Conversions of the vitamin also occur in the blood so that it can be more easily metabolized and transported to the areas of the body that need it. (1)

What Is Vitamin B9 Good For?

Common uses for vitamin B9 involve the prevention and treatment of various conditions. Recent research has supported the several uses of folate. For instance, studies have found that oral supplementation of vitamin B9 improves symptoms of vitiligo, a skin condition in which abnormal white patches are formed on the skin. Additionally, increased blood pressure due to kidney problems in children can be treated in part by improving folic acid intake. Vitamin B9 supplementation has also been found through research to help reduce gum swelling, ulcers, and bleeding as side effects of an anti-seizure medication called Phenytoin.

Below are several more benefits of vitamin B9 for your entire family, along with the science to back them: (2)(5)

Cognitive development
Cancer prevention
Heart disease prevention
Depression prevention
Improved blood sugar levels

Cognitive development: Vitamin B9 plays a critical role in adolescent and child brain development as well as brain functions, like memory, learning ability and mental health. Ensuring adequate vitamin B9 in a child’s diet ensures vitamin B9 benefits and can aid with their academic performance and extracurricular activities. It can be helpful to address nutrition when considering challenges that a child may face, like child learning disability, childhood depression, and child memory problems.

Research Support:
Observational studies have found an association between high homocysteine levels as well as increased incidence of Dementia and Alzheimer’s disease. Elevated homocysteine can negatively affect the brain by causing a lack of blood to the brain and nerve cells. Additional observational studies have found a link between low folate in blood levels and higher risk of Dementia. However, clinical trials have not found that folic acid supplementation directly prevents the development of Dementia or improves cognitive function, even if it reduces homocysteine levels. (2)

Cancer prevention: Vitamin B9 plays a significant role in cell replication, therefore an adequate amount can prevent mutations in the cell. Early cases of childhood cancers are also connected to low folate intake, so folate can be a key nutrient in cancer prevention for children.

Research Support:
Observational studies show that people who get above average amounts of folate from their diets or folic acid supplements over the course of 15 years or more have lower risks of colon cancer and breast cancer. When looking at the relationship between any vitamin supplement and cancer, like folic acid with methotrexate, it is important to remember that cancer cells are essentially our own cells on overdrive, growing and rapidly dividing; therefore, they have a greater need for nutrients than most of our normal cells do. In fact, one successful chemotherapy agent works to prevent cells from using folic acid, which can hinder rapid cell division and therefore treat the spread of cancer. (2)

Heart disease prevention: Cardiovascular events are a leading cause of death among US citizens, including a growing number of children and adolescents. Nutritional influences have been studied in relation to heart disease prevention and how to treat congenital heart disease in adults and children. Child heart disease puts a child at risk for developing impairing symptoms, and it is important to consult with a physician or cardiac specialist when caring for a child with congenital heart disease.

Research Support:
Several randomized trials have tested for the effects of B vitamins on homocysteine levels and prevention of heart disease and stroke. The studies found that taking high doses of vitamins B6, B12 and B9 (folic acid) lowered homocysteine levels in individuals who have had a history of or were at high risk of heart disease or stroke. Additional randomized control trials reported a 10% lower risk of stroke and 4% lower risk of overall cardiovascular diseases with folic acid supplementation. (2)

Prevents depression: A child with depression who is being treated with antidepressants has been shown to have improved mental health with adequate folate levels, or vitamin B9, in their bodies, either through natural food sources or supplementation in vitamin form. Consulting with a mental health professional in addition to a pediatrician can be helpful for parents in addressing how to help child depression from a holistic perspective.

Research Support:
The use of folic acid for depression, or folate for depression, has been studied in research over the years. One study showed that taking supplements with folate (including folic acid and methylfolate) alongside prescribed antidepressant medications aided in the improvement of depression and child depression symptoms at a higher rate than those who took antidepressants alone. Therefore, ensuring healthy nutrition can be beneficial in child depression treatment. (6)

Improve blood sugar levels: Kids with a genetic predisposition to diabetes should have a balanced diet with enough vitamin B9 to prevent the onset of childhood diabetes. For child diabetes treatment, it is important to have folate included in their diet. A nutritionist or registered dietician can be a helpful resource for creating a child diabetes diet and addressing how to get folic acid in food or supplementing in order to prevent symptoms that might interfere with a child’s wellbeing.

Research Support:
Research on folic acid and diabetes has suggested that folate-based supplements may help improve blood sugar control, reduce insulin resistance, and enhance cardiovascular function in those with diabetes. These supplements may also help reduce diabetic complications, including neuropathy. (7)

What Are the Symptoms of Vitamin B9 Deficiency?

Vitamin B9 is an essential vitamin for health at all ages since it participates in the biosynthesis of nucleotides, amino acids, neurotransmitters, and certain vitamins. It is also essential for tissue growth. It is becoming clear through ongoing research that folic acid deficiency and impaired folate pathways are implicated in many diseases of both early life and old age.

Folate is also used for the formation of DNA, cell replication and hundreds of other functions. Therefore, deficiency of vitamin B9 can cause alterations in the DNA leading to anemia.

Below are some common causes of folate deficiency:

Intestinal surgeries or digestive disorders that cause malabsorption: Celiac disease and inflammatory bowel disease can impede the absorption of folate. Surgeries involving the digestive organs or that reduce the normal level of stomach acid may also interfere with absorption.
Genetic variants: People carrying a variant of the gene MTHFR cannot convert folate to its active form to be used by the body.
Lack of vitamins in your diet: Vitamin deficiency can happen if a child follows a fad diet or has a generally poor diet for a long time. This cause is more common in developing, impoverished and under-nourished societies. (2)(8)

Symptoms of vitamin B9 deficiency:

A deficiency of this vitamin can cause a wide range of problems, and you might be able to spot folate deficiency in your child early on if you notice these signs and symptoms:

Disturbed vision
Problems with memory, understanding and judgment
Extreme tiredness/fatigue
Muscle weakness
Lack of energy
Pins and needles sensation
Soreness and redness of the tongue
Mouth ulcers
Psychological problems, which may include depression and confusion
Headache
Dizziness
Paleness
Shortness of breath

Disturbed vision: Ensuring that children receive sufficient vitamins and nutrients can optimize their eyesight and reduce the risk of irreversible damage in the eyes due to various diseases. While a direct connection between vitamin B9 and improved vision has not been clearly proven, it has been suggested through research that vitamin B9 alongside other vitamins, like A, B6 and B12 are beneficial for clarity of vision and other functions like reducing long-term risks for age-related macular degeneration. (9)

Research Support:
“Folic acid deficiency also leads to an abnormal accumulation of homocysteine. Increased retinal homocysteine induces retinal neuron death, altering the inner and outer retinal layers and affecting the cells of the ganglion cell layer. Some clinical studies have implicated homocysteine in maculopathy, open-angle glaucoma, and diabetic retinopathy. Lack of folate is also involved in nutritional optic neuropathy, which is characterized by damage to the retinal nerve fiber layer. In a patient diagnosed with folate deficient optic neuropathy, folate deficiency is presented as a visual abnormality with a 4-week history of progressive visual loss. Bilateral retrobulbar optic neuropathy was also found to be present. Investigations revealed severe folate deficiency. Subsequent correction of the folate levels with oral supplementation improved the patient’s visual acuity.” (10)

Memory problems and issues with brain development: A child with memory problems, child memory loss, or issues in early child brain development might be experiencing short- and long-term effects of folate deficiency that occurred in their mother during pregnancy. Folic acid for baby development related to brain and memory function is vital and it begins when the child is in utero. Additionally, folate deficiency has been shown to impact cognitive health in the aging population, particularly related to Dementia and Alzheimer’s disease.

Research Support:
Studies involving both animals and humans have suggested that there is a link between intake of folate in mothers and brain development in fetal and child growth. One study revealed low maternal folate levels affecting short-term memory in 3-week-old mice, suggesting that child memory problems can be impacted by folate deficiency. Additionally, folate has been studied in its impact on the aging population, and research has suggested that folate deficiency sometimes leads to reversible dementia and also increases the risk of Alzheimer's disease and vascular dementia. This is possibly due to methylation related processes or homocysteine mediated vascular or neurotoxic mechanisms. (11)(12)

Additional symptoms: Headache, dizziness, paleness and shortness of breath are also symptoms of anemia that can indicate a deficiency in vitamin B9 (folate). Doctors will usually test for folate and vitamin B12 deficiencies when anemia is being treated, and it is important to seek medical attention when experiencing any of these above symptoms to rule out vitamin deficiency. (8)

How Much Vitamin B9 Should Your Child Have per Day?

Research on folate intake in the United States has indicated that adolescent females are at greater risk for insufficient intake than males. This is a cause of concern among adolescent females who are menstruating and who are sexually active, as having adequate folic acid before conception is important for the prevention of birth defects such as spina bifida. Folic acid is also of prime importance during pregnancy, especially in young and teen pregnancies as well as other populations in which there may not be as great of an awareness surrounding nutritional needs. Folic acid is important to prevent neural tube defects, and it is recommended that those who are pregnant take 600-800 mcg of folic acid daily in the form of a supplement. (13)

Is it good to take folic acid everyday? The daily recommended intake of vitamin B9 (folate) for both males and females is listed below. Consultation with a physician is strongly advised in order to establish the best routine of supplementation for your child's particular needs. (14)

Age	*RDAs (males and females) in micrograms (mcg)**
Birth to 6 months	65 mcg DFE**
7-12 months	80 mcg DFE
1-3 years	150 mcg DFE
4-8 years	200 mcg DFE
9-13 years	300 mcg DFE
14-18 years	400 mcg DFE
19+ years	400 mcg DFE

*RDAs = Recommended Dietary Allowances

**DFE= Daily Folate Equivalent

1 mcg DFE = 1 mcg food folate
1 mcg DFE = 0.6 mcg folic acid from fortified foods or dietary supplements consumed with foods
1 mcg DFE = 0.5 mcg folic acid from dietary supplements taken on an empty stomach

Should You Give Your Child Vitamin B9 Supplements?

What is the best source of vitamin B9? Children typically do not have trouble getting enough vitamin B9 with a diet of diverse foods; however, deficiency is possible in the event of poor diet, some diseases, or excessive urination. Parents might consider increasing the amount of folate rich foods, or vitamin B9 foods, like leafy green vegetables (i.e. spinach and lettuce) in their children’s diets. A supplement may also be considered for children who are picky eaters or if a parent suspects their child is not obtaining an adequate amount of vitamins and minerals through food sources.

Foods That Are Rich in Vitamin B9

A balanced diet diverse in foods can provide children with adequate amounts of vitamin B9. One can achieve the recommended folic acid intake in the form of fruits and vegetables, meat and meat products, dairy, seafood and nuts and seeds. Examples of folic acid and folate in food are listed below.

Selected food sources of folate and folic acid are listed below. (14)

Food Name	Serving size	DFE per serving in micrograms (mcg)	% Daily value (DV)
Beef liver, braised	3 oz	215	54
Spinach, boiled	1/2 cup	131	33
Black-eyed peas, boiled	1/2 cup	105	26
Fortified breakfast cereals	1/2-1 cup	100	25
White rice, cooked	1/2 cup	90	22
Asparagus, boiled	4 spears	89	22
Brussels sprout, boiled	1/2 cup	78	20
Spaghetti, cooked, enriched	1/2 cup	74	19
Lettuce, romaine	1 cup	64	16
Avocado, raw	1/2 cup	59	15
Spinach, raw	1 cup	58	15

Can Too Much Folate Be Harmful?

The upper cut-off value for folic acid is set at 1,000 mcg daily, and research has shown that taking higher amounts than this can lead to folate side effects, like a lack in vitamin B12. Adults, and particularly those who maintain a vegetarian diet with less opportunities to take in enough vitamin B12, are more prone to a vitamin B12 deficiency as a result of excessive folic acid intake.

The folic acid and vitamin B12 relationship is an important one to consider. Both folate and vitamin B12 are associated with making red platelets, and a lack of either can bring about iron deficiency. It is important to understand that, although high doses of folic acid may make one feel temporarily better, the folate benefits can still mask a deficiency of vitamin B12. If high folate admission continues to "cover up" the side effects of B12 deficiency over an extended period of time, irreversible harm to the mind and sensory system may occur. Therefore, when taking a folic acid or folate supplement, it is recommended that one stays within the lower range of 400 mcg daily or less. This range accounts for the extra folate (folic acid) one will likely receive from natural food sources and fortified food sources, like oats and breads. When relying solely on food sources to get folate, it is unlikely that a person will take in excess amounts of the vitamin. (5)

What happens if you have too much vitamin B9? Folic acid is unsafe when taken by mouth in enormous portions. Although amounts of up to 5 mg per day have been safely administered in past research, taking folic acid in excess of 1 mg per day may cause uncomfortable side effects including: (5)(2)

Stomach cramps
Diarrhea
Skin irritation
Restlessness and sleep issues
Irritability
Disarray
Stomach upset
Vomiting
Behavior changes
Seizures
Gas
Sensitivity
Excitability

Summary

Folate is a water-soluble vitamin critical for optimal health in people of all ages. Recent attention has focused on the supply of folic acid to the population, with particular emphasis on the reduction of the incidence of neural tube defect rates in newborn infants. Folic acid is used for preventing and treating low blood levels of folate (folate deficiency) and high blood levels of homocysteine. Through various research, folate has also been found to aid in depression, treatment for child depression, cognitive development, cancer prevention, heart disease prevention and lowering blood sugar levels.

Recent evidence is challenging current public health strategies with respect to food fortification, necessitating a review of current approaches. Innovative alternative approaches to supplying folate to the human population include the use of bio-fortified foods and novel, stabilized forms of folate. Vitamin B9 sources include both natural food sources and supplementation in vitamin form.

Food sources of folate should include naturally occurring folate, found in dark green leafy vegetables and citrus fruits, and folic acid found in fortified grain products, like enriched grain products. Those who have certain diseases that affect folate intake or excessive urination due to other conditions may benefit from a folic acid supplement. Supplementation in vitamin form can also benefit certain health conditions, like Vitiligo and kidney issues, and consultation with a physician is always recommended. Children who are picky eaters and do not regularly have a diversity of whole foods in their diets might also benefit from supplementation of folic acid in vitamin form.

References

Disclaimer: The content of this blog post is intended for informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. You should not use this information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always seek the advice of your physician or other qualified health provider before taking any medication or nutritional, herbal or homeopathic supplement and with any questions you may have regarding a medical condition.

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