At a glance
Folate is the water-soluble B vitamin B9, involved in cell division, blood formation and homocysteine metabolism.
In Vykea: calcium L-methylfolate (5-MTHF) (600 µg per sachet).
It is already in the active form and does not first need to be converted in the body.

Folate is a water-soluble B vitamin (vitamin B9). The term covers around 100 naturally occurring compounds with folate activity and derives from the Latin word for leaf. Folate is involved in cell division, blood formation and homocysteine metabolism, and in Europe and North America it is regarded as one of the micronutrients most frequently consumed in insufficient amounts. In Omnia All-In-One we use calcium L-methylfolate, the already active form of folate (5-MTHF), at 600 µg per sachet. This entry explains the forms, food sources, functions, requirements, laboratory testing, possible signs of deficiency and interactions of folate.

In food, folate occurs mainly as polyglutamate. This form must first be broken down by enzymes in the gut, and only about 20% of it is absorbed. Free monoglutamates, by contrast, are absorbed almost completely. On average, around half of the folate contained in food is available to the body.

Strictly speaking, the term folic acid refers to the synthetic form (pteroylmonoglutamic acid). It is more stable than natural folates, but has to be converted into the active form in the body over several steps. The actual coenzyme is tetrahydrofolic acid (THF).

The directly usable, active form is called 5-methyltetrahydrofolate, or 5-MTHF for short. It is available as calcium L-methylfolate (also known as Metafolin) and as a glucosamine salt (Quatrefolic), among other forms, and does not first need to be converted. When converting to folate equivalents, EFSA applies a higher factor to 5-MTHF in food supplements than to synthetic folic acid, from an intake of 400 µg per day. Omnia uses calcium L-methylfolate.

Good sources of folate are above all dark green leafy vegetables such as spinach, kale, chard and lamb's lettuce, as well as broccoli, green beans, asparagus, tomatoes and radishes. Wholegrain products, egg yolk and liver also contribute. Particularly high levels are found in yeast, wheat germ and wheat bran.

Folate is sensitive to heat, light and oxygen. Storage, prolonged heating and repeated reheating cause an average loss of around 35%. Regular alcohol consumption also impairs folate status.

Folate acts as a coenzyme (tetrahydrofolate) in several key metabolic pathways:

The next section shows which of these functions are authorised as health claims.

The following health claims are authorised for folate in the EU:

These claims apply to folate in general and therefore also to the form used in Omnia, calcium L-methylfolate.

The following values are given in folate equivalents and are taken from the D-A-CH reference values of the German Nutrition Society (DGE).

The nutrient reference value for labelling (NRV) is 200 µg per day. The European Food Safety Authority (EFSA) gives a tolerable upper intake level of 1,000 µg per day from food supplements and fortified foods for adults.

Folate requirements are higher in some life stages and situations: during growth phases, before and during pregnancy and while breastfeeding, in older people, when absorption from the gut is impaired (for example with chronic inflammatory bowel disease or persistent diarrhoea), with liver and kidney disease, with vitamin B12 deficiency, and with regular alcohol consumption and smoking. Certain medicines also increase requirements (see the Interactions section).

Dietary surveys show that average folate intake is often below the reference value. In Austria, women consume an average of around 216 µg and men around 197 µg per day, against a reference value of 300 µg.

Folate requirements are significantly higher before and during pregnancy. At 550 µg per day, the reference value is almost twice as high as usual. The additional requirement is explained by the growth of the foetus and placenta, increased maternal blood formation and higher losses via the kidneys.

The embryo's neural tube closes very early, roughly between day 21 and day 27 of pregnancy, often before the pregnancy has even been noticed. Inadequate folate status during this phase is associated with neural tube defects such as spina bifida and anencephaly. The scientific literature also associates low birth weight and cleft lip and palate with folate deficiency in early pregnancy.

The DGE therefore recommends: “Women who want to become pregnant or could become pregnant should take 400 µg of synthetic folic acid per day, or equivalent doses of other folates, in the form of a supplement in addition to a folate-rich diet, in order to prevent neural tube defects.” Intake should begin at least four weeks before pregnancy and continue throughout the first trimester.

Note: Folate intake during pregnancy should be supervised by a doctor.

Homocysteine is a sulphur-containing amino acid that is continuously produced in cell metabolism and broken down again via two pathways. In the remethylation pathway, homocysteine is converted back to methionine. Here, 5-methyltetrahydrofolate transfers a methyl group, and the vitamin B12-dependent enzyme methionine synthase catalyses this step. In the second pathway, known as transsulfuration, homocysteine is broken down via cystathionine to cysteine. The enzymes responsible for this require the active form of vitamin B6 (pyridoxal-5-phosphate) as a cofactor. Vitamin B2 (riboflavin) plays a supporting role in the background, as its active form (FAD) drives the enzyme MTHFR, which provides the 5-methyltetrahydrofolate needed in the first place.

This interplay explains why nutritional science considers folate, vitamin B6 and vitamin B12, supported by vitamin B2, together: they interlock at the same metabolic junction. A deficiency of one of these vitamins can disrupt the breakdown of homocysteine and thus impair the function of the others, because the two breakdown pathways depend on the available homocysteine and are interdependent. If vitamin B12 is lacking, for example, remethylation stalls even when sufficient folate is available; if vitamin B6 is lacking, transsulfuration is slowed.

In a systematic review, homocysteine levels fell by an average of around 32% with an intake of folic acid together with vitamin B12 and/or vitamin B6, while they remained almost unchanged in the comparison groups. These are general relationships from nutritional science, not a promise of effect for any individual product.

You can find more about the partner vitamins in the Vitamin B6 and Vitamin B12 entries.

Together with vitamins B6 and B12, folate is involved in the breakdown of homocysteine. Folate deficiency can therefore lead to elevated homocysteine levels in the blood. In research, an elevated homocysteine level is regarded as an independent risk factor for arteriosclerotic vascular changes. According to statistical analyses of large study datasets, a 25% lower homocysteine level is mathematically associated with about 10% fewer cases of heart disease and about 20% fewer strokes. These are epidemiological relationships at population level, not a promise of effect for any individual product.

Because of its central role in building and repairing genetic material, folate deficiency is considered in scientific discussion as a possible risk factor in the development of tumours, particularly colorectal tumours. People with chronic inflammatory bowel disease are more likely to have folate deficiency. Individual controlled studies have investigated whether high-dose folic acid (for example 5 mg per day) affects the recurrence of colorectal adenomas. The evidence here is inconsistent.

Note: Such high doses are not a general recommendation and should be left to a doctor.

Folate status is determined by a doctor from a blood sample. Serum or plasma folate (reference range approximately 2 to 17 µg/l, borderline below 4 µg/l) is measured after fasting and mainly reflects intake over the last few hours and days. Folate in the red blood cells, which is determined in whole blood (reference range approximately 250 to 1,000 µg/l), is more informative about longer-term status; the haematocrit is also needed for this.

Low values in serum and erythrocytes indicate a deficiency; very high values usually indicate a high intake from supplements. Treatment with methotrexate or leucovorin can affect the measurement.

Note: Interpreting the values and any supplementation should be left to a doctor.

Folate deficiency usually develops slowly. At first, non-specific symptoms appear, such as tiredness, lack of energy, pallor, irritability or difficulty concentrating. Because folate is particularly important for rapidly dividing cells, a longer-lasting deficiency mainly affects blood formation. A typical finding is anaemia with enlarged red blood cells (macrocytic anaemia). Changes in the mucous membranes (such as inflammation of the tongue), elevated homocysteine levels and, with pronounced and longer-lasting deficiency, neurological symptoms are also possible.

Such signs are not conclusive and can have many causes.

Note: Investigation and diagnosis should be left to a doctor.

The following information summarises the areas of use described in the specialist literature. It does not replace medical advice; targeted or higher-dose use should be left to a doctor.

In rare cases, very high doses can cause itching or gastrointestinal complaints.

Note: In megaloblastic anaemia caused by vitamin B12 deficiency, giving folate alone can improve blood values while accompanying nerve damage progresses unnoticed. Folate therapy should therefore not be given without first checking vitamin B12 status.

Some medicines can lower folate status or impair its absorption, including certain anti-epileptic drugs (for example carbamazepine, phenytoin), metformin, sulfasalazine, some diuretics (such as furosemide), non-steroidal painkillers (for example aspirin, ibuprofen), certain antibiotics and oral contraceptives. Folate antagonists such as methotrexate, trimethoprim or co-trimoxazole specifically interfere with folate metabolism.

Note: If you take such medicines, be sure to check with a doctor before taking additional folate.

Conversely, some nutrients support the utilisation of folate: vitamin C is involved in activating folate, zinc is needed for its absorption, and folate works closely with vitamins B6, B12 and B2 in metabolism.

Some people carry a common genetic variant of the enzyme MTHFR that can reduce the body's own production of the active form of folate. This is a normal variant, not a disease. For carriers of this variant, the specialist literature describes a combined intake of folate with vitamins B2, B6 and B12, as these vitamins work together in the same metabolic pathway. Calcium L-methylfolate is already present as active 5-MTHF and does not need to go through this conversion step.

Folate is contained in Omnia All-In-One:

The amount stated refers to the weight of the calcium L-methylfolate. The % of NRV is based on the labelling value of 200 µg. The D-A-CH reference values above are given in folate equivalents and are not directly comparable with the amount of substance. In Omnia, folate is combined with vitamins B6, B12 and B2. One daily dose corresponds to one sachet.

Food supplements are not a substitute for a balanced, varied diet and a healthy lifestyle.

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