From the Guidelines
Management of hyperfolatemia typically involves identifying and addressing the underlying cause, rather than specific treatment for the elevated folate levels themselves. The primary approach is to determine the reason for the high folate levels, which can include excessive supplementation, high consumption of folate-rich foods, or certain medical conditions. According to a policy statement on folic acid and neural tube defects 1, increased folate consumption can have potential hazards, such as masking megaloblastic anemia caused by vitamin B12 deficiency, particularly in individuals older than 65 years.
Key considerations in managing hyperfolatemia include:
- Reducing or discontinuing excessive supplements under medical supervision
- Adjusting the dosage of prenatal vitamins or folic acid supplements if necessary
- Moderating consumption of folate-rich foods like leafy greens, legumes, and fortified grains to help normalize levels
- Checking vitamin B12 levels to rule out deficiency, which can lead to neurological damage if untreated, as elevated folate can sometimes mask this condition
- Investigating rare associations with certain cancers or increased cell turnover if elevated folate levels persist without explanation
It is essential to monitor folate levels regularly after implementing these management strategies to confirm their effectiveness. By addressing the underlying cause and considering potential interactions with other nutrients like vitamin B12, healthcare providers can effectively manage hyperfolatemia and mitigate potential risks associated with elevated folate levels, as suggested by the study on folic acid and neural tube defects 1.
From the Research
Management of Hyperfolatemia
There are no direct research papers that provide guidance on the management of hyperfolatemia (elevated folate levels) [ 2, 3, 4, 5, 6 ]. However, the available evidence suggests that high intakes of folic acid and/or elevated blood folate concentrations have been associated with negative health outcomes, such as masking the diagnosis of a vitamin B12 deficiency [ 3, 4, 5 ].
Key Considerations
- High-dose folic acid supplementation in patients with pernicious anemia or epilepsy can cause significant reductions in serum B12 [ 4 ].
- Cognitive function test scores are lower and blood homocysteine and methylmalonic acid concentrations are higher in people with low B12 and elevated folate than in those with low B12 and nonelevated folate [ 4 ].
- The evidence for excess folic acid exacerbating B12 deficiency is primarily correlative or from uncontrolled clinical observations [ 4 ].
Population-Specific Considerations
- Older adults and others with low B12 intake or conditions that are associated with B12 malabsorption, who also ingest excessive folic acid or are prescribed folic acid in high doses, should be monitored for B12 deficiency [ 4 ].
- Black men and women tend to have lower folate intakes and lower red blood cell folate concentrations compared to white or Mexican-American men and women [ 6 ].