It has been estimated that at least two-thirds of American adults consume alcohol and about 5% suffer from chronic alcohol addiction . There is, of course, a great distinction between occasional to moderate alcohol use, and the type of alcohol abuse that can lead to liver disease. However, as each of our bodies and metabolic systems is unique, the line between use and abuse may look different for each individual. On the other hand, there is no gray area around the fact that alcohol does act as a pathogenic toxin in the body. One of the problematic interferences caused by alcohol is the absorption and metabolism of folate.
Does Alcohol Deplete Folate or Cause Folate Deficiency?
It can. Folate deficiency has long been recognized as a clinical feature of alcoholism, and as scientists have worked to better understand folate metabolism, they have also revealed the mechanisms by which alcohol inhibits healthy folate homeostasis.
When a healthy person consumes foods or supplements containing folate (vitamin B-9), it first must be converted to a form that can be absorbed into the blood through the walls of the small intestine. Folate is then shuttled by the blood to the liver where it must again be absorbed and further processed before being circulated for use by the rest of the body. The release of excess folate through the urine is regulated and controlled by the kidneys.
When a person is regularly consuming too much alcohol for their body type, there are multiple reasons their folate levels will likely decrease. First, studies have shown that when a subject is abusing alcohol, significantly less folate is absorbed from the diet through the small intestine . Second, of the folate that is absorbed from the small intestine, even less is absorbed by the liver, meaning the little folate brought in is unlikely to be processed properly for use throughout the body . Further still, studies have measured an increase in the amount of folate excreted by the kidneys, showing that the folate absorbed is not being stored, it is leaving the body without ever contributing to the bodily processes for which it is required .
How Does a Folate Deficiency Affect the Body?
Folate deficiency may be difficult to detect without a blood test, but not because it is a superfluous nutrient. In fact, folate is used in nearly every cell of the body, constantly, and can be the rate-limiting factor in crucial metabolic processes. As your cells divide and grow to replace old, damaged cells, a critical step is correctly copying the DNA that will provide instructions for the new cell and those that come after it. Without folate and its coenzymes, DNA cannot be copied and the expression of the proper genes for continued growth and function may not take place . Improper DNA methylation is likely to lead to a less-functional or mutated developing cell and has been linked in some cases to cancer development .
Folate is also critical to the metabolism of several important amino acids, including methionine, cysteine, serine, glycine, and histidine . The synthesis of methionine from homocysteine requires not only folate (as L-methylfolate) but also vitamin B-12. Deficiency in folate or B-12 can result in decreased synthesis of methionine and accumulation of homocysteine, which poses several serious health risks .
Additionally, folate deficiency can lead to megaloblastic anemia, a condition in which your body makes fewer red blood cells that are larger, misshapen, and do not deliver oxygen throughout the body as efficiently as normal red blood cells . This condition may lead to feeling ill, tired, pale, and experiencing a consistently low mood .
Folate is especially important during pregnancy, as the cells of the fetus are so rapidly dividing and growing. Chronic and heavy alcohol use in pregnancy leads to reduced folate transport to the fetus. Low folate concentrations in the placenta and fetus may in part contribute to the pathologies observed in babies with fetal alcohol spectrum disorders (FASD) .
Can I Take Folate Supplements if I Drink Alcohol?
You are unlikely to experience an immediate adverse reaction between alcoholic beverages and folate supplements. However, if you choose to drink, you now know that the absorption of your folate may be impaired by alcohol use, and folate does not counteract the damage done to your body by alcohol. You should still follow the daily recommended intake for folate, and seriously consider choosing a supplement containing the L-methylfolate form, as it is the most bioavailable option. Speak candidly with your doctor about your alcohol use to determine if your body is able to healthfully process the amount of alcohol you regularly consume, or whether cutting back or cutting out alcohol is necessary for your longevity.
- Halsted, Charles H., et al. “Metabolic interactions of alcohol and folate.” The Journal of nutrition 132.8 (2002): 2367S-2372S.
- Higdon, Jane. “Folate”. Oregon State University: Linus Pauling Institute’s Micronutrient Information Center. Last updated June, 2014. https://lpi.oregonstate.edu/mic/vitamins/folate#reference12
- Johns Hopkins Medicine. “Folate Deficiency Anemia”. Johns Hopkins Health: Conditions and Diseases. Accessed Nov 18, 2019. https://www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia
- Hutson, Janine R., et al. “Folic acid transport to the human fetus is decreased in pregnancies with chronic alcohol exposure.” PloS one 7.5 (2012): e38057.