Physiology of folic acid in health and disease

Folates are important cofactors in the transfer and utilization of one-carbon-groups and play a key role in the remethylation of methionine thus providing essential methyl groups for numerous biological reactions. Furthermore, folates donate one-carbon units in the process of DNA-biosynthesis with implications for the regulation of gene expression, transcription, chromatine structure, genomic repair and genomic stability. As the role of folate deficiency in atherosclerotic cardiovascular disease, neurological and neuropsychiatric disorders, in congenital defects and carcinogenesis has become better understood, folate has been recognized as having great potential to prevent these many disorders through folate supplementation for the general population. Folate acts directly to produce antioxidant effects, interactions with enzyme endothelial NO synthase (eNOS) and effects on cofactor bioavailability of NO. Folate acts indirectly to lower homocysteine levels and insure optimal functioning of the methylation cycle. Folate metabolism provides an interesting example of gene-environmental interaction. A great part of the population, especially subgroups with higher demand, appears to have suboptimal folate intake, as determined through more sensitive parameters now widely determined. The available data strongly suggest that criteria for folate deficiency may have to be redefined.