Dangerous and surprising ways you may be folate deficient

As I was preparing my body to get healthy before trying to conceive I unfortunately came down with an infection. It was so bad that it required a 14-day course of antibiotics (Bactrim).

While prescribed the antibiotic by the doctor, I was not once asked if I was pregnant. Or if I was going to try and become pregnant within that month of taking that medication.

Because I was planning on trying to conceive, and keeping a close watch on my health, I asked about Bactrim’s safety in pregnancy. The doctor advised me that it wasn’t a good idea to try for pregnancy that month. She told me that the antibiotic was not safe for a developing baby.

This setback had me disappointed that I was out another cycle. With the Bactrim in hand, my number one priority was to get healthier.

Curious about the dangers of this particular medication, I did a bit of researching. This research led me to the term and found the term “folate synthesis inhibitors”. I was at the time supplementing 2 grams of folic acid into my diet.

Folate Synthesis Inhibitors

Folate is an essential b-vitamin that helps the body process red blood cell production. Folic acid is the manufactured version of this vitamin. Folic Acid has lesser bioavailability ( the rate at which it is available for use in the body) than food sourced folate.

Doctors recommend supplementation of folic acid months before getting pregnant and thereafter to thwart pregnancy related complications and neural tube defects in the baby. So a folate synthesis inhibitor (my Bactrim medication) essentially can impede the amount of folic acid in the body and take away from what the baby needs for healthy development.

Folate synthesis inhibitors use in pregnancy

Bactrim being a folate synthesis inhibitor is a category “D” or unsafe in pregnancy (USA)(UK) medication. Bactrim is only used if benefit outweighs the risk. Folate is vital in the first trimester of pregnancy for healthy fetal development. The use of antifolates is contraindicated in pregnancy. Taking it while pregnant carries significant teratogenic (disturbs fetal development) risk.

Folate deficiencies can be treated with extra supplementation of folic acid. Folate can be simply by adding fortified foods in diet. As discussed sulfa drugs like Bactrim can make you folate deficient. If you are in child bearing age, and plan on getting pregnant, there are other conditions and medications that can put you at risk for this deficiency.

How sulfa drugs (Bactrim) inhibit folate

Sulfa antibiotics inhibit the pathway that bacteria use to synthesize folic acid, which is an important substance formed by metabolism for all cells. Bacteria have to make folic acid on their own. Drugs that inhibit folic acid synthesis are bacteriostatic because the bacteria can’t reproduce if they don’t have enough folic acid to make new DNA, RNA and proteins. They are also broad-spectrum drugs – they are effective against many types of bacteria.


List of sulfa drugs

  • Sulfamethoxazole-trimethoprim (Bactrim, Septra)
  • Erythromycin-sulfisoxazole (Eryzole, Pediazole)

Warning to consumers

For the sake of women’s health, warning labels should be on medication to inform of its potential for birth defects. In fact I believe this should be mandatory (it may be in your country or county but is not in Canada). On my particular antibiotic, the pharmacist slapped a “take with food label” and told me in the counselling that it would be hard on my stomach. Not so much in the way of mentioning interactions or complications when it comes to pregnancy or breastfeeding. He could see my 6 month old with me so I was in child bearing years and be breastfeeding. He could have counselled me or placed stickers warning pregnant or breastfeeding mothers of the drugs dangers. With another pharmacist, at another location, their counselling might have been different. I may have received specific pertinent advice on safety.

There is a long way to go in recognizing the full picture of women’s health. As women we need to be our own advocates and educate to empower ourselves and our bodies.

Ways folate may be decreased in the body

Consuming alcohol- Decreased folate levels due to decreased nutritional uptake in the intestines, and dietary inadequacies

Celiac disease, gastric bypass, vascular insufficiency- The digestive systems is compromised so that vitamin-B absorption is decreased through intestinal wall causing the deficiency

Drugs that decrease the bodies folate:

  • Dapsone– used for treatment of leprosy
  • Iclaprim – a multi use drug, skin infections, obesity, pneumonia
  • Phenytoin (valproic acid, carbamazepine, phenobarbital, phenytoin, and primidone, Lamotrigine– Seizure medications
  • Pemetrexed, Pralatrexate – treatment of some cancers
  • Methotrexate- arthritis, psoriasis, treatment of some cancers
  • Pemetrexed-anti cancer
  • Proguanil-anti malarial
  • Pyrimethamine Trimethoprim anti bacterial, antibiotic
  • sulfasalazine- antibiotic

Diet – Overheating destroying content in cooking. Not consuming a well rounded diet such as natural leafy greens beans fortified cereals and breads, citric fruits, and animal products.

Congenital folic acid absorption defect

Symptoms of low folate levels

  • Fatigue
  • Pale skin
  • Loose stool
  • Decreased appetite
  • Decreased energy
  • Oral ulcers
  • Irritability
  • Folate-deficiency anemia
  • Subsequent vitamin B12 deficiencies



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