Active Folate (RBC)
Active Folate (RBC) measures the concentration of folate stored within red blood cells, making it one of the most reliable indicators of long-term folate status. Because RBCs have a lifespan of about 120 days, this biomarker reflects folate availability over several months rather than short-term dietary intake captured by serum folate levels.
Folate is essential for DNA synthesis and repair, cell division, neurotransmitter production, and methylation, the biochemical process that regulates gene expression, detoxification, and metabolic balance. Adequate RBC folate is critical for fetal development, cardiovascular health, neurological function, reproductive health, and red blood cell formation. Low RBC folate can impair one-carbon metabolism, reduce methylation efficiency, and increase homocysteine levels.
RBC folate levels can be affected by dietary folate intake, B-vitamin status (particularly B12), gastrointestinal absorption, alcohol use, chronic inflammation, increased metabolic demand, and genetic variations in folate-processing enzymes (such as MTHFR or DHFR). Elevated levels may reflect high folate intake, supplementation, or imbalances in folate utilization.
Interpreting Active Folate (RBC) alongside other folate derivatives (5-MTHF, 5-Formyl-THF, 10-Formyl-THF, THF), methylation markers (SAM, SAH, SAM/SAH ratio), and homocysteine provides a comprehensive view of one-carbon metabolism and folate-cycle health.
What does it mean if your Active Folate (RBC) result is too high?
High Active Folate (RBC) may reflect increased dietary folate intake, supplementation, or enhanced folate storage. Elevated levels can also indicate imbalances in folate conversion or utilization. Reviewing this marker alongside 5-MTHF, folinic acid, THF, and methylation markers helps determine its clinical significance.
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What does it mean if your Active Folate (RBC) result is too low?
Low Active Folate (RBC) indicates long-term folate deficiency, which may impair DNA synthesis, methylation, red blood cell formation, and cellular repair. Causes include low dietary folate, poor absorption, B12 deficiency, alcohol use, chronic inflammation, high metabolic demand, or genetic factors affecting folate metabolism. Symptoms may include fatigue, anemia risk, cognitive issues, elevated homocysteine, and reduced cellular resilience.
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