Folate and Alcoholism

Alcohol has many effects on folate metabolism. Excess alcohol consumption is often associated with a poor (folate deficient) diet and malabsorption. Alcohol accelerates the induction of megaloblastic anemia in subjects on a low folate diet. It antagonizes the hematopoietic response to folate (75 yg/day) in folate-deficient alcoholics, but its effect can be overcome either by larger doses of folic acid or by cessation of alcohol ingestion. Alcohol also induces an acute fall in serum folate which is rapidly reversible on withdrawal of the alcohol and is not correlated with depletion of folate stores. This acute fall in serum folate is not due to an assay artefact and may be due to the interference by alcohol with the delivery of folic acid from stores to the peripheral circulation. While the exact mechanism of alcohol's effect on folate storage and release by the liver is still under investigation, alcohol may produce a reversible sequestration of folate in the hepatocyte (as intracellular polyglutamate) at the expense of its release into bile as the methyltetrahydrofolate monoglutamate for recirculation to tissues. The significance of alcohol-induced changes in folate binding and folate binding protein to the delivery of folate to tissue stores is unclear. Thus, the relationship of alcohol with folate deficiency and megaloblastic anemia is multifaceted.