Folic acid isa vitamin of B complex, otherwise known as vitamin B9. It is considered as one of the most important vitamins, as its deficiency leads to megaloblastic anemia.
Why is folate so necessary?
Folic acid is a necessary vitamin, as the human body is unable to synthesize it. Its intake can only be ensured through food or supplements. The body needs folic acid to synthesize DNA, RNA and genetic information, as well as for cell division and proliferation. It is used for the development of neurons and body tissues, as well as for the metabolism of amino acids and proteins.
What is folic acid?
It is a water-soluble vitamin, which is found in foods in its natural form (folate or folacin) as well as in dietary supplements in its synthetic form (folic acid). The term folic acid, however, is often referred to all kinds of folic acid.
Which foods are rich in folate?
Natural sources of folate are green leafy vegetables, fruits and juices (mainly orange), beans, peas and dairy products. Foods with the highest concentration of folacin are spinach, liver, yeast, asparagus and Brussels sprouts. In smaller concentrations, it is found in meat and poultry, eggs, seafood and fortified cereals and grains.
What happens when there is a lack of folate?
Usually, deficiency of folate coexists with deficiency of vitamin B12 and/or vitamin B6 and is caused due to poor diet, alcoholism and syndromes that cause malabsorption.
Megaloblastic anemia and folate
The greatest consequence of folate deficiency is the appearance of megaloblastic anemia, which is characterized by large immature erythrocytes (red blood cells) and vitamin B12 deficiency. Symptoms of megaloblastic anemia are fatigue, impaired cognitive function, irritability, hair loss, headaches, herpes, as well as pale skin.
Cardiovascular health and folate
Folate is essential for the transformation of homocysteine into methionine. Homocysteine is an amino acid that results from the metabolism of proteins. Folic acid deficiency usually coexists with deficiency of vitamin B12 and B6 and leads to an increase of homocysteine levels and thus, increased cardiovascular risk. Supplementation of folic acid helps reduce homocysteine levels and reduces the risk of stroke.
Neural tube defects and folate
Women who do not take adequate amounts of folate through supplements or diet have an increased risk during pregnancy their infants to develop neural tube defects and neurological disorders. In addition, inadequate intake of folate in pregnancy has been associated with low birth weight, premature birth and slower fetal development.
Dementia, cognitive function and Alzheimer’s disease
Many observational studies have shown that folate deficiency is associated with an increased risk of poor cognitive function, dementia and Alzheimer’s disease. The supplemental intake of folic acid, vitamin B12 and B6 is beneficial. However, studies are still pending confirming the benefit of taking supplements with vitamins of B complex, after impairment of cognitive function has been established.
Individuals with low levels of folate are more likely to suffer from depression or do not respond to antidepressant therapy. Supplementation of folic acid appears to make antidepressant therapy more effective.
Folate intake through food seems to have a protective effect on cancer, but on the other hand, supplementation of folic acid through supplements requires attention. Large doses of folic acid (> 1000 mcg) are not recommended in cases of cancer history or adenoma.
People who are at greatest risk of folate deficiency are:
- pregnant women
- people with malabsorption syndrome
- people with poor nutrition
Folic acid intake varies depending on the stage of development and sex. Adults should receive 400mcg daily, while during pregnancy and breastfeeding the recommended daily intake is 600mcg per day. The upper safe threshold for adults is 1000mcg.
Contraindications – interactions
Folic acid can interact with many medications such as antiepileptics, anti-cancer drugs (methotrexate) and ulcerative colitis medications. Large doses of folic acid increase the risk of developing cancer and hide any vitamin B12 deficiency. People with a history of cancer should not take large doses of folic acid.