folic acid

If you have ever been pregnant, chances are you have heard about the importance of getting enough folic acid in your diet for the health and development of your baby. But folic acid can be also beneficial to men, women, and children.
Folic acid acts by helping the body produce and maintain new cells. In particular, red blood cell formation is dependent upon adequate levels of this vitamin. Folic acid deficiency is a known cause of anemia in both adults and children. Folate may also help cells resist changes in their DNA associated with the development of cancer.
According to the British Dietetic Association (BDA), folic acid is vital for making red blood cells, as well as:

• the synthesis and repair of DNA and RNA
• aiding rapid cell division and growth
• enhancing brain health, although the evidence is mixed and more research is needed
• age-related hearing loss

For pregnant women (or women of childbearing years, ages 15-49) who have a folic acid deficiency, many health problems may develop in the unborn child if there is a folic acid deficiency. Getting enough folic acid before and during pregnancy can prevent major birth defects of her baby’s brain or spine. Risks include:

• anemia
• congenital deformities
• a higher risk of developing clinical depression
• possible problems with memory and brain function
• a higher risk of potentially developing allergic diseases
• a higher potential long-term risk of lower bone density

The following foods are known to be rich in folic acid:

• asparagus
• baker’s yeast
• broccoli
• Brussels sprouts
• cabbage
• cauliflower
• cereal (check the box for the daily allowance)
• egg yolk
• lentils
• lettuce
• liver, although women should not consume this during pregnancy
• many fruits, especially papaya and kiwi
• milk
• oranges
• parsnips
• peas
• spinach
• sunflower seeds
• whole wheat bread, as it is usually fortified

If you don’t get enough folic acid from the foods you eat, you can also take it as a dietary supplement.
Folic acid is available in multivitamins and in prenatal vitamins. The U. S. Public Health Service and CDC recommend that all women of childbearing age consume 400mcg of folic acid everyday to prevent two common and serious birth defects: spina bifida and anencephaly. If you are pregnant, the CDC recommends 600 mcg/day.
All women between 15 and 49 years of age should consume folic acid daily because half of U.S. pregnancies are unplanned and because these birth defects occur very early in pregnancy (3-4 weeks after conception), before most women know they are pregnant.
The CDC estimates that most of these birth defects could be prevented if this recommendation were followed before and during early pregnancy.
About 35% of adults and 28% of children aged 1 to 13 years in the United States use supplements containing folic acid. Children’s multivitamins commonly contain between 200 and 400 mcg folic acid. Adults aged 51 to 70 years are more likely than members of other age groups to take supplements containing folic acid. Use is also higher among non-Hispanic whites than non-Hispanic blacks or Mexican Americans, which generally due to a lack of knowledge of the importance of getting your daily allowance of folic acid.

Groups at Risk of Folate Inadequacy

Folate deficiency is rare in the United States, but some individuals might be at risk for marginal folate status due to a medical condition or when taking certain prescription drugs.
Alcoholics
People with alcohol dependence frequently have poor-quality diets. Alcohol also interferes with folate absorption and metabolism, and accelerates its breakdown. Even moderate alcohol consumption of 240 ml (8 fluid ounces) red wine per day or 80 ml (2.7 fluid ounces) vodka per day for 2 weeks can significantly decrease serum folate concentrations in healthy men.
Women of childbearing age
All women capable of becoming pregnant should obtain adequate amounts of folate to reduce the risk of Neural Tube Defects (NTD) and other birth defects. Unfortunately, some women of childbearing age obtain insufficient folate even when intakes from both food and dietary supplements are included. Women of childbearing age should obtain 400 mcg/day of folic acid from dietary supplements and/or fortified foods in addition to the folate present in a varied diet.
Pregnant women
During pregnancy, demands for folate increase due to its role in nucleic acid synthesis. The recommended daily allowance of folic acid in pregnant women is 600 mcg throughout the pregnancy. This level of intake might be difficult for many women to achieve through diet alone. The American College of Obstetricians and Gynecologists recommends a prenatal vitamin supplement for most pregnant women to ensure that they obtain adequate amounts of folic acid and other nutrients.
People with malabsorptive disorders
Several medical conditions increase the risk of folate deficiency. People with malabsorptive disorders—including celiac disease, and inflammatory bowel disease—might have lower folate absorption than people without these disorders. Diminished gastric acid secretion associated with atrophic gastritis, gastric surgery, and other conditions can also reduce folate absorption.

Interactions with Medications

Folic acid supplements can interact with several medications. Individuals taking these medications on a regular basis should discuss their folate intakes with their healthcare providers.
Methotrexate
Methotrexate (Rheumatrex®, Trexall®), a medication used to treat cancer and autoimmune diseases, is a folate antagonist. Patients taking methotrexate for cancer should consult their oncologist before taking folic acid supplements because folic acid could interfere with methotrexate’s anticancer effects. However, for patients taking low-dose methotrexate for rheumatoid arthritis or psoriasis, folic acid supplements might reduce the gastrointestinal side effects of this medication.
Antiepileptic medications
Antiepileptic medications, such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®), and valproate (Depacon®), are used to treat epilepsy, psychiatric diseases, and other medical conditions. These medications can reduce serum folate levels. Furthermore, folic acid supplements might reduce serum levels of these medications, so patients taking antiepileptic drugs should check with their healthcare provider before taking folic acid supplements.
Sulfasalazine
Sulfasalazine (Azulfidine®) is used primarily to treat ulcerative colitis. It inhibits the intestinal absorption of folate and can cause folate deficiency. Patients taking sulfasalazine should check with their healthcare provider about increasing their dietary folate intake, taking a folic acid supplement, or both.
If you have questions or are not sure if you are getting enough folic acid in your diet, talk to your doctor or ask one of our pharmacists.
 
Sources: CDC, MNT, NIH