Information About Folic Acid

Folic Acid

Introduction

Folic acid is also known as vitamin M, folate or folacin. It is a B-complex water-soluble vitamin that can be naturally found in food sources and supplements. It is popular for its essential role in pregnancy and prevention of birth defects. These defects often involve the malformation of the neural tube, which is responsible for the development of the baby’s brain and spinal cord. Mothers with folate deficiency tend to give birth to infants with neural tube defects, often resulting in brain and spinal cord disorders such as spina bifida.

There are three main components of folic acid namely PABA, glutamic acid and pteridine. Since it has a complex structure, it also has a rather complicated interaction with the human body. There are food sources that do not have folic acid, and body enzymes in the intestines have to chemically alter these food substances to form folate.

Functions of Folic Acid

Several functions of folic acid in the body include:

• Red blood cell production and support for circulation. Without the presence of folic acid, red blood cells cannot form properly and would not continue dividing. Folic acid also helps in the maintenance of healthy blood circulation by preventing the build-up of homocysteine. An increased intake of folic acid in men has been suggested to lower the risk of cardiovascular disease. It also aids in the prevention of anaemia.

• Cell production especially in the skin. Skin, intestinal, and cells that line the body cavities have a minimal life span and are dependent on folic acid for their production. Certain conditions arise when there is folic acid deficiency like periodontal disease, seborrhoea dermatitis and cancer.

• Prevention of nervous system disorders. Folic acid allows nerves to function normally. It also maintains the proper balance and synthesis of neurotransmitters in the nervous system.
• Folic acid is also said to prevent osteoporosis-related bone fractures.
Deficiency Conditions
Several factors that can contribute to insufficient folic acid includes poor dietary intake; deficiency of B vitamin intake; poor protein intake; insufficient supply of glycine and serine which are responsible for folate recycling; and excessive smoking, alcohol consumption and coffee.
Failure of the body to absorb folic acid can result to conditions like Crohn’s disease or ulcerative colitis. In pregnant women, poor folate intake can result to the infant growth retardation, macrocytic anaemia, GI disorders, glossitis and neural tube defects. Studies have also linked folate deficiency and high homocysteine levels with coronary heart disease, cerebral vascular disease and peripheral vascular diseases.
Deficiency Symptoms in Adults and Children

Since folate is related to nervous system functions, insufficient folate levels can result in irritability, forgetfulness, mental fatigue, depression, confusion and insomnia. In connection with circulatory functions, deficient folate can cause general or muscular fatigue. Lack of folate intake can also cause problems in the intestinal tract like diarrhoea and oral conditions like gingivitis and periodontal disease.

Mild folic acid anaemia may have no symptoms at all. As the insufficiency of folate increases, certain symptoms of anaemia may develop. Less common symptoms may include the following:

• Abdominal pain and diarrhoea

• Tongue sores

• Chapped lips especially around the corners of the mouth

• Shortness of breath with activity and exertion

• Chest pains with rapid and irregular heart rate

As the deficiency progresses, it would lead to common symptoms of anaemia which may include:

• Weakness and fatigue

• Feeling of light-headedness

• Forgetfulness

• Irritability

• Pale appearance

• Weight loss and lack of appetite

• Difficulty to focus and concentrate 

Recommended Daily Intake of Folate

Recommended daily intake of folic acid is dependent on particular age and gender groups. Pregnant women obviously need a greater amount of folate intake in consideration with foetal development.

Infants from birth to 6 months need 65 mg/day of folate; infants 7-12 months require 80 mg/day. Children aged 1-3 years old need 150 mg/day; children aged 4-8 years are required to have 200 mg/day of folate.

Males and females aged 9-13 need a dose of 300 mg/day of folic acid; both males and females from ages 14-18 are required to have 400 mg/day and both men and women 19 years and up need 400 mg/day of folate. In pregnant women, folate intake of 600 mg/day is recommended whilst lactating mothers would need 500 mg/day of folate.

Folic Acid Food Sources

Excellent sources of folate include green leafy vegetables such as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, beans, peas and lentils, Brussels sprouts, broccoli, beets, parsley and collard greens. Poultry, calf’s liver, wheat germ, nutritional yeast, tuna, mushrooms, and fruits like oranges, bananas, strawberries and cantaloupes are also good sources of folic acid. Folic acid is now also added to bread and grain products to encourage folate intake and decrease the prevalence of neural tube defects. 

Requirement for Increased Amounts of Folic Acid

Pregnant adult women and breastfeeding mothers are usually given an increased amount of folate to prevent birth defects in infants. In addition, folate can also be used in adjunct treatments to enhance the response to antidepressants. Other conditions that require increased folate amounts include:

• Anticonvulsant-induced folate deficiency

• Cancers of the colon, pancreas and cervix

• Drug-induced toxicity

• End stage renal disease or ESRD

• Folate deficiency

• Hyperhomocysteinemia

• Megaloblastic anaemia

• Prevention of neural tube defects

• Phenytoin-induced gingival hyperplasia

• Pregnancy-related gingivitis

Drug Interactions with Folic Acid

Certain types of prescription drugs can deplete the body’s folate supply. It is essential that patients would inform their doctors if they are taking these medications.  Prescription medications that can interact with folate include the following:

• Anti-cancer medications such as methotrexate

• Cholesterol-lowering drugs like cholestyramine

• Anti-inflammatory drugs like sulfasalazine

• Biguanide drugs like buformin, phenformin and metformin used for diabetes treatment

• Birth control pills (oral contraceptives)

• Potassium-sparing diuretics such as triamterene

• Antibiotics such as trimethoprim  and pyrimethamine