Nutrition / DietPregnancy / Obstetrics

Folic acid: What you need to know

Folic acid is the synthetic source of folate which is a vitamin B and occurs naturally. Folate is an aid in producing DNA and other genetic material. It is especially important when it comes to maternal health.

Folate, also known as vitamin B-9, is a B vitamin which occurs naturally in some foods. Folic acid is the folate component that producers add to vitamin supplements and fortified foods.

This article discusses the body’s functions of folic acid, some sources, the recommended doses and the deficiency consequences.

Why is it important?

Folic acid may reduce the risk of preterm birth.
Folic acid may reduce the risk of preterm birth.

Folate is important to a variety of body functions.

For example, it helps the body keep fresh red blood cells healthy. Red blood cells carry oxygen everywhere in the body. If this is not adequately rendered by the body, a person may develop anemia, leading to fatigue, weakness, and pale complexion.

A person may also develop a form of anemia called folate deficiency anaemia without adequate folate.

As well, folate is essential for the synthesis and repair of DNA and other genetic material, and cells need to divide.

Gaining enough folate during pregnancy is particularly important. Folate deficiency can cause neural tube defects during pregnancy, such as spina bifida and anencephaly.

The Food and Drug Administration (FDA) allows manufacturers to add folic acid to enriched bread, pasta, rice, cereals, and other grain products in the United States, due to its value for health. The number of babies born with neural tube defects has shrunk after they launched this.

The following list looks at some factors which may have an effect on folic acid supplements:

Neural tube irregularities

Taking supplements with folic acid before and during pregnancy can help prevent fetal neural tube abnormalities.

It may also reduce the risks of, among other things, premature birth, heart defects and cleft palate.

The Dietary Supplements Office says all women who might soon become pregnant should take 400 micrograms (mcg) of folic acid daily — from supplements or fortified foods— alongside the folate they get from their regular diet.

Depression

People with lower folate rates may have a greater chance of developing depression. Nevertheless, taking supplements with folic acid may make medicines for depression more successful.

Autism

Some research suggests that taking folic acid before and during early pregnancy may reduce the baby’s chance of having autism. Nevertheless, the results of the study are not definitive, and it will require further research to determine the potential role of folic acid.

Rheumatoid arthritis

Doctors for rheumatoid arthritis may use folic acid to support a methotrexate prescription.

For this condition, methotrexate is an effective medication, but it can remove folate from the body, causing gastrointestinal symptoms. Studies suggest that taking supplements of folic acid could reduce these side effects by about 79%.

Who should take folic acid?

Most people are getting enough folate from their diet, and folate deficiency is uncommon in the U.S.

Having said that, official guidelines recommend taking folic acid for all pregnant women and women who may become pregnant.

This is because folic acid is essential to the early development of fetuses. The spinal cord is one of the first parts of the body to develop, and folate deficiency may cause abnormalities in the spinal cord.

Recommended intake

The Office on Women’s Health recommends taking 400–800 mcg of folic acid per day for women who are or may become pregnant, and taking 4,000 mcg per day for people with spina bifida or a family history of neural tube abnormalities. Those who breastfeed will aim to take about 500 mcg a day.

The body absorbs folic acid more from vitamins and fortified foods than the folate from natural foods.

The Office of Dietary Supplements recommends that people get the following equivalents of dietary folate (DFEs) from sources of food or vitamin:

AgeRecommended amount
0–6 months65 mcg DFE
7–12 months80 mcg DFE
1–3 years150 mcg DFE
4–8 years200 mcg DFE
9–13 years300 mcg DFE
14–18 years400 mcg DFE
19+ years400 mcg DFE

It is important to note that folic acid can interact with certain medications and may not be safe for everyone to take.

A person should speak to a doctor before taking folic acid if they have any of the following:

  • epilepsy
  • type 2 diabetes
  • rheumatoid arthritis
  • lupus
  • inflammatory bowel disease (IBD)
  • celiac disease

People undergoing kidney dialysis may also wish to avoid taking folic acid.

Sources

Folic acid is present in dietary supplements and fortified foods, including breads, flours, cereals, and grains. It is also a common addition to B-complex vitamins.

Obviously a lot of foods are rich in folate. Among the best sources, are:

  • beef liver
  • boiled spinach
  • black-eyed peas
  • asparagus
  • Brussels sprouts
  • lettuce
  • avocado
  • broccoli
  • mustard greens
  • green peas
  • kidney beans
  • canned tomato juice
  • Dungeness crab
  • orange juice
  • dry-roasted peanuts
  • fresh orange and grapefruit
  • papaya
  • banana
  • hard-boiled egg
  • cantaloupe

Folate deficiency

Folate deficiency occurs when insufficient folate is present in the body. That can lead to a type of megaloblastic anemia.

Folate deficiency increases your risk of congenital defects during pregnancy.

Some Folate deficiency symptoms include:

  • weakness
  • fatigue
  • trouble concentrating
  • headache
  • irritability
  • heart palpitations
  • sores on the tongue and inside the mouth
  • a change in color of the skin, hair, or fingernails
  • irritability, headache, heart palpitations, and shortness of breath

Some groups at increased risk of folate deficiency include:

  • people with alcohol use disorder
  • pregnant women
  • people of childbearing age
  • people with conditions that affect nutrient absorption, including IBD and celiac disease
  • people with MTHFR polymorphism

Side effects of folic acid

No serious side effects of taking too much folic acid are associated with this. Humans can report an upset stomach in very rare cases.

There’s no cause for concern when a person takes more folate than is required. Folic acid is water soluble so any excess can flow through the urine naturally.

Summary

The synthetic source of folate is folic acid, which is an effective vitamin B. Most people get enough folate from their diet but people at risk of deficiency and women who may get pregnant may need to take supplements with folic acid.

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