Drug and Supplements

Folic Acid

Written by Dr. K Sneha and medically reviewed by Neha Singh Rathod

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Overview of Folic Acid

Folic acid is the synthetic form of folate, which is a water-soluble vitamin B9. It is the crucial ingredient in the synthesis and repair of DNA (Deoxyribonucleic acid) and RNA (Ribonucleic acid). Folate is the naturally available form of vitamin B9, while folic acid is the man-made form. Folate is naturally seen in green leafy vegetables, fruits (banana, watermelon, oranges), okra, asparagus, mushrooms, meat (liver and kidney), dried beans, peas, and nuts. Because of its health benefits, folic acid is added in bread, cereals, cookies, and other grain products.

Folic acid must be converted into active vitamin B9, known as 5-MTHF (L-Methylfolate) before the body can use it. This is a four-step process that requires several enzymes, including an enzyme called MTHFR (Methylenetetrahydrofolate reductase). Some people have a genetic mutation that makes enzyme MTHFR less effective, leading to a folic acid build-up in the blood. This has been linked to negative health impact in some people. It might cause poor immunity, reduce brain function, and increases the growth of pre-existing cancer.

How Is Folate Useful?

Folate might be useful in treating or preventing the following health conditions:

  1. Folate Deficiency: Taking folic acid supplements improves the symptoms caused by folate deficiency.
  2. Heart Disease and Stroke: Kidney diseases cause high levels of homocysteine in the blood (hyperhomocysteinemia). This high level of homocysteine is linked to heart diseases and stroke. Folate helps in lowering the homocysteine, thus preventing stroke and heart disease.
  3. Birth Defects: It helps in reducing the risk of neural birth defects. A neural birth defect is when your baby’s neural tube does not close properly. Spina bifida, encephalocele, and anencephaly are examples of such defects. Research shows that taking folic acid reduces the incidence of such defects by 50 %. It is also shown to protect your baby against cleft lip, premature delivery, low birth weight, miscarriage, etc.
  4. Methotrexate: Methotrexate is a chemotherapeutic drug and an immunosuppressant. It is used in the treatment of cancer and rheumatoid arthritis. Methotrexate removes folate from the body and causes gastrointestinal symptoms like nausea and vomiting. Folate supplements are given to reduce the gastrointestinal side effects of Methotrexate.
  5. Depression: It is seen that people with low folate level in their blood are more prone to have depression. Folate supplements, especially the one with 5-MTHF might make the antidepressants more effective.
  6. Gum Diseases: It seems to improve gum diseases during pregnancy when applied directly on the gums. It is also useful in gingivitis caused by taking Phenytoin.
  7. Vision: Taking vitamin supplements have shown to reduce the risk of developing age-related vision loss.
  8. Vitiligo: It helps to improve the symptoms caused by vitiligo. Vitiligo is a type of skin discoloration.Apart from these, it is also vital in forming red blood cells, synthesis and repair of DNA and RNA, aids rapid cell division and growth, and aid in age-related hearing loss.

Am I Getting Enough Folate?

By consuming folate-rich food regularly in the right amount and with the help of fortified food products, the daily requirement of folate is usually met. The recommended daily amount of folate for adults is 400 mcg.

How Much Folic Acid Should Be Taken Before, After, and During Pregnancy?

Generally, the recommended dose for women is as follows:

  • While planning pregnancy - 400 to 800 mcg.
  • First trimester – 400 mcg.
  • Second and third trimester – 600 mcg.
  • While breastfeeding – 500 mcg.
  • Women having spina bifida or had a baby with neural tube defect or have a family member with spina bifida – 4000 mcg.

This dosage can vary depending on your condition, so always take medicines under medical supervision.

Are There Any Drug Interactions with Folate?

Folate supplements can interact with various medications. Few of the examples are as follows:

  1. Methotrexate: Folic acid might decrease the effectiveness of Methotrexate.

  2. Anti-Seizure Medications: Medicines like Phenytoin, Carbamazepine, and Valproate, which are used to treat seizures, may reduce the blood levels of folate. So, taking folate supplements minimizes the effectiveness of these medicines.

  3. Sulfasalazine: Sulfasalazine is used for ulcerative colitis. It can reduce the folate absorbing ability of the body and cause folate deficiency.

It is best to get the daily Vitamin B9 requirement from food. So, add dark leafy vegetables, meat, and other folate-rich food in your diet. A balanced diet contains vitamins, minerals, fiber, and other substances required for a healthy life. Take folate supplements only if prescribed by your physician. Tell your doctor about all the other medicines that you are taking, as it can interfere with folate and might cause side effects.

What If I Do Not Get Enough Folate?

Folate deficiency can result in anemia, which is a blood disorder that causes weakness, trouble concentrating, headache, palpitations, and shortness of breath. It can also cause ulcers in the mouth and might change the color of the skin, hair, and nails. Women with folate deficiency are at risk of having babies with neural tube defects like spina bifida and anencephaly. It also increases the chances of having a premature baby or a low weight baby.

Spina Bifida: The condition where a baby’s spinal column does not close fully during development in the womb, is called spina bifida. It leaves the baby’s spinal cord exposed; as a result, the nerves controlling the legs and other organs do not work. Such children have lifelong disabilities and need many corrective surgeries.

Anencephaly: In this condition, a part or the entire brain and skull do not develop in the womb. Such babies die before or soon after birth.

Can Taking Too Much Folate Be Harmful?

You should not consume more than 1000 mcg of folic acid a day unless prescribed by your doctor. Some precautions and side effects have to be considered before taking folate:

  1. Mask Vitamin B12 Deficiency: Megaloblastic anemia can be caused by both folate and vitamin B12 deficiency. Just taking folate for anemia might hide vitamin B12 deficiency. Vitamin B12 deficiency can lead to permanent damage to the brain, nerves, and the spinal cord.

  2. Risk of Cancer: High doses of folate might increase the risk of colorectal cancer and a few other types of cancer. It can also increase the growth of any pre-existing cancer.

  3. Reduce Immunity and Brain Function: As folic acid takes time to be converted into its active form, it gets accumulated in the bloodstream. This is linked to poor immunity and reduced brain function.

Oral folate supplements may cause a bad taste in the mouth, confusion, loss of appetite, irritability, nausea, skin rash, etc.

Last reviewed at: 25.Dec.2018



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