Folic Acid Requirement

Folic acid, folate and folacin refer to one of the b-vitamins required for a healthy body. Folic acid aids in the prevention of birth defects called neural tube defects (NTDs) such as spina bifida and anencephaly.

Whether or not a woman is expecting a child, it is recommended that women of child-bearing age take folic acid every day in order to help prevent NTDs. It is recommended that women take 0.6mg (600mcg) folic acid daily prior to conception and through the first 3 months of pregnancy.

Although folic acid is found in vegetables, fruits, grain products, meat and meat alternatives, it is difficult to get the entire amount from food. Cooking foods at high heat on the stove or in a microwave, or with too much water, will reduce folate content. Try to eat vegetables lightly steamed or raw.

To get the required daily intake, it is recommended that both men and women consume good sources of folic acid every day, as well as a multivitamin supplement which contains 0.2mg (200mcg) or more of folic acid. Taking more than 1mg (1000mcg) of folic acid is not recommended unless prescribed by your physician.

 


Signs, symptoms & indicators of Folic Acid Requirement

Lab Values - Cells  

Macrocytic red cells



Lab Values - Nutrients  

Low folic acid level or history of folic acid deficiency



Counter Indicators
Lab Values - Nutrients  

Normal/high folic acid level




Conditions that suggest Folic Acid Requirement

Autoimmune  

Gluten Sensitivity / Celiac Disease

Mild malabsorption may result in a folic acid deficiency.



Immunity  

Canker Sores (Aphthous Ulcers)

See the link between apthous ulcers and iron deficiency.



Mental  

Depression

There is substantial scientific evidence linking folic acid deficiency to depression. Folate deficiency is common in depressed individuals. [Journal of Psychiatric Research 1982;20(2): pp.91-101, British Journal of Psychiatry 1991;159: pp.271-2, Nutrition Reviews 1997;55(5): pp.145-9]

Again, a lower dietary folic acid intake was associated with an increased risk of depressive symptoms in a study of over 2,000 middle aged men in Finland. There was no link detected between the intake of cobalamin (B12), pyridoxine (B6) or riboflavin (B2), and depression in this study. [J Nutr 2003;133(10): pp.3233-6]



Musculo-Skeletal  


Risks  

Increased Risk of Leukemia

Maternal folic acid supplementation during pregnancy was associated with a reduced risk of acute lymphoblastic leukemia in children in a study in Western Australia. [Lancet 2001;358(9297): pp.1935-40]




Risk factors for Folic Acid Requirement

Autoimmune  

Crohn's Disease

All inflammatory bowel disease patients are prone to low serum folate levels.



 

Ulcerative Colitis

All inflammatory bowel disease patients are prone to low serum folate levels. The drug sulfasalazine depletes the body of folic acid, so anyone taking sulfasalazine should be supplementing their diet with folic acid.



Medications  

Birth Control Pill / Contraceptive Issues

Birth control pill use tends to cause folic acid depletion.



Supplements and Medications  

(Past) H2-blocker antacid use

There is some evidence that H2 blockers may slightly reduce the absorption of folate. Folate is an important nutrient and one that is commonly deficient in the diet, so if you are taking H2 blockers you should probably take folate supplements as well.



 

Typical/high Metformin use

See the link between this question and Megaloblastic Anemia.



Counter Indicators
Supplements and Medications  

Multiple vitamin supplement use



 

History of folic acid use or folic acid supplementation




Folic Acid Requirement suggests the following may be present

Autoimmune  

Ulcerative Colitis

All inflammatory bowel disease patients are prone to low serum folate levels. The drug sulfasalazine depletes the body of folic acid, so anyone taking sulfasalazine should be supplementing their diet with folic acid.



 

Crohn's Disease

All inflammatory bowel disease patients are prone to low serum folate levels.




Recommendations for Folic Acid Requirement

Vitamins  


Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
Likely to help

Glossary

Folic Acid

A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.

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Neural Tube

The tube of tissue that lies along the central axis of the early embryo. It gives rise to the brain, spinal cord, and other parts of the central nervous system.

Spina Bifida

A nerve tube defect present at birth that results in a gap in the bone that surrounds the spinal cord. Spina bifida is relatively common, occurring about 10 to 20 times per 1,000 births.

Milligram

(mg): 1/1,000 of a gram by weight.

Microgram

(mcg): 1/1,000 of a milligram in weight.

Ulcer

Lesion on the skin or mucous membrane.

Iron

An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.

Cobalamin

Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Pyridoxine

(Vitamin B-6): A B-complex vitamin that plays a role as a coenzyme in the breakdown and utilization of carbohydrates, fats and proteins. It facilitates the release of glycogen for energy from the liver and muscles. It also participates in the utilization of energy in the brain and nervous tissue and is essential for the regulation of the central nervous system.

Vitamin B6

Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.

Riboflavin

(Vitamin B-2): A B-complex vitamin that acts as a coenzyme that activates the breakdown and utilization of carbohydrates, fats and proteins. It is essential for cellular oxidation and necessary for healthy skin and eyes.

Acute

An illness or symptom of sudden onset, which generally has a short duration.

Leukemia

Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).

Serum

The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

H2 Blockers

Medications in this family sharply decrease stomach acid production. They are widely used for the treatment of ulcers as well as for mild cases of esophageal reflux (heartburn). Drugs that fall into this family include cimetidine (Tagamet, Tagamet HB); famotidine (Pepcid, Pepcid AC, Pepcid RPD); nizatidine (Axid, Axid AR); ranitidine hydrochloride (Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75).

Anemia

A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

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