What are the primary uses of folic acid. How does folic acid benefit pregnant women. What are the potential side effects of taking folic acid supplements. When is folic acid supplementation most effective. How does folic acid impact homocysteine levels in the blood.

Understanding Folic Acid: A Vital B Vitamin

Folic acid, a synthetic form of folate (vitamin B9), plays a crucial role in various bodily functions. This essential nutrient is found naturally in many foods and is also added to fortified products. Since 1998, the United States has mandated the addition of folic acid to certain grain products to reduce the risk of birth defects.

Foods rich in folate include:

• Leafy green vegetables
• Asparagus and okra
• Beans and legumes
• Citrus fruits and juices
• Mushrooms
• Animal liver and kidney

Folic acid supplements are also widely available, often combined with other B vitamins for enhanced effectiveness.

The Importance of Folic Acid in Pregnancy

One of the most well-known benefits of folic acid is its role in preventing birth defects. Why is folic acid so crucial during pregnancy? This B vitamin is essential for the proper development of the neural tube, which forms the baby’s brain and spinal cord.

Pregnant women or those planning to conceive are typically advised to consume 600-800 mcg of folic acid daily. This intake can come from a combination of dietary sources and supplements. For women at higher risk of having a child with neural tube defects, healthcare providers may recommend a higher dosage of 4000-5000 mcg per day.

Folic Acid’s Impact on Neural Tube Defects

How effective is folic acid in preventing birth defects? Studies have shown that adequate folic acid intake can reduce the risk of neural tube defects, such as spina bifida, by up to 70%. This significant reduction underscores the importance of folic acid supplementation before and during early pregnancy.

Folic Acid and Homocysteine Levels

Beyond its role in pregnancy, folic acid has been linked to cardiovascular health through its effect on homocysteine levels. High levels of homocysteine in the blood (hyperhomocysteinemia) have been associated with an increased risk of heart disease and stroke.

How does folic acid affect homocysteine levels? Folic acid supplementation has been shown to effectively lower homocysteine levels in individuals with normal or elevated levels, including those with kidney failure. This reduction in homocysteine may contribute to a decreased risk of cardiovascular events, although more research is needed to fully understand this relationship.

Cognitive Function and Folic Acid

The potential cognitive benefits of folic acid have garnered significant attention in recent years. Can folic acid supplementation improve memory and thinking skills in older adults?

Research suggests that folic acid intake, either alone or in combination with other supplements, may enhance memory and cognitive function in older individuals experiencing a more rapid decline in mental abilities than expected for their age. However, it’s important to note that folic acid supplementation doesn’t appear to prevent the normal age-related cognitive decline in healthy older adults.

Folic Acid and Depression

Another area of interest is the potential role of folic acid in managing depression. Some studies have indicated that taking folic acid alongside antidepressant medications may improve symptoms in certain individuals with depression. This suggests that folic acid might play a supportive role in mental health treatment, although more research is needed to fully understand its effects.

Folic Acid in Cardiovascular Health

Beyond its impact on homocysteine levels, folic acid has been studied for its potential effects on blood pressure and stroke risk. How does folic acid influence cardiovascular health?

Research has shown that daily folic acid supplementation for at least six weeks may help reduce blood pressure in some individuals with hypertension who are not taking other blood pressure medications. This effect could contribute to overall cardiovascular health and potentially reduce the risk of related complications.

Regarding stroke prevention, the benefits of folic acid supplementation appear to be more pronounced in regions where grain products are not fortified with folic acid. In these areas, folic acid supplements have been associated with a reduced risk of stroke. However, in countries with mandatory folic acid fortification, such as the United States, the additional benefits of supplements for stroke prevention are less clear.

Folic Acid in Medical Treatments

Folic acid plays a role in certain medical treatments, particularly in managing side effects of specific medications. How does folic acid interact with these treatments?

Methotrexate Toxicity

For patients undergoing treatment with methotrexate, a drug used for cancer and autoimmune diseases, folic acid supplementation can be beneficial. Taking folic acid orally has been shown to reduce nausea and vomiting associated with methotrexate treatment, improving patient comfort and potentially enhancing treatment adherence.

Phenytoin-Induced Gum Enlargement

In individuals taking the anti-seizure medication phenytoin, gum enlargement can be a troublesome side effect. Topical application of folic acid to the gums has shown promise in preventing this issue, although oral supplementation doesn’t appear to have the same protective effect.

Potential Side Effects and Precautions

While folic acid is generally considered safe and essential for many bodily functions, it’s important to be aware of potential side effects and precautions. What should individuals know about folic acid supplementation?

Most people tolerate folic acid well, with side effects being rare when taken at recommended doses. However, some individuals may experience:

• Nausea
• Loss of appetite
• Bloating
• Gas
• Sleep disturbances

It’s crucial to note that high doses of folic acid can mask vitamin B12 deficiency, potentially leading to neurological complications if left untreated. Therefore, it’s recommended to consult with a healthcare provider before starting any new supplement regimen, especially for individuals with pre-existing health conditions or those taking medications.

Folic Acid and Cancer Risk

The relationship between folic acid and cancer risk is complex and an area of ongoing research. While adequate folate intake is important for DNA synthesis and repair, which may help prevent certain cancers, some studies have suggested that excessive folic acid intake could potentially promote the growth of existing precancerous lesions.

Current evidence does not support the use of folic acid supplements for cancer prevention. For instance, taking folate during pregnancy does not appear to reduce the risk of leukemia in children. As with any supplement, it’s important to follow recommended dosages and consult with a healthcare provider, especially if there are concerns about cancer risk.

Folic Acid in Specific Populations

The benefits and considerations of folic acid supplementation can vary among different population groups. How does folic acid impact specific demographics?

Elderly Population

In older adults, folic acid supplementation has shown mixed results. While it may improve cognitive function in some individuals with more severe cognitive decline, it doesn’t appear to prevent the normal age-related decline in mental function. Additionally, folic acid supplementation, even when combined with other B vitamins, does not seem to prevent falls or reduce the risk of osteoporosis-related fractures in the elderly.

Individuals with Vitiligo

For people with vitiligo, a condition causing white patches on the skin, oral folic acid supplementation has shown promise in improving symptoms. This suggests that folic acid may play a role in skin health and pigmentation, although more research is needed to fully understand its effects.

Men with Fertility Issues

Despite some initial interest, current evidence does not support the use of folic acid, either alone or in combination with other supplements, for improving male fertility. Men experiencing fertility issues should consult with a healthcare provider for appropriate evaluation and treatment options.

In conclusion, folic acid plays a vital role in numerous bodily functions and offers significant benefits, particularly in preventing birth defects and managing certain health conditions. However, its effects can vary depending on the specific health context and population group. As with any supplement, it’s essential to consult with a healthcare provider to determine the appropriate use and dosage of folic acid based on individual health needs and circumstances.

Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Folate and folic acid are forms of vitamin B9 used for deficiency and to prevent pregnancy complications. Many foods contain folate or have folic acid added.

Since 1998, folic acid has been added to cold cereals, flour, breads, pasta, bakery items, cookies, and crackers, as required by federal law. Foods that are naturally high in folate include leafy vegetables, okra, asparagus, certain fruits, beans, yeast, mushrooms, animal liver and kidney, orange juice, and tomato juice. Folic acid is also available as a supplement, and is often used in combination with other B vitamins.

Folic acid is used for preventing and treating low blood levels of folate (folate deficiency) and high blood levels of homocysteine (hyperhomocysteinemia). People who are pregnant or might become pregnant take folic acid to prevent serious birth defects such as spina bifida. Folic acid is also used for many other conditions including depression, stroke, decline in memory and thinking skills, and many others.

Uses & Effectiveness ?

Effective for

• Folate deficiency. Taking folic acid improves folate deficiency.

Likely Effective for

• High levels of homocysteine in the blood (hyperhomocysteinemia). This condition has been linked to heart disease and stroke. Taking folic acid by mouth lowers homocysteine levels in people with normal or high homocysteine levels and in people with kidney failure.
• Toxicity caused by the drug methotrexate. Taking folic acid by mouth seems to reduce nausea and vomiting from methotrexate treatment.
• Birth defects of the brain and spine (neural tube birth defects). Consuming folic acid 600-800 mcg by mouth daily during pregnancy reduces the risk of these birth defects. Folic acid can come from the diet or supplements. Some people who are at high risk should get 4000-5000 mcg daily.

Possibly Effective for

• Decline in memory and thinking skills in older people. Taking folic acid by mouth, with or without other supplements, may improve memory and thinking skills in older people who have a larger decline in thinking skills than expected at that age. But it doesn’t seem to work in older people who are experiencing the usual decline in thinking skills for their age.
• Depression. Taking folic acid by mouth along with antidepressants seems to improve symptoms in some people with depression.
• High blood pressure. Taking folic acid by mouth daily for at least 6 weeks reduces blood pressure in some people with high blood pressure who are not taking other blood pressure medications.
• Gum enlargement caused by the drug phenytoin. Applying folic acid to the gums seems to prevent this issue. But taking folic acid by mouth doesn’t seem to help.
• Stroke. In areas of the world that don’t add folic acid to grain products, taking folic acid supplements can reduce the risk of stroke. But supplements don’t seem to be helpful for people who live in countries that do add folic acid to grain products.
• A skin disorder that causes white patches to develop on the skin (vitiligo). Taking folic acid by mouth seems to improve symptoms of this condition.

Possibly Ineffective for

• Low levels of healthy red blood cells (anemia) due to iron deficiency. Adding folic acid to an iron supplement does not help to treat anemia any better than taking an iron supplement alone.
• Decline in memory and thinking skills that occurs normally with age. Taking folic acid by mouth doesn’t seem to prevent a decline in mental function that occurs normally in healthy aging adults.
• Cataracts. Taking folic acid by mouth with vitamin B6 and vitamin B12 does not prevent cataracts. In fact, it might increase the number of cataracts that need to be removed.
• Diarrhea. Taking folic acid by mouth doesn’t seem to prevent diarrhea in children who are at risk of malnutrition. In fact, it may even increase the risk of having diarrhea that lasts more than a few days.
• Fall prevention. Taking folic acid by mouth with vitamin B12 does not seem to prevent falls in older people who are also taking vitamin D.
• Male infertility. Taking folic acid by mouth, alone or with other ingredients, does not seem to improve male fertility.
• Death of an unborn or premature baby. Taking folic acid by mouth during pregnancy does not seem to reduce the risk of a baby dying just before or after birth. But it does help prevent other health issues in the baby.
• Cancer of the white blood cells (leukemia). Taking folate by mouth during pregnancy does not reduce the risk of this type of cancer in children.
• Weak and brittle bones (osteoporosis). In elderly individuals with osteoporosis, taking folic acid by mouth with vitamin B12 and/or vitamin B6 does not seem to prevent broken bones.
• Physical performance in elderly adults. Taking folic acid by mouth with vitamin B12 doesn’t seem to help older people walk better or have stronger hands.
• High blood pressure during pregnancy. High-dose folic acid supplements do not seem to reduce blood pressure during pregnancy, or the risk of developing a condition called pre-eclampsia.
• Infection of the airways. Taking folic acid by mouth doesn’t seem to prevent infections in the lungs in children at risk of malnutrition.

Likely InEffective for

• Non-cancerous growths in the large intestine and rectum (colorectal adenoma). Taking folic acid supplements does not prevent growths in the large intestine or rectum.
• An inherited condition marked by learning disabilities (fragile-X syndrome). Taking folic acid by mouth does not improve symptoms of fragile X syndrome.
• Preterm birth. Taking folic acid by mouth during pregnancy does not decrease the risk of having a premature baby. But it does help to prevent other health issues in the baby.

There is interest in using folic acid for a number of other purposes, but there isn’t enough reliable information to say whether it might be helpful for these uses.

Side Effects

When taken by mouth: It is likely safe for most people to take folic acid in doses of no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior changes, skin reactions, seizures, and other side effects.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe for most people in doses up to about 400 mcg daily.

There is some concern that taking too much folic acid for a long time might cause serious side effects. Some research suggests that taking folic acid in doses of 0.8-1.2 mg daily might increase the risk for cancer or increase the risk of heart attack in people who have heart problems.

Special Precautions and Warnings

When taken by mouth: It is likely safe for most people to take folic acid in doses of no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior changes, skin reactions, seizures, and other side effects.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe for most people in doses up to about 400 mcg daily.

There is some concern that taking too much folic acid for a long time might cause serious side effects. Some research suggests that taking folic acid in doses of 0.8-1.2 mg daily might increase the risk for cancer or increase the risk of heart attack in people who have heart problems. Pregnancy and breast-feeding: Folic acid 300-400 mcg daily is recommended during pregnancy to prevent certain birth defects. The maximum recommended amount of folic acid during pregnancy or breastfeeding is 800 mcg daily for those under 18 years of age and 1000 mcg daily for those over 18 years of age. Do not use more unless directed by a healthcare professional.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe to take at a dose of up to 400 mcg daily when pregnant or breastfeeding.

Children: It is likely safe for children to take folic acid by mouth in the recommended amounts for their age. But children should avoid taking folic acid in doses that are higher than the daily upper limits. These limits are 300 mcg for 1-3 years of age, 400 mcg for 4-8 years of age, 600 mcg for 9-13 years of age, and 800 mcg for 14-18 years of age.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe in children.

Procedures to widen narrowed arteries (angioplasty): Using folic acid, vitamin B6, and vitamin B12 might worsen narrowed arteries. Folic acid should not be used by people recovering from this procedure.

Cancer: Early research suggests that taking 0.8-1 mg of folic acid daily might increase the risk of cancer. Until more is known, people with a history of cancer should avoid high doses of folic acid.

Seizure disorder: Taking folic acid supplements, especially in high doses, might make seizures worse in people with seizure disorders.

Vitamin B12 deficiency: Taking folic acid supplements might improve certain lab tests in people with low vitamin B12 levels. This may make it seem like vitamin B12 deficiency is improved when it isn’t. If left untreated, this could cause permanent nerve damage.

Interactions ?

Moderate Interaction

Be cautious with this combination

• Fosphenytoin is used for seizures. The body breaks down fosphenytoin to get rid of it. Folic acid can increase how quickly the body breaks down fosphenytoin. Taking folic acid along with fosphenytoin might decrease the effects of fosphenytoin for preventing seizures.

• Phenobarbital is used for seizures. Taking folic acid can decrease how well phenobarbital works for preventing seizures.

• The body breaks down phenytoin to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin. Taking folic acid and taking phenytoin might decrease the effectiveness of phenytoin and increase the possibility of seizures.

• Primidone is used for seizures. Folic acid might cause seizures in some people. Taking folic acid along with primidone might decrease how well primidone works for preventing seizures.

• Pyrimethamine is used to treat parasite infections. Folic acid might decrease the effects of pyrimethamine for treating parasite infections.

• There is some concern that taking large amounts of folic acid with 5-fluorouracil might increase some side effects of 5-fluorouracil, especially stomach problems. Talk with your healthcare provider before taking folic acid.

• There is some concern that taking large amounts of folic acid might increase the side effects of capecitabine, especially stomach problems like diarrhea and vomiting. Talk with your healthcare provider before taking folic acid.

Dosing

Folic acid is an important nutrient. The amount that should be consumed on a daily basis is called the recommended dietary allowance (RDA). The RDA for folic acid is provided as Dietary Folate Equivalents, or DFE. This is because the body absorbs the folic acid in supplements better than the folate found in food. 1 mcg DFE is the same as 1 mcg of folate found in food. But 1 mcg DFE is the same as 0.6 mcg of folic acid supplements.

The RDA in adults is 400 mcg DFE daily. In pregnancy, the RDA is 600 mcg DFE daily. When breastfeeding, the RDA is 500 mcg DFE daily. In children, the RDA depends on age. Speak with a healthcare provider to find out what dose might be best for a specific condition.

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.
© Therapeutic Research Faculty 2020.

4 Potential Side Effects of Too Much Folic Acid

Taking high doses of folic acid supplements may cause side effects, including accelerating mental decline in older adults and increasing the likelihood of cancer recurring.

Folic acid is the synthetic form of vitamin B9, and it’s only found in vitamin supplements and some fortified foods.

When vitamin B9 occurs naturally in foods, it’s called folate. You get folate from beans, oranges, asparagus, Brussels sprouts, avocados, leafy greens, and more.

Regardless of whether it’s in the form of folate or folic acid, vitamin B9 is important for cell and DNA formation in your body (1).

Low blood levels of folate have been linked to health issues like a higher risk of birth defects, heart disease, stroke, and certain cancers (2, 3, 4, 5, 6).

On the other hand, high blood levels of folate are not a concern for most healthy adults. Still, consuming excessive amounts of folic acid from supplements can be harmful.

Here are 4 potential side effects of too much folic acid.

Your body doesn’t absorb folate as easily as it absorbs folic acid.

It’s estimated that about 85% of folic acid from fortified foods or supplements is absorbed, while only 50% of natural folate from foods is used by your body (1).

After folic acid is absorbed into your bloodstream, it’s broken down into smaller compounds by your liver. However, the liver is only able to process a certain amount of folic acid at a time (7).

As a result, consuming too much folic acid from fortified foods and supplements can cause unmetabolized folic acid (UMFA) to accumulate in your blood. This doesn’t happen when you eat high folate foods (7).

This is concerning because high blood levels of UMFA appear to be linked to various health concerns (1, 8, 9, 10, 11).

Dietary folate equivalents

Because folic acid is more readily absorbed than folate from food, the Food and Nutrition Board (FNB) at the National Academies of Sciences, Engineering, and Medicine have developed dietary folate equivalents (DFEs) to set clearer folate intake recommendations (1).

1 mcg DFEs equals (1):

• 1 mcg of folate from foods
• 0.6 mcg of folic acid from fortified foods or dietary supplements consumed with foods
• 0. 5 mcg of folic acid from dietary supplements taken on an empty stomach

There is no upper limit (UL) established for naturally occurring folate from foods.

However, the National Institutes of Health (NIH) recommends that adults over the age of 19 limit their intake of folic acid from fortified foods and supplements to 1,000 mcg per day. The UL for children is even less, ranging from 300–800 mcg depending on age (12)

Keep in mind that most people don’t consume more than 1,000 mcg of folic acid per day unless they’re taking supplements in high doses.

In fact, according to the NIH, it’s estimated that only about 5% of men and women ages 51–70 take more than this amount per day, mostly due to the use of supplements (1).

summary

Your body absorbs folic acid from fortified foods and supplements easier than it absorbs naturally occurring folate from foods. Getting too much folic acid can cause unmetabolized folic acid (UMFA) to build up in your body, which might harm health.

High folic acid intake may mask a vitamin B12 deficiency.

Your body uses vitamin B12 to make red blood cells and keep your heart, brain, and nervous system functioning optimally (13).

If left untreated, vitamin B12 deficiency can lead to irreversible nerve damage, which makes a delayed diagnosis particularly worrisome (13).

Your body uses folate and vitamin B12 similarly, meaning that a deficiency in either can cause similar symptoms.

For this reason, folic acid supplements may mask vitamin-B12-induced megaloblastic anemia and cause an underlying vitamin B12 deficiency to go undetected (14, 15, 16).

Megaloblastic anemia is a condition characterized by enlarged red blood cells. It can cause symptoms like weakness, fatigue, difficulty concentrating, and shortness of breath (14, 15).

If you take folic acid supplements and recognize any of these symptoms, consider getting your B12 levels checked.

summary

High intakes of folic acid may mask a vitamin B12 deficiency. In turn, this could increase your risk of brain and nervous system damage.

Excess folic acid intake may speed age-related mental decline, particularly in people with low vitamin B12 levels.

One study in people over the age of 60 linked high blood levels of folate or UMFA to mental decline in those with low vitamin B12 levels. This link was not seen in those with normal B12 levels (17).

Another study suggested that people with high folate and low vitamin B12 levels may be up to 3.5 times more likely to experience a loss of brain function than those with normal blood parameters (18).

However, keep in mind that more studies are needed before it can be said with certainty that supplementing with high amounts of folic acid could be detrimental to mental health.

summary

A high intake of folic acid may speed up age-related mental decline, particularly in individuals with low vitamin B12 levels. Nonetheless, further research is necessary.

Adequate folate intake during pregnancy is necessary for your baby’s brain development. It also reduces the risk of birth defects (19, 20, 21, 22).

Because many women don’t meet their folate needs through food sources alone, those of childbearing age are often encouraged to take folic acid supplements (1).

However, supplementing with too much folic acid while pregnant may increase insulin resistance and slow brain development in children.

In one study, 4- and 5-year-olds whose mothers supplemented with over 1,000 mcg of folic acid per day while pregnant scored lower on brain development tests than the children of women who took 400–999 mcg per day (10).

Another study linked higher blood levels of folate during pregnancy to a greater risk of insulin resistance in children ages 9–13 (11).

Though further research is needed, it may be best to avoid taking more than the recommended daily dose of 600 mcg of folic acid supplements during pregnancy unless advised otherwise by a health professional.

summary

Folic acid supplements are a practical way to boost folate levels during pregnancy, but excessive doses may increase insulin resistance and negatively affect brain development in children.

Folic acid’s role in cancer development and recurrence appears to be twofold.

Research suggests that exposing healthy cells to adequate levels of folic acid may protect them from becoming cancerous. However, exposing cancerous cells to high levels of folic acid may help them grow or spread (23, 24).

Still, research is mixed. While a few studies note a small increase in cancer risk in people taking folic acid supplements, most studies haven’t found a link (2, 25, 26, 27).

It’s speculated that the risk may depend on the type of cancer and your health history.

For instance, some older studies suggest that people previously diagnosed with prostate or colorectal cancer who supplemented with more than 1,000 mcg of folic acid per day had a 1. 7–6.4% higher risk of cancer recurrence (28, 29).

Still, eating lots of folate-rich foods doesn’t appear to increase cancer risk. It may even reduce it (30, 31, 32).

Ultimately, more research is needed on the potential link between folate, folic acid supplements, and cancer risk and recurrence.

summary

Excessive folic acid supplement intake may increase cancer cells’ ability to grow and spread, which could be particularly detrimental to people with a history of cancer. Still, more research is needed.

Folic acid is included in most multivitamins, prenatal supplements, and B complex vitamins, but it’s also sold as a supplement. In certain countries, some foods are also fortified with the vitamin.

Folic acid supplements are typically recommended to prevent or treat low blood folate levels. Moreover, those who are pregnant or are planning to become pregnant often take them to reduce the risk of birth defects (1).

The Recommended Dietary Allowance (RDA) for folate is 400 mcg for those over 14. People who are pregnant and breastfeeding should get 600 and 500 mcg, respectively. Supplement doses typically range from 400–800 mcg (1).

You can purchase folic acid supplements without a prescription. They’re generally considered safe when taken in normal doses (33).

That said, they can interact with some prescription medications, including some that are used to treat seizures, rheumatoid arthritis, and parasitic infections. Thus, if you’re taking other medications, it’s best to consult a health professional before using folic acid supplements (1).

summary

Folic acid supplements are used to reduce the risk of birth defects and prevent or treat folate deficiency. They’re generally considered safe if taken in recommended amounts but may interact with some prescription drugs.

Folic acid supplements are generally safe and can be a convenient way to maintain adequate folate levels.

However, getting too much folic acid may cause several side effects, including slower brain development in children and accelerated mental decline in older adults.

While further research is needed, you can work with your healthcare professional to determine your folate levels and whether you need to take a supplement.

Just one thing

Try this today: Adding more folate-rich foods to your diet is a great way to increase your intake of folate safely and naturally. Check out this article for a list of the top healthy foods high in folate.

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Folic acid – laboratory article DNAOM

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Published:
02/15/2022

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Updated:

05/08/2022

• Pregnancy
• Vitamins and trace elements

General

Folic acid (vitamin B9) is a water-soluble vitamin involved in the synthesis of DNA and individual amino acids.

Folic acid is indicated for:

• vitamin B9 deficiency in the body,
• during pregnancy,
• for foodborne anemia, infancy and early childhood,
• for megaloblastic anemia,
• when taking anti-epileptic drugs.

Folic acid is a member of the B vitamin family and an important cofactor for enzymes involved in DNA and RNA synthesis. More specifically, it is required by the body for the synthesis of purines, pyrimidines, and amino acids before incorporation into DNA or protein. A high folic acid content is especially important during periods of rapid cell division such as infancy, pregnancy and erythropoiesis. Because humans cannot synthesize folic acid endogenously, a special diet and nutritional supplements are needed to prevent deficiency. For example B9found in green vegetables, beans, avocados and some fruits, mushrooms, liver and kidneys, tomato and orange juice.

Folic acid deficiency can cause a number of health problems:

• cardiovascular disease;
• megaloblastic anemias;
• cognitive impairment;
• neural tube defects.

Folic acid is usually given during pregnancy to prevent the development of neural tube defects and in people with alcoholism to prevent the development of neurological disorders.

Folic acid can be combined with iron supplements to treat iron deficiency anemia, as well as other vitamins and minerals.

Folic acid is rapidly absorbed from the small intestine, primarily from the proximal intestine. Naturally occurring conjugated folates are enzymatically reduced to folic acid in the gastrointestinal tract and then absorbed. Folic acid appears in plasma approximately 15-30 minutes after oral administration; peak levels are usually reached within 1 hour.

Folic acid is metabolized in the liver to the coenzymes dihydrofolate and tetrahydrofolate by the enzyme dihydrofolate reductase. These substances are actively involved in metabolic processes, the maturation of megaloblasts and the formation of the neural tube in the fetus.

Indications for use

Folic acid is prescribed when there is a deficiency of this substance in the body. The reason for this may be a number of the following conditions and diseases:

• celiac disease;
• tropical sprue;
• amyloidosis;
• insufficiency of mesenteric vessels;
• taking methotrexate, phenytoin, sulfasalazine and trimethoprim;
• congenital deficiency of enzymes necessary for the metabolism of folic acid;
• high levels of homocysteine ​​in the blood, which is associated with the development of cardiovascular diseases;
• prevention of congenital defects of the neural tube in the fetus;
• decreased memory and thinking skills in the elderly;
• depression;
• treatment of megaloblastic anemia;
• intestinal tuberculosis;
• epilepsy;
• high blood pressure;
• alcohol intoxication;
• psoriasis.

The therapeutic dose of folic acid for adults usually does not exceed 5 mg per day, and for children under 1 year old, this dose is much less and is determined by the attending physician. Folic acid is taken after meals with a small amount of liquid. Pregnant women are recommended from 300 to 800 micrograms of folic acid per day, depending on the trimester. For a healthy person, the daily dose of folic acid should not exceed 1 mg.

Contraindications for taking folic acid

• allergic reaction to folic acid;
• pernicious anemia;
• oncological disease;
• patient on hemodialysis;
• the patient undergoes angioplasty procedures;
• convulsive disorder.

Side effects

Folic acid can cause serious side effects, including:

• redness;
• skin rash;
• itching;
• bad feeling;
• labored breathing;
• loss of appetite;
• nausea;
• bloating;
• increased gas formation;
• bitter or unpleasant taste in the mouth;
• insomnia;
• difficulty concentrating;
• irritability;
• hyperactivity;
• excitation;
• depression.

Overdose

For most people, it is safe to take folic acid at a dose of no more than 1 mg per day. Overdose can cause indigestion, nausea, diarrhea, irritability, confusion, behavioral changes, skin reactions, seizures, and other side effects. Some studies show that long-term (excess) folic acid in doses of 0.8–1.2 mg per day may increase the risk of cancer or heart attack in people with heart problems.

Slimming folic acid

At the moment, there are no clinical studies confirming the therapeutic effect of folic acid for weight loss. However, many nutritionists recommend it in complex therapy for overweight people, and patients show impressive results. Most likely, the effect of the complex action of folic acid, its participation in metabolism and lipolysis (fat breakdown) affects.

Folic acid for pregnancy planning

The neural tube of the fetus begins to develop in the first 4 weeks of pregnancy. Therefore, doctors recommend starting folic acid intake already at the stage of pregnancy planning, at least three months before the intended conception. Lack of this substance in the first trimester doubles the risk of a neural tube defect and can also contribute to other pregnancy pathologies such as miscarriage, miscarriage, etc.

Folic acid for men

Folic acid, together with vitamin B12, regulates the amount of homocysteine ​​in the body, preventing the development of cardiovascular diseases, especially in men. Folic acid also helps prevent Alzheimer’s disease and is an important tool in the fight against depression. Folic acid deficiency in men (as in women) can cause a range of symptoms of anemia, including severe headache, lethargy, and fatigue. In addition, folic acid promotes the formation and restoration of DNA.

Get tested for folic acid.

Author:

Latynina Yulia Sergeevna

Specialization:

biologist of clinical laboratory diagnostics

• Pregnancy
• Vitamins and trace elements

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List of sources

1)
I.V. Kuznetsova, V. A. Konovalov. Folic acid and its role in female reproduction // Gynecology. – 2014, Vol. 16, No. 4.

2)
Naderi N., House J. D. Recent developments in folate nutrition // Advances in food and nutrition research. – 2018. – T. 83. – S. 195-213.

3)
Clinical guidelines. Folate deficiency anemia in children. − 2016.

4)
A M Molloy, D G Weir, J M Scott. Homocysteine, folate enzymes and neural tube defects // Haematologica. – 1999, Jun.

5)
https://www.mayoclinic.org/drugs-supplements-folate/art-20364625

6)
https://www.nhs.uk/medicines/folic-acid/

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Side effects from excessive folic acid intake.

What can cause an excess of folic acid

Folic acid is a form of vitamin B9, which plays an important role in the formation of cells and DNA. This acid is found in vitamins and some natural products. However, vitamin B9 is often referred to as folate when it is found in foods. The highest content of this substance is observed in beans, legumes, oranges, asparagus, Brussels sprouts, avocados and greens.

The Daily Value (RDI) for this vitamin is 400 micrograms. At the same time, pregnant and lactating women should receive daily 600 and 500 micrograms of folic acid, respectively.

Low levels of folic acid in the blood can increase the risk of birth defects in children, heart disease, stroke and even some cancers. Despite this, its excess can also negatively affect your health.

Consider four side effects of taking too many vitamin B9 supplements.

What can cause too much folic acid

The human body absorbs folate and folic acid slightly differently. So, all the folate you get is broken down and converted to its active form in the intestines before it enters the bloodstream. At the same time, folic acid is converted to an active form to a lesser extent, regardless of whether it was obtained from supplements or from natural products. During the transformation process, the body uses the liver and some other tissues, which speeds up the process of assimilation of nutrients.

Due to these characteristics, high vitamin B9 supplements or fortified foods may cause accumulation of unmetabolized folic acid (UFA) in the blood, which is not the case with natural foods containing this acid. According to scientists, it is the high level of UFA that is the main reason for the deterioration of health.

Too much folic acid can mask vitamin B12 deficiency

High folic acid intake can mask vitamin B12 deficiency. In the human body, this vitamin is necessary for the formation of red blood cells, the normalization of the heart, brain and nervous system. Left untreated, vitamin B12 deficiency can reduce the quality of brain function and lead to permanent damage to nerve cells. The latter effect is usually irreversible, making delayed diagnosis of vitamin B12 deficiency particularly dangerous.

The body uses folic acid and vitamin B12 in very similar ways, which means that a deficiency in either can lead to similar symptoms. Research data show that vitamin B9 supplements can mask megaloblastic anemia caused by vitamin B12 deficiency. This can cause vitamin B12 deficiency to go unnoticed.

Therefore, people experiencing symptoms such as weakness, fatigue, difficulty concentrating and shortness of breath should have their vitamin B12 levels checked periodically.

May accelerate age-related brain decline B12. A study in healthy people over the age of 60 found that high levels of the vitamin folic acid in the body are associated with poor brain function in people with low B12 levels. At the same time, the abuse of appropriate supplements does not have any negative effect on individuals with normal B12 levels.

In this study, participants with high blood folic acid levels achieved their levels by consuming fortified foods and supplements rather than by eating natural foods high in vitamin B9.

Another study suggests that people with high blood levels of folic acid and low levels of B12 are more likely to have impaired brain function than people whose levels of these vitamins are normal.

Study authors warn that taking folic acid may harm the mental health of older adults with low B12 levels. However, other studies have linked overuse of folic acid supplements to the development of mental disorders.

It should be borne in mind that a number of additional studies will be required for unambiguous conclusions.

May increase the risk of developing cancer

The effect of folic acid on cancer is controversial. Research shows that exposing healthy cells to adequate amounts of folic acid can protect them from cancer. However, exposure to vitamin B9 on cancer cells can speed up their growth or spread.

However, the study is mixed. While some studies have noted a slight increase in cancer risk in people who take folic acid supplements, most other studies report no association.

The risks of taking folic acid therefore depend on the type of cancer and personal medical history. For example, studies show that in people who had previously been diagnosed with prostate or colorectal cancer, taking more than 1000 mcg of folic acid per day increased the risk of recurrence by 1.7-6.4%. However, more research is needed for more specific conclusions.

Keep in mind that eating a lot of folate-rich foods does not increase the risk of cancer and in some cases even reduces it.

Too much folic acid can slow brain development in children various violations. Because many women fail to get 600 micrograms of vitamin B9only from food, they are often advised to include appropriate supplements in their diet. But keep in mind that getting too much folic acid can increase insulin resistance and slow brain development in children.

In one study, 4- and 5-year-old children whose mothers took more than 1000 micrograms of folic acid per day during pregnancy, which is more than the allowable amount, scored lower on tests of brain development compared with the children of women who took 400– 999 mcg per day. Another study shows that high folic acid intake, in excess of the recommended amount, during pregnancy causes an increased risk of developing insulin resistance in children aged 9-13 years.

Although further research is needed, it is best to avoid excessive folic acid intake during pregnancy. The exception is the inclusion of a large amount of vitamin B9 in the diet on the recommendation of a doctor.

Directions for use and dosage

Folic acid is found in most prenatal multivitamins and supplements. However, it is also sold as an individual supplement. In some countries, you can even find foods fortified with vitamin B9.

Folic acid supplements are commonly used to prevent or treat low blood levels of vitamin B9. Moreover, pregnant women or those who plan to become pregnant often take them to reduce the risk of developmental defects in the child.
The RDI for folic acid is 400 micrograms per day for adults, 600 micrograms during pregnancy, and 500 micrograms for nursing mothers. At the same time, the doses recommended by doctors usually range from 400–800 mcg.

Folic acid supplements are available without a prescription. Their use in moderation is considered absolutely safe for the body. However, folic acid may interact with certain prescription medications. These include drugs to treat seizures, rheumatoid arthritis, and parasitic infections.

Therefore, before taking folic acid, you should consult your doctor, especially before using it in combination with other medicines.

Conclusion

Folic acid supplements are not harmful to the human body. What’s more, they are a convenient way to maintain normal vitamin B9 levels.

Despite this, excessive folic acid intake can cause several side effects, including slower brain development in children and faster brain deterioration caused by the natural aging process.