Folic Acid

Folic Acid (Folacin or Folate) is another of the key water-soluble B vitamins. It received its name from the Latin word folium, meaning “foliage,” because folic acid is found in nature’s leafy green vegetables, such as spinach, kale, and beet greens. Folacin, a derivative of folic acid, is a dull yellow crystalline substance made up chemically of a pteridine molecule, para-aminobenzoic acid (PABA), and glutamic acid. It is actually a “vitamin within a vitamin,” with PABA as part of its structure.


Folic acid is very sensitive and is easily destroyed in a variety of ways, such as by light, heat, any type of cooking, or an acid pH below 4; it can even be lost from foods when they are stored at room temperature for long periods. The potency of this B vitamin is diminished in most food processing and food preparation.


When folic acid is consumed, it is actively transported into the blood from the gastrointestinal tract, where it acts as a coenzyme for a multitude of functions and often is converted to its active form, tetrahydrofolic acid (THFA), in the presence of the niacin coenzyme (NADPH) and vitamin C. In the body, folic acid is found mainly as methyl folate, and vitamin B12 is needed to convert it back to the active THFA. Extra folic acid is stored in the liver, enough for six to nine months of vitamin for body use before deficiency symptoms might develop.


Folic acid deficiency, however, may still be one of the most common vitamin deficiencies. It is more likely to be a problem in the elderly, in alcoholics, in psychiatric patients, in epileptics, in women on birth control pills, and with drug therapy such as the sulfa antibiotics and tetracyclines that deplete folic acid-producing bacteria in the colon. Pregnancy is a time for concern about sufficient folic acid intake (the RDA doubles during pregnancy). Also, those eating the standard American diet that is high in fats, meats, white flour, white sugar, and desserts may develop folic acid deficiency. Eating some fresh or lightly cooked vegetables daily will allow us to maintain normal folate levels.


Folic acid was discovered in 1931 as a “cure” for the anemia of pregnancy. Eating extra yeast also seemed to relieve the symptoms of pernicious anemia, but the neurological symptoms of this disease either were not resolved or appeared later on, confirming some doctors’ feelings that there were two different problems involved. In 1945, folic acid was isolated from spinach; we now know that B12 and folic acid produce two very similar deficiency problems. B12 deficiency may lead to progressive and irreversible neurological damage, whereas a lack of folic acid will not, but taking a lot of folic acid may cover up the B12 anemia and other symptoms until it is too late for effective treatment with vitamin B12. Therefore, vitamin tablets of folic acid with over 400 mcg. have been taken off the market and are available by prescription only. If megaloblastic (enlarged red blood cells) anemia occurs, both folic acid and vitamin B12 levels should be checked to assure proper treatment and follow-up.


Sources: The best source of folic acid is foliage, the green leafy vegetables. These include spinach, kale, beet greens and even beets, chard, asparagus, broccoli, sources are liver and kidney and brewer’s yeast. Starchy vegetables containing some folacin are corn, lima beans, green peas, sweet potatoes, artichokes, okra, and parsnips. Bean sprouts, such as lentil, mung, and soy, are particularly good, as are wheat germ or flakes and soy flour. Whole wheat bread, other natural, whole grain baked goods, and milk also have some folic acid. And many fruits have folic acid, such as oranges, cantaloupe, pineapple, banana, and many berries, including loganberries, boysenberries, and strawberries.


Remember, folic acid is available from fresh, unprocessed food, which is why it is so commonly deficient in our culture’s processed-food diet. Luckily, though, it is easily absorbed, used, and stored by our body. It is also manufactured by our intestinal bacteria, so if colon flora is healthy, we have another good source of folic acid.


Functions: Folic acid, or more specifically, its coenzyme tetrahydrofolic acid (THFA), has functions very similar to those of cobalamin, vitamin B12. Folic acid aids in red blood cell production by carrying the carbon molecule to the larger heme molecule, which is the iron-containing part of hemoglobin (the oxygen-carrying molecule of the red blood cells).


With B12 and vitamin C, THFA helps in the breakdown and utilization of protein. With B12, it assists in many amino acid conversions, such as the methylation of methionine, serine, histidine, and even the B vitamin choline. Folic acid is also used in the formation of the nucleic acids for RNA and DNA. Actually, the anemia that results from folic acid deficiency comes from the lack of THFA and decreased synthesis of the purines and pyrimidines that make up the DNA. So folic acid has a fundamental role in the growth and reproduction of all cells.


Since folic acid is important to the division of cells in the body, it is even more essential during times of growth, such as pregnancy. Pregnancy is a time of rapid cell multiplication. If there is a deficiency of folic acid, there is decreased nucleic acid synthesis, and cell division is hampered. This deficiency can lead to low birth weight or growth problems in infants.


Uses: Folic acid is, of course, used to restore its deficiencies and treat the problems resulting from them. People who are very stressed or fatigued or who have any loss of adrenal gland function may benefit from additional folic acid. Those who drink alcohol or take high amounts of vitamin C also require more of this vitamin. Also, epileptics on drug therapy require more folic acid, which may help them by improving mood and mental capacities. In patients with psoriasis, folate is used rapidly by the skin, thus is needed in increased amounts. Teenagers on poor diets with no vegetables and the elderly often are helped by folic acid supplementation.




POSSIBLE CLINICAL USES OF FOLIC ACID



































Seborrheic dermatitisElderly
PregnancySkin ulcers
Restless leg syndromeLactation
DepressionDiarrhea
AlcoholismPoor appetite
Cervical dysplasiaFatigue
Cervical cancerAnemia
NeuropathyCanker sores
Birth control pillsGout
AtherosclerosisViral hepatitis
Immune weaknessAcne
DementiaInfection
Organic brain syndromeGingivitis
Periodontal problemsOsteoporosis
Estrogen supplementation






With increased estrogen, as in pregnancy or when taking birth control pills, folic acid supplementation helps prevent deficiency symptoms. More is also required during lactation, which it also aids. Folic acid is often used when there are any menstrual problems. The “restless leg syndrome,” which is characterized by creeping, irritating sensations in the legs and occurs most commonly in later pregnancy, is often helped by increasing folic acid, as it may specifically be a deficiency problem.


With both folic acid deficiency anemia and pernicious anemia, folic acid is usually supplemented along with vitamin B12. The fatigue, easy bruising, and inflammation of the tongue that may go along with anemia are often helped as well. Treatment of various blood diseases, osteoporosis, and atherosclerosis has been supported with folic acid. There is some suggestion that it helps in ischemia, with reports of improved blood flow to the eyes and improved vision in those with circulatory deficits.


Folic acid has been used for chronic diarrhea or malabsorption problems and to stimulate a depressed appetite. It may also be helpful in some cases of depression, dementia and brain disorders, epilepsy, or neuropathies, especially when deficient. Folic acid supports healthy skin and may help in healing skin ulcers, particularly of the leg, or sebborheic dermatitis. Usually 1 mg. tablet daily or an oral folate solution may be helpful in treating gingivitis or other periodontal diseases. It has been suggested and used with varying results, usually along with PABA and pantothenic acid, to prevent the graying of hair. Higher doses may have some use in healing dysplasia (precancerous cell changes) of the cervix, which is often associated with lowered folate levels. Further research is needed to substantiate some of these uses.


Deficiency and toxicity: There are no specific toxic symptoms from folic acid intake, at least up to 5 mg. daily. However, excess folic acid in the face of a B12 deficiency, when B12 is not supplemented and absorbed, may lead to serious consequences. Folic acid will mask the B12-related anemia and early symptoms of vitamin B12 deficiency by helping the synthesis of DNA and red blood cell production, but folic acid has no effect on the myelin sheath covering the nerves, so nerve damage may occur where folic acid covers up a B12 deficiency. Higher doses of folate may also depress B12 levels. In recent research where higher levels (15 mg. daily) of folate have been used, some side effects developed after a month of treatment. These included gastrointestinal symptoms, insomnia, irritability, and malaise.


Folic acid deficiency is fairly common. It generates a picture similar to that of a B12 deficiency—anemia, fatigue, irritability, anorexia, weight loss, headache, sore and inflamed tongue, diarrhea, heart palpitations, forgetfulness, hostility, and a feeling of paranoia. Often, the mental symptoms occur before the anemia, with poor memory (possibly from decreased RNA synthesis), general apathy, withdrawal, irritability, and a decrease in basic mental powers.


Folic acid-deficiency anemia is not correctable with iron, and as it progresses, it will appear very different from iron-deficiency anemia. The blood will show large, irregular red blood cells, while low iron causes small red blood cells. In pregnancy, this megaloblastic anemia is of great concern. Folic acid deficiency is very common during pregnancy, when the requirements are at least double those for the nonpregnant state. Since folic acid stores in the liver can last several months, deficiency symptoms are more likely in later pregnancy. The fetus can readily draw on the folic acid of the mother, and deficiencies can cause problems in both. The mother’s folacin-deficiency mental symptoms of indifference, lack of motivation, withdrawal, or depression may be passed over as hormonal. The anemia may likewise not be considerd a matter for concern. Serious problems can result from a major deficiency. Toxemia of pregnancy, premature birth, and hemorrhage are all possible in addition to the anemia of the mother. The fetus could develop birth deformities, brain damage, or show poor growth as a child. It is very important to supplement folic acid during pregnancy.




In general, folic acid deficiencies can result from:



  • Inadequate nutrition, particularly lack of fresh fruits and vegetables;
  • Poor absorption, as in malabsorption, with intestinal problems, with pellagra, or after stomach or intestinal surgery;
  • Metabolic problems, such as those created by alcohol or drug use; and
  • Excessive demands by tissues, as with stress, illness, or pregnancy.




We should be concerned about folate deficiency primarily in pregnancy, during breast-feeding, and in the elderly. Folic acid absorption seems to diminish with age, and deficiency is common in the elderly, especially those in rest or nursing homes, who are unlikely to get fresh vegetables or supplements. Often, the first manifestation of a low folate level is feeling depressed. Folic acid deficiency is more common in people with depression or other psychological symptoms in mental institutions. Alcoholics have had serious problems maintaining proper folic acid levels. Teenagers with poor diets, who do not eat green vegetables or many vegetables at all other than fried potatoes, may more easily become folic acid deficient. If we suspect deficiencies, it is wise to get a blood folate level as well as a B12 level before treatment with supplements. A red-blood-cell folate level may more accurately reflect body stores of folic acid.


Besides causing mental symptoms, folate deficiency can also affect the skin. As in vitamin B2 (riboflavin) deficiency, cracks or scaling at the lips and corners of the mouth (cheilosis) may occur. Also possible with deficiency are decreased growth, fatigue, and more rapid graying of the hair. More recently, folid acid deficiency (along with vitamin A deficiency) has been associated with cervical dysplasia and cancer.


Requirements: The RDA for folic acid is 400 mcg. in adults, 800 mcg. during pregnancy, and 600 mcg. during lactation. And many factors increase the minimum requirement for folic acid. But the average American diet contains only about half of this, about 220 mcg. This reveals why disorders involving folic acid deficiency are so common.


Between 180 and 200 mcg. of folic acid are needed daily to maintain the tissue stores of folate. During pregnancy, times of stress or illness, or with alcohol use, the demands are increased, and a 200 mcg. daily intake is not sufficient for supporting folic acid functions and maintaining tissue stores. Deficiency symptoms may then occur.


Other things besides stress, illness, and alcohol use create greater need for folic acid. Birth control pills may reduce absorption of this vitamin by 50 percent. Other drugs besides estrogen may interfere with absorption or metabolism. These include the sulfa antibiotics,




RDAs for Folic Acid


















Infants30–50 mcg.
1–3 years100 mcg.
4–6 years200 mcg.
7–10 years300 mcg.
14 years older400 mcg.
Pregnant women800 mcg.
Lactating women600 mcg.






phenobarbital, and antiepileptic drugs such as Dilantin and Mysoline. Consumption of more than 2,000 mg. of vitamin C per day also increases the need for folic acid. Anyone in these situations needs supplements of folic acid.


Most vitamin formulas contain 400 mcg. of folic acid. Higher amounts, such as 1 mg. (1,000 mcg.), 1.5 mg., or even 10 mg., are available only by prescription because of the concern of masking vitamin B12 deficiency. Injectable folate, in doses nutritional medicine. Some doctors describe impressive results in many patients, especially the elderly, with injections of 1,000 mcg. of B12 and 10 mg. of folic acid. The suggested therapeutic dosages for most uses of folic acid or treating deficiency problems is about 1 mg. twice daily; it may take several months for this vitamin therapy to correct the deficiency and replenish stores of folic acid. Some studies are researching folic acid doses of 5–15 mg., and even up to 60 mg. daily.


The elderly, the pregnant, and women on birth control pills should definitely take additional folic acid. And the alcoholic also needs extra folic acid supplementation.

Elson M. Haas MD Written by Elson M. Haas MD

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