Alternative Names: Increased Folic Acid Requirement
Folic acid deficiency is one of the most common of all vitamin deficiencies. Although it occurs in both males and females, folic acid deficiency anemia most often affects women over 30. It becomes increasingly common as age impedes the body's ability to absorb folic acid, a water-soluble vitamin that is manufactured by intestinal bacteria and stored for a short time in the liver.
, 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. Research has shown that adequate amounts of folic acid can prevent up to half of these birth defects, if women start taking folic acid supplements shortly before conception.
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 or, more specifically, its coenzyme THFA, has functions very similar to those of 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
Alongside 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.
Folic acid is necessary for growth and cellular repair, since it is a critical component of DNA and RNA. It is also essential for the formation and maturation of red blood 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.
For this reason, pregnancy is a time for concern about sufficient folic acid intake (the RDA doubles during pregnancy). Also, those eating the standard American diet ("SAD") 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 one to maintain normal folate levels.
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.
Incidence; Contributing Risk FactorsFolic acid
deficiency is fairly common.
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.
Signs and Symptoms
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.
Besides causing mental symptoms, folate deficiency can also affect the skin. As in vitamin B2
) 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.Folic acid
deficiency generates a picture similar to that of a B12
deficiency – anemia
, fatigue, irritability, anorexia
, weight loss, headache, sore and inflamed
, 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.
Diagnosis and Tests
If deficiency is suspected, it is wise to get a blood folate level test 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
Treatment and PreventionFolic acid
supplements are usually prescribed, and self-care includes avoiding:
- non-herbal tea, antacids, and phosphates (contained in beer, ice cream, and soft drinks), which restrict iron absorption
Although adequate folic acid intake usually cures this condition in about three weeks.
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
More recently, folid acid deficiency (along with vitamin A
deficiency) has been associated with cervical dysplasia
Severe deficiencies can result in congestive heart failure