Folic Acid

Folic Acid: Overview

Alternative Names: Folacin or Folate.

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.

Source

While we get some folic acid from our intestinal bacteria, most of our daily intake must come from our diet or through supplementation.  It has been estimated that only half of the USRDA, which is 0.4mg (400mcg), is actually consumed in an average American diet.  The best source of folic acid is foliage, the green leafy vegetables. 

Tips for Obtaining and Absorbing Folic Acid:

  • Eat good food sources of folic acid every day.  Some good sources are root vegetables, dark-green leafy vegetables (spinach, kale, beet greens, collard greens, chard), beets, asparagus, brussels sprouts, romaine lettuce and broccoli.  Other good sources are red beans, soy, black-eyed peas, cantaloupe, orange juice, peanut butter, oatmeal, other whole grains/whole-grain cereals, wheat germ, brewer's yeast, mushrooms, and liver, kidney and other organ meats.

    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.

  • Eat fresh, raw fruits and vegetables often.  Don't overcook food.  Heat destroys folic acid.
  • Take the daily vitamin supplement your doctor suggests or prescribes, which will often be a multivitamin supplement that 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.
  • Don't smoke.
  • Don't drink alcohol.  It interferes with absorption of folic acid.
Remember that 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.

Most of the folic acid in foods (with the exception of the folic acid added to enriched flour and breakfast cereals) occurs as folate.  Folate is only about half as available for the body to use as is the folic acid in pills and supplements.

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 during most food processing and food preparation.

In 1998 the government ordered some grain products such as flour, breakfast cereal and pasta to be fortified with folic acid.  Folic acid is best obtained from fresh vegetables, which should be your primary source.  If, for whatever reason, you are unable to obtain folic acid from vegetables and you are a woman who could get pregnant, it would be highly recommended to add folic acid to your supplement program.

The FDA limits the amount that can be purchased over the counter to 400mcg per tablet.  Higher concentrations are available and considered safe by holistic doctors.

Higher amounts, such as 1mg (1,000mcg), 1.5mg, or even 10mg, are available only by prescription because of the concern of masking vitamin B12 deficiency.  Some doctors describe impressive results in many patients, especially the elderly, with injections of 1,000mcg of B12 and 10mg of folic acid.

Function; Why it is Recommended

As an important human vitamin, folic acid is used by the body as a cofactor in many enzymatic reactions.  Folic acid is a molecule made from Glutamic acid (an amino acid), para-amino benzoic acid (PABA) and Pteridine.

Folic acid is critical for neural tube formation during the first weeks of fetal development and is vital in the diet of pregnant women.  It is for this reason that the US government issued a requirement for folic acid fortification in flours and cereals by the year 2000.  Folic Acid is a key component in the enzymatic conversion of homocysteine to methionine.  Homocysteine is now considered an independent risk factor for vascular disease, especially atherosclerosis.  Folic acid supplementation, with B6 and B12, has been shown to reduce homocysteine levels in a number of clinical studies.

Folic acid deficiency can be a result of alcoholism, low dietary intake, or poor absorbtion.  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.

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.

Instructions

A healthy adult needs at least 400mcg of folic acid every day.  Requirements at least double (800mcg) during pregnancy, and increase by 50% (to 600mcg) when a woman is breastfeeding (lactation).  The average American diet, high in fats, sugar, and white flour, provides about 220mcg of folic acid, approximately the amount needed to maintain tissue stores of the substance for six to nine months before a deficiency develops.  This reveals why disorders involving folic acid deficiency are so common.

Between 180 and 200mcg 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 200mcg Daily intake is not sufficient for supporting folic acid functions and maintaining tissue stores.  Deficiency symptoms may then occur.

Many doctors now recommend at least 800mcg per day of folic acid via supplements.  The suggested therapeutic dosages for most uses of folic acid or treating deficiency problems is about 1mg 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 5-15mg, and even up to 60mg daily.

Higher folic acid intake can mask B12 deficiency and reduce zinc absorption, so these should be noted and monitored if high dose (over 2mg/day) folic acid supplementation is continued for long periods.

Side-Effects

There are no specific toxic symptoms from folic acid intake, at least up to 5mg 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 can help with the following:

Addictions

Autoimmune

Folic Acid often helps with Vitiligo Vitiligo

See the link between Vitiligo and Vitamin B12.

Circulation

Folic Acid often helps with Atherosclerosis Atherosclerosis

For improved homocysteine metabolism, folic acid (800mcg per day), B6 (50mg per day), B12 (400mg per day), betaine (200 to 1,000mg per day are recommended.

Digestion

Folic Acid may help with Hydrochloric Acid Deficiency Hydrochloric Acid Deficiency

In cases of low stomach acid (hypochlorhydria) or no stomach acid (achlorhydria), supplemental use of hydrochloric acid normalizes folate absorption.

Hormones

Folic Acid is highly recommended for Histapenia (Histamine Low) Histapenia (Histamine Low)

The rationale underlying this treatment is that folic acid in conjunction with vitamin B12 injections raises the blood histamine while lowering the degree of symptoms.

Not recommended for
Folic Acid is often not recommended for Histadelia (Histamine High) Histadelia (Histamine High)

Histadelics should avoid supplemental folic acid as it can produce excess histamine.  In fact, anti-folate drugs may be required.  Folic acid increases depression in histadelic patients and a trial of folic acid could be used to distinguish between histapenics and histadelics.  In extreme cases, folic acid in food or in multivitamins is enough to produce the adverse effects.

Lab Values

Folic Acid is highly recommended for Elevated Homocysteine Levels Elevated Homocysteine Levels

A deficiency of vitamin B12 is associated with elevated homocysteine levels and folic acid is essential for its proper metabolism.

Metabolic

Folic Acid may help with Syndrome X / Metabolic Syndrome Syndrome X / Metabolic Syndrome

Folic acid helps break down protein and may reduce the risk of heart disease.

Musculo-Skeletal

Folic Acid often helps with Restless Leg Syndrome Restless Leg Syndrome

If there is a circulatory problem (as evidenced by other circulatory problems such as athersclerosis, hypertension, etc.), you may respond very well to extra folic acid and B12, as well as a product high in specific nutrients that strengthen and elasticize the vessel walls.  One such product is called Cyruta Plus, and can obtained through professionals handling Standard Process Labs products.  Folic acid at 5-50mg per day (a very large dose) may be helpful when the condition runs in the family; otherwise, it may only help the occasional person.  [Folic Acid in Neurology, Psychiatry and Internal Medicine, New York, Raven Press, 1979]

Nutrients

Folic Acid is highly recommended for Folic Acid Deficiency Folic Acid Deficiency

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.

Organ Health

Folic Acid often helps with Chronic Renal Insufficiency Chronic Renal Insufficiency

Patients with chronic renal failure have homocysteine levels that are significantly elevated at an early stage.  Taking 5mg of folic acid daily can significantly lower these homocysteine levels.  [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]

Folic Acid may help with Hepatitis Hepatitis

See the link between Hepatitis and Vitamin B-Complex.

Reproductive

Folic Acid is highly recommended for Pregnancy-Related Issues Pregnancy-Related Issues

The need for this vitamin more than doubles during pregnancy.  This is often not met by the diets of pregnant women, so a supplement of 400mcg to 1mg per day of folic acid is recommended throughout pregnancy.

In 1992, the U.S.  Public Health Service recommended that all women of childbearing age consume additional folic acid.  This means that increased consumption of folic acid is crucial not only during pregnancy, but also before conception.  It has been estimated that if all women of childbearing age met this allowance, the number of neural tube defect cases in the United States could decrease by at least 50%.  [CDC.  Morbidity and Mortality Weekly Report, 1992; 41(RR-14)]

Although foods such as dark-green leafy vegetables provide a reasonable source of folic acid, most women don't reach the recommended 400mcg through diet alone.  [Johnston RB, Staples DA.  1997.  J Am Med Assoc 1997;278 (11): pp.892-3]

Neural tube defects: (spina bifida): In one study, women who consumed 400mcg of folic acid per day cut in half their chances of having babies with birth defects of the brain and spinal cord, such as spina bifida.  Whether a baby develops these defects is determined in the first days after conception (the critical time may be day 27-28) – perhaps before a woman knows she is pregnant.

In another study, one-half of women who had delivered children with spina bifida or anencephaly were found to have had a poor diet during the pregnancy which ended with a child with a neural tube defect.  103 of these women received dietary counseling prior to their next pregnancy while 71 controls received no counseling.  Of those who improved their diet, all delivered normal children, while all 8 out of 186 newborns with NTD were born to women who ate a poor diet during their first 6 months of pregnancy [Laurence KM.  Nutr Health 2( 3/ 4), 1983].

Scientists currently theorize that women who give birth to babies with neural tube defects are less able to convert homocysteine to methionine, and that high levels of homocysteine may cause birth defects.  Folic acid, along with vitamin B12, is required for this biochemical conversion, as well as new tissue production and growth in both baby and mother. 

Downs: Mothers with a genetic abnormality that hinders how the body processes folic acid were 2.6 times more likely to have a child with Down syndrome than mothers without that genetic defect.  Millions of women appear to have this genetic abnormality, yet the risk of having a child with Down syndrome actually is small – one in 600 births.  If you have this mutation and you happen to have a very poor diet, it magnifies the problem; the researchers call this a gene-nutrient interaction.  The March of Dimes estimates there are 250,000 Americans with Down syndrome.  (American Journal of Clinical Nutrition October 1999)

Cleft palate: Only high pharmacological doses (6mg per day) of folic acid in the critical period of the primary and the secondary palate development seem to be effective for the reduction of clefts.  Doses less than 1mg of folic acid cannot reduce these birth defects.

Case Report: After giving birth, a woman developed severe depression, confusion, disorientation and hallucinations.  Over the next 19 months, trials with numerous medications and electroshock therapy were unsuccessful.  Folic acid deficiency was diagnosed and folate supplementation was started.  In 10 days, she was completely cured.

Uro-Genital

Folic Acid often helps with Cervical Dysplasia Cervical Dysplasia

Folic Acid in high doses of 10 to 50mg per day have been used successfully to return Pap smears to normal.  Folic acid supplementation has resulted in improvement or normalization of cytological smears in patients with cervical dysplasia in placebo-controlled and clinical studies.  As folic acid is the most common vitamin deficiency in the world, and quite common in women who are pregnant or taking oral contraceptives, it is probable that many abnormal cytological smears reflect folate deficiency rather than "true" dysplasia.  This is particularly applicable to cases in which patients are taking oral contraceptives.

Folic Acid can help prevent the following:

Aging

Folic Acid often prevents Alzheimers Disease Alzheimer's Disease

There is growing evidence suggesting that low blood folate levels can increase the risk of getting Alzheimer's.

In an ongoing study searching for new clues to the aging process, researchers took blood samples of nuns between the ages of 78-101years old living in a convent in Mankato, Minnesota.  After 30 of the nuns died, researchers examined their brains for signs of atrophy and compared the results with previous blood nutrient levels. 

In brain samples showing numerous Alzheimer's disease brain lesions, researchers found that significantly lower blood levels of folate corresponded with more severe atrophy of the neocortex, the region of the brain containing a rich supply of nerve cells.

Although the study was small, and did not attempt to prove a causal effect, it supports previous evidence linking defects in B-vitamin metabolism with age-related dementia and Alzheimer's.  "Optimal folate concentration may in fact be higher in old age or when diseases such as Alzheimer's are present," commented the researchers.

Low folate levels can trigger a build-up of the amino acid homocysteine, which has been linked to higher risk of Alzheimer's and accelerated atrophy of the medial temporal lobe in Alzheimer's patients.

"There seems little doubt now that there is an association between the evolution of certain brain diseases associated with cognitive decline in the elderly and vitamin deficiencies associated with hyperhomocysteinemia," a related editorial resounded. 

Although the full extent to which B-vitamin metabolism influences the actual causal mechanisms of dementia is still not clear, "the potential therapeutic options [implicated by these discoveries] are exciting", the authors posited. 

The nuns provided a unique population sample to study because they all had similar long-term diet and exercise habits.  Researchers found strong evidence of biochemical individuality among the group, despite their similar lifestyle and eating habits.  Blood nutrient levels varied widely, reflecting differences in "drug-nutrient and disease-nutrient interactions or differences in the intake, absorption, and metabolism of the nutrients."

NOTE: As this study suggests, even people with similar diets may show striking differences in nutrient metabolism related to various physiological functions.  Assessing each patient is the best way to gauge the effectiveness of nutrient intervention strategies. 

Sources:

Snowdon DA, Tully CL, Smith CD, Riley KP, Markesbery WR.  Serum folate and the severity of the atrophy of the neocortex in Alzheimer disease: findings from the Nun Study.  Am J Clin Nutr 2000;71: pp.993-8.

Weir DG, Molloy AM.  Microvascular disease and dementia in the elderly: are they related to hyperhomocysteinemia? Am J Clin Nutr 2000;71: pp.859-60.

Circulation

Folic Acid often prevents Stroke Stroke

A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13% respectively, compared with those who consumed less than 136mcg of folic acid per day.
[Stroke 2002;33: pp.1183-9]

Folic Acid may help prevent Coronary Disease / Heart Attack Coronary Disease / Heart Attack

Reduces homocysteine levels (major cause of heart disease), thereby decreasing risk of heart disease.  A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13% respectively, compared with those who consumed less than 136mcg of folic acid per day.  [Stroke 2002;33: pp.1183-9]

Musculo-Skeletal

Folic Acid may help prevent Osteoporosis - Osteopenia Osteoporosis - Osteopenia

Folate (folic acid) and the B-vitamins involved in homocysteine conversion (such as B12 and B6) may be beneficial in reducing the risk of osteoporosis because high levels of homocysteine are implicated in chronic diseases such as osteoporosis.

Tumors, Malignant

Folic Acid often prevents Colon Cancer Colon Cancer

Long-term use of a multivitamin containing 400mcg of folic acid, found mostly in leafy green vegetables, beans and nuts, may reduce the risk of colon cancer in women by as much as 75%.  The investigators in one study found that folic acid obtained from dietary supplements had a stronger protective effect against colon cancer than folic acid consumed in the diet.  In other words, although foods naturally high in folate may provide other beneficial micronutrients, consumption of these foods is probably less effective than use of supplements and fortified foods in enhancing folate status.  [Annals of Internal Medicine October 1, 1998;129: pp.517-524]

KEY

May be useful: may help with; may help prevent
May be useful:
may help with; may help prevent
Moderately useful: often helps with; often prevents
Moderately useful:
often helps with; often prevents
Very useful: is highly recommended for
Very useful:
is highly recommended for
Often counterindicated: is often not recommended for
Often counterindicated:
is often not recommended for