What is Folic Acid?

Folic acid is one of the water-soluble B Vitamin, also referred as Vitamin B9. Folic acid at times is also referred as folate, though, later is a collective term used for folic acid and various of its congeners   including methyltetrahydrofolate, tetrahydrofolic acid, folinic acid and methenyltetrahydrofolate.

What are the sources of Folic Acid?

Folates are found naturally in various food items. A synthetic form of folic acid, however, is being add to various food items since 1998 including flour, pasta, breads, cold cereals, bakery items, crackers and cookies.

Food items naturally rich in folates are:

  1. Leafy vegetables (like broccoli, spinach and lettuce), asparagus, okra
  2. Fruits like bananas, lemons, melons
  3. Beans
  4. Yeasts
  5. Mushrooms
  6. Meat products like beef liver and kidney
  7. Orange and tomato juice

What is the function of folic acid?

Folic acid is required for proper growth and development of the living cells and tissues. It is essential in creating DNA, the backbone of genetic material, along with several other bodily functions.

When do we require Folic acid supplementation?

Folic Acid Deficiency

In cases where there is deficiency of folates in the body, folic acid supplementation is quite effective in treating it. Folic acid deficiency complications like tired blood anemia or incapacity of bowels in absorbing nutrients are also treated with folic acid supplementation. It’s also used in other conditions associated with folic acid deficiency like liver disease, ulcerative colitis, kidney dialysis and alcoholism.

Kidney Disease

In majority of patients suffering from kidney disease there is a chance of increased levels of homocysteine. Its high levels are related to greater risk of stroke and heart disease. The intake of folic acid is shown to reduce the levels of homocysteine in patients suffering from serious kidney disease. Though, it is yet to be proved if folic acid supplementation can decrease the risk of heart disease.

Hyperhomocysteinemia

Even in those patients who have high levels of homocysteine for reasons other than kidney disease the risk of stroke and heart disease is increased.  The patients can also be supplemented with folic acid to reduce homocysteine levels. People with homocysteine levels of > 11 micromoles per liter are advised to take supplemental folic acid along with Vitamin B12.

Countering side-effects of Methotrexate

Folic acid is found to be useful in alleviating the side-effects like nausea and vomiting in patient taking methotrexate.

Preventing neural tube effects

Since folate plays an important role in formation of DNA, an important building block of living cells, it becomes particularly important during pregnancy. Taking folic acid during pregnancy reduces the risk of neural tube defects in the fetus.

Age-related vision loss

Also, known as age-related macular degeneration. Research has shown that folic acid supplementation along with other vitamins like vitamins B12 and Vitamin B6 lowers the risk of age-related vision loss development.

Depression

Some research have shown that folic acid taken with antidepressants can result in improving symptoms better than when antidepressant are taken alone.

Hypertension
According to studies folic acid supplementation for 6 weeks can also lower blood pressure in patients with hypertension. Though, folic acid supplementation along with medications for blood pressure doesn’t appear to be any more beneficial than medications alone.

Phenytoin side-effects

Folic acid is shown to be useful in gum problems caused by use of phenytoin, an anti-epileptic drug. Application of folic acid on gums avoids gum problems. But, oral folic acid supplementation doesn’t seem effective.

Gum disease in pregnancy

Folic acid also appears to be effective in gum problems during pregnancy. Application of folic acid on gums is effective.

Vitiligo

Vitiligo is a skin condition characterized by skin discoloration, presenting as white skin patches on different parts of body. Oral folic acid supplementation may help in alleviating vitiligo symptoms.

Other conditions

Folic acid is also used in preventing conditions like cervical cancer, colon cancer, Alzheimer’s disease, memory loss, age-related hearing loss or other age-related symptoms, osteoporosis, sleep problems, restless leg syndrome, depression, muscle pain, nerve pain, AIDS and Fragile-X syndrome (a hereditary disease).

Side effects of Folic Acid

Folic acid is relatively safe to use in adults orally or via injection. Usually no side effects are seen in adults in dosage lesser than 1000 mcg per day.

However, in higher oral dosages of folic acid taken over a longer period may result in several side effects. The possible side-effects are diarrhea, abdominal cramps, rashes, irritability, sleep disorders, confusion, nausea, vomiting, stomach upset, flatulence, behavioral changes, seizures, skin reactions, among other side effects.

Some studies have shown that folic acid taken in large doses (800-1200 mcg) can increase the heart attack risk in individuals with heart conditions. Some studies have also shown that high doses may increase risk of lung cancer or prostate cancer.

Precautions while using Folic Acid

  1. In individuals with narrowed arteries, and those who have undergone angioplasty, folic acid along with Vitamin B6, and vitamin B12, may worsen the condition. Folic acid is contraindicated in patients recovering from angioplasty.
  2. In cancer patients, high doses (800-1000 mcg) of folic acid are shown in some research to further elevate the risk of cancer. Until further research has shown otherwise, folic acid should be avoided in cancer patients or in individuals with history of cancer.
  3. Some studies suggest that folic acid along with Vitamin B6 may enhance the risk of heart attack in patients with existing heart condition or with history of heart disease.
  4. Sometimes anemia caused by Vitamin B12 deficiency may be confused with folic acid deficiency. In such confusion, the patient may be treated wrongly, and while it would show early improvement, overall condition will deteriorate. Hence, care should be taken.
  5. Folic acid supplementation may worsen seizures in patients with existing seizure disorders, especially when taken in high doses.