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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.
Folic acid, 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; Risk Factors
Folic 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 & 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 (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.
Folic acid deficiency 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.
Diagnosis & 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 & Prevention
Folic acid supplements are usually prescribed, and self-care includes avoiding:- alcohol
- non-herbal tea, antacids, and phosphates (contained in beer, ice cream, and soft drinks), which restrict iron absorption
- tobacco
Although adequate folic acid intake usually cures this condition in about three weeks.
Complications
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.
More recently, folid acid deficiency (along with vitamin A deficiency) has been associated with cervical dysplasia and cancer.
Severe deficiencies can result in congestive heart failure.
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Signs, symptoms & indicators of Increased Folic Acid Requirement:
Conditions that suggest Increased Folic Acid Requirement:
Risk factors for Increased Folic Acid Requirement:
Increased Folic Acid Requirement suggests the following may be present:
Recommendations and treatments for Increased Folic Acid Requirement: | | | | | Vitamins |  Folic Acid | 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. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
AIDS
Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Anorexia Nervosa (Anorexia)
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Antacid (Antacids)
Neutralizes acid in the stomach, esophagus, or first part of the duodenum.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cervical Dysplasia
Abnormal cells on the surface of the cervix, classified as either mild (70% of cases fall into this category; the cells regress on their own), moderate, or severe, or as class 1, 2 or 3. While dysplasia itself does not cause health problems, it is considered to be a precancerous condition. Left untreated, dysplasia sometimes progresses to an early form of cancer known as cervical carcinoma in situ, and eventually to invasive cervical cancer.
Choline
A lipotropic substance sometimes included in the vitamin B complex as essential for the metabolism of fats in the body. Precursor to acetylcholine, a major neurotransmitter in the brain. Choline prevents the deposition of fats in the liver and facilitates the movement of fats into the cells. Deficiency leads to cirrhosis of the liver.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Coenzyme
A heat stable molecule that must be associated with another enzyme for the enzyme to perform its function in the body. It is necessary in the utilization of vitamins and minerals.
Congestive
Pertaining to accumulation of blood or fluid within a vessel or organ.
Diarrhea
Excessive discharge of contents of bowel.
DNA
Deoxyribonucleic acid, the large molecule that is the main carrier of genetic information in cells. DNA is found mainly in the chromosomes of cells.
Folic Acid
A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
H2 Blockers (H2 Blocker)
Medications in this family sharply decrease stomach acid production. They are widely used for the treatment of ulcers as well as for mild cases of esophageal reflux (heartburn). Drugs that fall into this family include cimetidine (Tagamet, Tagamet HB); famotidine (Pepcid, Pepcid AC, Pepcid RPD); nizatidine (Axid, Axid AR); ranitidine hydrochloride (Zantac, Zantac EFFERdose, Zantac GELdose, Zantac 75).
Heme
The deep red iron-containing hemoglobin found in foods of animal origin.
Hemoglobin
The oxygen-carrying protein of the blood found in red blood cells.
Hemorrhage (Hemorrhaging)
Profuse blood flow.
Histidine
An amino acid. Precursor to histamine, a vasodilator and gastric juice stimulant. Has been used as a therapeutic aid for arthritis.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Leukemia
Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Megaloblast (Megaloblastic, Megaloblasts)
An abnormally large nucleated red blood cell found especially in people having pernicious anemia or certain vitamin deficiencies.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Methionine
Essential amino acid. Dietary source of sulfur and methyl groups. Important for proper growth in infants, nitrogen balance in adults, healthy nails and skin and the synthesis of taurine, cysteine, phosphatidylcholine (lecithin), bile, carnitine and endorphins. It is an antioxidant nutrient and lipotropic agent which promotes the physiological utilization of fat.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Neural Tube
The tube of tissue that lies along the central axis of the early embryo. It gives rise to the brain, spinal cord, and other parts of the central nervous system.
Niacin (B3, B-3, Niacinamide, Vitamin B3)
A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Nucleic Acid
A chemical compound found in all viruses and plant and animal cells. RNA and DNA are the two principal types.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Preeclampsia (Toxemia Of Pregnancy)
A toxic condition developing in the last 4 or 5 months of pregnancy that is characterized by a sudden rise in blood pressure, excessive weight gain, generalized edema (especially hands, ankles, feet and face), albuminuria, severe headache, and visual disturbances. It used to be called toxemia of pregnancy.
Some rise in blood pressure is normal during pregnancy, but in preeclampsia the rise is dramatic and is accompanied by other changes. The most notable of these are high concentrations of protein in the urine and a tendency to swell up, especially in the face and hands. This can cause women with preeclampsia to put on several pounds in a few days.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Purines (Purine)
These are waste products or metabolites of nucleoproteins. They are not recycleable and are broken down further to the primary excretable form, uric acid. High purine presence in a tissue signifies a recent high turnover in nucleoproteins from injury or cell death, which is why some purines, such as allantoin, will stimulate cell regeneration. Many plants contain allantoin, most noticeably Comfrey. Some foods are heavy purine producers and can elevate serum uric acid levels. These include organ meats, seafood, legumes, and foods such as spirulina, chlorella, and bee pollen.
RDA (RDAs, US RDA, USRDA)
Recommended Daily Allowance of vitamins or other nutrients as determined by the FDA. U.S. RDAs are more widely used than RDAs, and focus on 3 age groups: Infants of 0-12 months; Children of 1-4 years; Adults and children of more than 4 years.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Riboflavin (B2, B-2, Vitamin B2)
A B-complex vitamin that acts as a coenzyme that activates the breakdown and utilization of carbohydrates, fats and proteins. It is essential for cellular oxidation and necessary for healthy skin and eyes.
RNA
A ribonucleic acid found in plant and animal cells; a complex protein chemical. Important in the coding of genetic information with DNA carrying information from the nucleus of the cell into the cytoplasm.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Spina Bifida
A nerve tube defect present at birth that results in a gap in the bone that surrounds the spinal cord. Spina bifida is relatively common, occurring about 10 to 20 times per 1,000 births.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Last updated: Jun 10, 2009
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