Should I Take a Folic Acid Supplement?
Formerly known as folacin, folate is the generic term for both folate and folic acid. It is a B vitamin, which is important for the growth and metabolism of cells. Studies have shown that many people do not get enough folic acid from diet alone.
Why do people take folic acid supplements?
For pregnant women and for women who plan to become pregnant, folic acid supplements are standard. It reduces birth defects such as spina bifida and anencephaly by 50-70 percent. Women of childbearing age are recommended to take folic acid supplements or multivitamins to prevent any birth defects, which may occur before becoming pregnant.
How does folic acid work?
Folic acid is essential for making the DNA of cells. Thus, it is important for growth and development. It is also important for the formation of a healthy nervous system and the formation of red blood cells (RBCs). If there is a deficiency of folic acid, the number of red blood cells drops.
Folic acid supplementation corrects the deficiency, and thereafter, the production of red blood cells increases. In pregnancy, folic acid is important for the development of the spinal cord and nervous system of the baby. Since these are important parts to develop in the baby, women should daily take folic acid supplements during the first 12 weeks of pregnancy or while trying to conceive since it is difficult to get enough folic acid from food alone.
It is true that many people in our country do not get enough folic acid from their normal diet. Folate is usually found in green vegetables, fruits, beans, and nuts. A number of products enriched with folic acid are now available in the market. It includes fortified bread, cereals, and other products. If the amount of folate obtained from the diet is not enough, a folic acid supplement is recommended. The recommended dietary allowance of folate in normal adults is 400 mcg per day. The folate requirement for pregnant women is 600 mcg and 500 mcg per day for breastfeeding women. Higher doses are given to treat deficiencies of this vitamin.
Folic acid supplements are usually given to pregnant women and those of childbearing age. It is important to reduce the risk of complications during delivery such as preeclampsia and early labor. Folic acid also reduces the risk of neurological birth defects such as spina bifida and anencephaly. Folic acid deficiency can increase the risk of birth defects even when it happens during the childbearing age.
It has been recommended by the US Department of Health that women should take 400 mg of folic acid daily while they are trying to conceive. This dose should continue for the first 12 weeks of pregnancy when the spine of the baby is developing. However, it is safe to continue taking folic acid supplements even after 12 weeks. This is to prevent anencephaly and spina bifida.
CDC has estimated that if these supplements are followed before and during pregnancy, then most birth defects can be prevented. Dietary sources of folate include green leafy vegetables, brown rice, granary bread, and breakfast cereals fortified with folic acid. However, it is impossible to get enough folic acid only from food. By taking folic acid supplements, you can be sure whether the right amount of folic acid is being taken or not.
Prevention of Neural Tube Defects
Some women may have an increased risk of having infants with neural tube defects. They are advised to take 5 mg of folic acid daily until they are 12 weeks pregnant.
The increased risks are:
- If either partner has a neural tube defect
- Previous pregnancy affected by a neural tube defect
- If either partner with a family history of neural tube defects
- You have diabetes
If you are taking an antiepileptic medication, then you might need a higher dose of folic acid.
Supplements are also suggested to people who have digestive disorders, liver disease, kidney impairment, and those who abuse alcohol. Generally, folic acid supplements are taken along with vitamin B12. This helps in improving the functioning of the nervous system and treats anemia.
People who take methotrexate often face toxicity issues that can be treated with folic acid supplements. It is often recommended for memory loss, Alzheimer’s disease, aging, osteoporosis, and even muscle pain.
Folic Acid Functions
1. Regulation of Gene Expression
The same genetic information is carried by each cell in our body. The function and metabolic activities of a cell indicate what genes are “active” or “expressed”. Folate is responsible for keeping certain genes “silent” by getting involved in a chemical reaction. If there is a deficiency of folate, it will lead to a loss of mechanism to control gene expression. This may increase the risk of developing cancer.
2. Amino Acid Metabolism
Amino acids are used by our body to build proteins. With the help of folate-dependent cofactors, our body converts amino acids into other chemicals. One important example of this is the conversion of homocysteine to methionine. If there is folate deficiency, then it may lead to the buildup of homocysteine in the bloodstream, which may influence the body’s risk of developing cardiovascular diseases.
3. Red Blood Cell Production
Each day, the body produces 65 million new blood cells, which is why the body requires a constant supply of folate, iron, vitamin B12, and other nutrients. The formation of new genetic material to produce new red blood cells slows down if there is folate deficiency. It may also lead to low bone marrow productivity. There are not enough new cells to take the place of old blood cells that have died, which then leads to anemia. Spinach, collards, and other greens are good sources of natural folate.
Folic acid supplements are needed to treat certain types of anemia, which can occur as a result of poor nutrition, malabsorption syndrome, alcoholism, pregnancy, taking certain antiepileptic medications, and celiac disease. Moreover, other types of anemia are caused by the rapid breakdown of red blood cells. In such case, doctors might recommend a folic acid supplementation. In the case of dialysis, folic acid is also recommended.
4. Other Functions
Folic acid enhances brain health. It was reported by Dutch researchers that folic acid supplements might help when it comes to improving memory. Evidence also suggests that folic acid may help improve heart health. Moreover, one study reported that folic acid supplements might slow down the onset of age-related hearing loss. Folic acid supplements help treat folic acid deficiency, leg ulcers, and certain menstrual problems.
Folate deficiency may cause:
- Diarrhea
- Mouth ulcers
- Peptic ulcer
- Swollen tongue
- Poor growth
- Gray hair
- Certain types of anemia
Side Effects of Folic Acid Supplements
In most cases, folic acid supplements are safe, but they may present certain side effects. High doses of folic acid may result in:
- Bloating
- Insomnia
- Seizures
- Excitability
- Nausea
- Poor appetite
- Unusual taste in the mouth
- Trouble sleeping
- Feeling depressed
Those who are taking seizure medications should be careful while using folic acid supplements, as high doses of folic acid may interfere with the effect of the medicine. Other drugs that may interact and reduce the absorption of folic acid include drugs used for diabetes, sleeping pills, and some antibiotics. Taking folic acid supplements for a long period of time is reported to cause serious health issues like cancer.
Other Side Effects:
- Gastrointestinal - Abdominal distension, mild gastrointestinal upset, nausea, and flatulence are some of the rare side effects of folic acid supplements. It was reported in patients taking 15 mg of folic acid every day for a month.
- Nervous System - Altered sleep patterns, overactivity, difficulty concentrating, and impaired judgment were also reported in patients taking 15 mg of folic acid every day for a month.
- Hypersensitivity - Anaphylaxis, which includes shock, allergic responses such as erythema, skin rashes, general malaise, and respiratory difficulty due to bronchospasm are also rare side effects of folic acid supplementation.
- Metabolic - Anorexia is rare, but it was reported in patients taking 15 mg of folic acid daily for a month. In patients with prolonged folic acid therapy, a decrease in vitamin B12 serum levels was observed.
Taking extremely high doses can increase the risk of developing cancer of the colon or rectum. One should not take more than 400 mcg of this vitamin a day unless prescribed by the doctor. Discuss with your physician before you decide on taking the supplement.
Folic acid comes in both tablet and liquid forms, which can be taken with or without food. Folic acid tablets at 400 mcg are available without a prescription at pharmacies, supermarkets, and health food shops. However, 5 mg folic acid in the form of tablets or liquid needs to be prescribed by a doctor. For most pregnant women, the recommended dose of folic acid is 400 mcg daily.
For anemic patients, the dose prescribed by the doctor depends on the cause of anemia and the age of the person. The person might need to take folic acid daily for a few months until the anemia is corrected. If the doctor has prescribed folic acid to prevent anemia, then the doctor might ask you to take the folic acid dose once daily or once in every few days. This depends on certain conditions of each patient, so always follow the doctor’s instructions.
The effects of some seizure medications can get blocked by high doses of folic acid. If you are taking any regular medications, ask the doctor whether it will affect your intake of folic acid. Drugs for diabetes, some antibiotics, and sleeping pills tend to lower the amount of folic acid the body can absorb. Sometimes, folic acid supplementation can mask the symptoms of serious and dangerous vitamin B12 deficiencies.
