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Folic Acid  (Folate)
Written by Christina Whitford

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Description
Folic acid is a B vitamin (water-soluble) that plays an important role DNA and RNA synthesis, production of red blood cells and maintenance of the nervous system. Fruits and veggies are the best dietary source (think folic – "foliage"), with dark leafy greens, oranges and orange juice, beans and peas leading the way. Brewer’s yeast is also a good source of folic acid and other B vitamins. Studies have confirmed that dietary supplement folic acid is absorbed better than food sources of Folate. 
On This Page
Folic Acid and Birth Defects
Folic Acid and Alcohol-Related Illness 
 
bulletClaims in Birth Defects
Prevention of neural tube birth defects Promotes heart health (reduced plasma homocysteine levels)
 
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Theory
Because folic acid has functions in DNA synthesis and nervous system maintenance, it has been linked to growth and development of the fetus during pregnancy. Clinical evidence clearly shows a beneficial effect of adequate folic acid intake in reducing the risk of brain and spinal cord birth defects.

Due to its role in red blood cell formation, homocysteine metabolism and the fact that deficiency of folic acid results in megaloblastic anemia, supplemental levels are often associated with maintenance of energy levels and heart health.
 
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Scientific Support
It is abundantly clear that an adequate intake of folic acid is essential during pregnancy. Overwhelming evidence is available to show women given folic acid supplements during pregnancy have a lower incidence of delivering babies with neural tube birth defects such as spinal bifida. Oral contraceptives ("the pill") have been associated with lower folate levels in women who conceived soon after they stop taking the pill. In some cases, former contraceptive users and women who have delivered babies with neural tube defects may especially benefit from supplemental levels of folate in their diets

The U.S. Department of Health recommends that pregnant women (and those trying to conceive) should take a daily folic acid supplement of 400 mcg (0.4mg). The U.S. Public Health Service recommends that all women of childbearing age consume the same amount of folic acid each day to decrease the risk of having a pregnancy affected by a neural tube defect (just in case). Three strategies are available to women to achieve this goal: eat more foods with naturally occurring folate (fruits/veggies); eat foods fortified with folic acid; or use dietary supplements.

Despite the wide-ranging public health benefits of adequate folic acid intake and the widespread public awareness of these benefits, as many as 68-87% of American women of childbearing age still have folic acid intakes below the recommended 400 micrograms per day. Elderly populations are also thought to be at increased risk for folate deficiencies – which may exacerbate the risk associated with heart disease, cancer and neurological impairments which are more prevalent in this population. Several recent studies have suggested that folate supplementation should be considered in elderly people, especially those with elevated plasma total homocysteine levels and cardiovascular disease, as well as in those individuals who experience neuropsychiatric disorders. Because of the possibility for high dose folate supplements to mask the symptoms of vitamin B12 (cyanocobalamin) deficiencies (which are also common in the elderly), folic acid supplements should be given in conjunction with B12.
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    Deficiency
    The symptoms of Folic acid deficiency include anemia, birth defects, tongue soreness, gastrointestinal disorders, growth disorders, fatigue, poor memory, and megaloblastic anemia. Megaloblastic anemia is a disease characterized by abnormal forms of the precursor cells of red blood cells.
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    Folic Acid Could Ease Risk of Alcohol-Related Illness
    According to a 16 year research study conducted by the Harvard School of Health, heavy alcohol consumption combined with low folate intake, could increase women's risk for cardiovascular disease and cancer. The heaviest alcohol drinkers had a nearly 36% higher risk compared to those whom abstained from alcohol and got at least 400 mg of Folate. Researchers also concluded that the increased risks associated with heavy drinking was reduced among women with higher folate intake.

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    bulletSafety

    Extremely high intakes (1-5 mg/day) have been associated with masking the signs and symptoms of pernicious anemia (vitamin B12 deficiency).

    bullet Value

    Because folic acid is destroyed during cooking, levels are typically highest in raw (or lightly steamed) vegetables. The chemical form of folic acid found in foods, (mono)-glutamic acid (conjugated), however, is less well absorbed compared to the synthetic form, polyglutamic acid (unconjugated), found in dietary supplements – suggesting that supplemental forms may even be warranted in high risk individuals in addition to a well-balanced intake of fruits and vegetables.

    bulletDosage
    The Daily Value for folic acid is 400 micrograms – an amount that ALL women of childbearing age should consume each day. Like the other B vitamins, needs may be somewhat elevated during times of stress and during pregnancy and lactation. In the elderly, a daily folate supplement of 500 mcg may be warranted – although it should not replace the need for a diet rich in fruit and vegetables. An estimated safe range of intake has not been established for folic acid, since levels of over 1,200 mcg per day have been found to be safe for adults. However, supplements supplying more than 900 mcg per dose can be obtained only by prescription.
     
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     References

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    2. Boddie AM, Dedlow ER, Nackashi JA, Opalko FJ, Kauwell GP, Gregory JF 3rd, Bailey LB. Folate absorption in women with a history of neural tube defect-affected pregnancy. Am J Clin Nutr. 2000 Jul;72(1):154-8.
    3. Brouwer IA, van Dusseldorp M, Thomas CM, Duran M, Hautvast JG, Eskes TK, Steegers-Theunissen RP. Low-dose folic acid supplementation decreases plasma homocysteine concentrations: a randomized trial. Am J Clin Nutr. 1999 Jan;69(1):99-10
    104. 4. Bunout D, Garrido A, Suazo M, Kauffman R, Venegas P, de la Maza P, Petermann M, Hirsch S. Effects of supplementation with folic acid and antioxidant vitamins on homocysteine levels and LDL oxidation in coronary patients. Nutrition. 2000 Feb;16(2):107-10.
    5. Carmody BJ, Arora S, Avena R, Cosby K, Sidawy AN. Folic acid inhibits homocysteine-induced proliferation of human arterial smooth muscle cells. J Vasc Surg. 1999 Dec;30(6):1121-8.
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    11. Fiatarone Singh MA, Bernstein MA, Ryan AD, O'Neill EF, Clements KM, Evans WJ. The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders. J Nutr Health Aging. 2000;4(1):5-
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    18. Lewis CJ, Crane NT, Wilson DB, Yetley EA. Estimated folate intakes: data updated to reflect food fortification, increased bioavailability, and dietary supplement use. Am J Clin Nutr. 1999 Aug;70(2):198-207.
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    31. Willett WC. A prospective study of folate intake and the risk of breast cancer. JAMA. 1999 May 5;281(17):1632-7.
    32. Williams CN. Should folic acid supplementation be used to reduce the risk of cancer in ulcerative colitis? Can J Gastroenterol. 1999 Nov;13(9):715-6.
    33. Zhang S, Hunter DJ, Hankinson SE, Giovannucci EL, Rosner BA, Colditz GA, Speizer FE,

     
     
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