Folic Acid

Folic Acid-The classic deficiency disease is megaloblastic anemia. This is an anemia in which the red blood cells are improperly formed. The symptoms include pallor, irritability, weakness and sleep difficulties. Alcoholics and persons with malabsorption disorders the most likely candidates for this anemia. Neural tube defect is one of the most serious and common birth defects in the US that can be eliminated if pregnant females consume 400mcg of folic acid/day at least one month before and six weeks after conception.

Fortification Laws -Newly discovered roles for folic acid, along with the above, over the last few years have prompted the Food and Drug Administration (FDA) to add folic acid fortification to the list of must have nutrients (thiamin, riboflavin, niacin) already added to refined bread and cereal products. The process involves putting back nutrients lost in the milling and processing(enrichment) and adding additional vitamin(fortification) to the products. Whole grain products do not have to be fortified since they not required to be enriched. What you have is whole grain products with lots of fiber and minerals or a low fiber product with lots of vitamins including folic acid.

Heart disease and folic acid- Elevated homocysteine (an amino acid) levels are an even better predictor of heart disease and stroke than cholesterol. Vitamin B 12, B6 and folic acid together keep homocysteine levels low along with the incidence of heart disease and stroke.

Folic acid and Cancer - there appears to be a connection between colon polyps, colon cancer and folic acid. Folic acid seems to prevent damage to the DNA. Adequate folic acid levels may also prevent cervical cancer by reversing cervical dyplasia, a precancerous condition.

Alzheimer's Disease. A British study suggests that high homocysteine levels may also be implicated in Alzheimer's disease. Patients with high levels were more likely to have the disease, those with normal levels were disease free. The subjects were 75yrs/old. Those with dementia had lower levels of B12 and folic acid. More studies are in progress.

Medications such as antacids, sulfasalazine(Azulfidine), ranitidine(Zantac), cimetidine(Tagament), cholestryamine(Questran) and metformin (Glucophage),trimethoprim with sulfamethoxazole (Bactrim), zidovudine (AZT) can reduce folic acid absorption. Stomach acid decreases with age and so does folic acid absorption as a consequence.

The vitamin and food- Folate is the food form of the vitamin found in oranges, leafy green vegetables, legumes, asparagus, broccoli, wheat bran and yeast as well as beef, lamb, pork and chicken. It is estimated that only 25-50% of folate is biologically available from food. Cooking reduces folate considerably. Sixty-eight percent of folate is removed when whole wheat is processed into white flour.

Folic acid is found in supplements and fortified foods (Total and Product 19 are fortified with 400 mcg folic acid) and is more potent than folate (natural form) found in food. Even if you eat a healthy diet the folate content is questionable. For optimal protection we recommend supplemental folic acid. A multivitamin with mineral supplement with 100% of the DV will provide 400mcg. No toxicity reported for folic acid. Available over the counter in units up to 800mcg. This is one vitamin your doctor might prescribe if you have heart disease or a family history.

Donna Tinnerello, MS, RD, CD/N.

Donna Tinnerello MS, RD,, CD/N is registered dietician with more than 10 years experience in HIV and nutrition. She works at Cabrini Medical Center in lower Manhattan,in private practice and the community.Her subspecialties are cardiovascular, renal, and gastrointestinal disease, diabetes and weight loss. Donna is available for private consultation by referral only.