Nutrition

Why Do You Need Folic Acid? What Are Its Benefits? What Happens If You Don’t Have Enough Of It?

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Why Do You Need Folic Acid? What Are Its Benefits? What Happens If You Don’t Have Enough Of It? Hyderabd040-395603080 May 29, 2019

Vitamins are vital amines. They are vital for your existence, growth, and functioning. Based on their availability, chemical structure, and activity, vitamins are named A, B, C, D, E, and K, and each has assigned and regulated roles. In this article, we will be exploring folic acid, a water-soluble B vitamin.

What does folic acid do? Why is it crucial, and who needs it more? Find answers to all these questions below. Start reading!

What Is Folic Acid? How Is It Different From Folate?

Folic acid is the man-made form of folate. Folate is vitamin B9. Folate is found naturally in certain fruits, vegetables, and nuts. Folic acid is found in supplements and fortified foods (1).

This vitamin helps in generating new red blood cells (RBCs). Red blood cells carry oxygen to all parts of your body. If your body does not make enough red blood cells, you can develop (megaloblastic) anemia (1).

Folate is vital for the synthesis of DNA nucleotides and amino acids. Above all, folate is essential for the proper development of the embryo and the fetus. Deficiency of this vitamin during fetal development can cause brain and spinal defects (1)

Hence, it is imperative to have enough folate in your body – especially if you are pregnant or planning to conceive. This can be done by consuming foods rich in folate.

But dietary folates are less bioavailable because of their chemical structure. They need to be reduced to be absorbed by your intestines. This takes more energy resources and, probably, time too (1).

How do we bridge the gap? Enter folic acid!

Why Do You Need To Take Folic Acid?

Folic acid is a synthetic molecule with a relatively simple chemical configuration. It is considerably more bioavailable than dietary folates.

The bioavailability of folic acid is assumed to be 100% when it is ingested as a supplement and 85% in fortified foods (1).

Randomized trials showed 60% to 100% reductions in neural tube defect (NTD) cases when women consumed folic acid supplements. Folic acid supplementation was given in addition to a varied diet a month before and a month after conception (1).

The US Public Health Service recommends that all women of conceivable age consume 400 μg of folic acid every day (2). However, only 30% of women are able to follow supplementation rigorously.

In the next section, you will understand the role of folate in your body, which systems it affects the most, and how folic acid supplementation contributes to your health.

Keep scrolling!

What Are The Benefits Of Taking Folic Acid?

Folate in foods and folic acid in supplements oversee several critical biochemical reactions in your body. This vitamin is responsible for the synthesis of red blood cells. It prevents anemia and cardiovascular and kidney diseases.

Here are the benefits in detail:

1. Reduces Risk Of Neural Tube Defects In Newborns

Neural tube defects (NTDs) are common complex congenital malformations of the central nervous system (CNS). These result from failure of the neural tube closure during the formation of the embryo (embryogenesis) (3).

Only 1% of children born with an open NTD are free from disability. These children usually have anesthesia of the skin and abnormalities of the hips, knees, and feet. They have reduced ability to walk, have little or no bowel and/or bladder control, and require frequent surgical interventions (3).

A substantial number of cases have strengthened the importance of folate in embryonic development. Since folate is critical for the synthesis of DNA and RNA, its deficiency may result in such errors.

Also, this vitamin is involved in the methylation pathway (3). Methylation of several enzymes and proteins might be essential for the neural tube assembly.

Several other mechanisms are still being researched. Until then, it is safe to presume that folic acid supplementation might partly reduce the risk of NTDs in newborns (3).

2. Might Prevent Cardiovascular Diseases (CVDs)

Research highlights the role of homocysteine, an amino acid, in cardiovascular diseases. Even moderately elevated levels of homocysteine in your blood increase the risk of CVDs (4).

The link between them is still being studied. But it is proposed that homocysteine might affect blood clotting, vasodilation, and thickening of arterial walls.

A study with 1980 Finnish men spanned over 10 years found a connection between folate and homocysteine. Those who had dietary folate had 55% lower risk of acute heart disease (5).

Hence, 400 μg of folic acid, 2 mg of vitamin B6, and 6 μg of vitamin B12 supplement regimen is followed.

Folic acid also reduces the thickness of arteries, preventing atherosclerosis. But a few studies still fail to establish the effect of this supplementation on high-risk individuals (6).

3. Can Mitigate Cancer Risk

Folate has a crucial role in DNA and RNA synthesis, methylation, and cell differentiation. All of these are important for the functioning of your body. A common manifestation of these molecular aberrations is cancer (7).

Cancer is thought to arise from DNA damage and faulty/uncontrolled gene expression. Due to its role in DNA and RNA synthesis and methylation, it is possible that insufficient folate intake contributes to cancer. Shortage of nucleotides and failure to control DNA repair damage might trigger the development of tumors (8).

Experimental evidence links folate deficiency to site-specific cancers. Hence, eating fruits and veggies rich in folate might decrease the incidence of cancer. Having folic acid-fortified food can be a good public health measure (1).

However, recent folic acid intervention trials did not show any specific benefit or harm regarding total and site-specific cancer incidence.

An inverse relationship was found between folate intake (supplements and dietary) and colorectal and breast cancers (9), (10).

Hence, the relationship between folate and cancer risk remains uncertain.

4. Improves Anemia In Women And Children

The odds of developing anemia are 40% more in folic acid-deficient women than their counterparts (11).

This suggests the significance of folate in the synthesis of RBCs (erythropoiesis). Folate, in the form of 5,10-methylene-THF (tetrahydrofolate), is essential for the DNA nucleotide synthesis (12).

When there is folate deficiency, there is reduced availability of 5,10-methylene-THF. This deficiency also inhibits DNA synthesis (12).

RBCs are made in your bone marrow, where the rate of cell division is very high. If folate is deficient, precursor cells might only divide, but the genetic material cannot. This results in increasing the intracellular volume but not the genetic matter. Thus, the RBCs look swollen, causing megaloblastic anemia (12).

Hence, folic acid supplementation can reduce anemia. It is essential for older and pregnant women. They have higher chances of anemia because of the years of menstrual blood loss and higher nutrient demand (13).

How Does Folic Acid Get Metabolized?

If you are a geek like me, you might like this!

  • Folic acid must first be converted to dihydrofolate (DHF) and then to tetrahydrofolate (THF) to become metabolically active (14).
  • This enzymatic process is catalyzed by the enzyme DHF reductase (DHFR).
  • THF can be converted to the biologically active L-methylfolate by the enzyme methylenetetrahydrofolate reductase (MTHFR).
  • This key conversion is necessary to provide L-methylfolate for the nucleotide synthesis during DNA and RNA assembly, DNA methylation, and to regulate homocysteine metabolism.
  • L-5-Methyltetrahydrofolate (L-methylfolate) is the predominant micronutrient form of folate.
  • It circulates in plasma and is involved in the biological processes.
  • This active form of folate is taken up within minutes by the liver and other primary targets..

5. Essential During Pregnancy And Childbirth

Essential During Pregnancy And Childbirth Pinit

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As it is vital for DNA and protein synthesis, folate has a primary role in fetal growth and development. That’s why there is an increased demand for folate in pregnant women. In the presence of enough folic acid, the embryonic cells divide and differentiate into tissues and organs.

The neural tube is one of the earliest structures to form. This structure is flat at first but molds into a tube only one month after conception. The neural tube develops to become the brain and spinal cord.

Without enough folic acid, the cells in this structure can’t grow properly, and the metamorphosis of this tube to the spine and brain is left incomplete. This leads to neural tube defects (15), (14).

Also, observational studies suggest that folate may be necessary during labor. Folic acid supplementation may prevent preterm births. It may also protect against miscarriages, stillbirth, multiple pregnancies, etc. (14).

Research seems to be in favor of folic acid supplementation for more than a year prior to conception (14).

6. Manages Polycystic Ovarian Syndrome (PCOS)

PCOS (polycystic ovary syndrome) affects at least 10-15% of women of childbearing age (16). It brings down the quality of oocytes. PCOS is one of the factors responsible for the failure of in-vitro fertilization (IVF) (17).

Hormone therapy, change of lifestyle, and diet might help. Women with PCOS should take more of folic acid, vitamins D, C, and B12, dietary fiber, and calcium, potassium, magnesium, and zinc.

They should cut down on consumption of total fats, saturated fatty acids, and cholesterol because these foods might trigger CVDs and diabetes. They might eventually worsen the dysfunction of ovaries (16).

Along with a folic acid-rich diet, taking myo-inositol and folic acid supplementation has shown to improve oocyte quality.

Patients undergoing IVF treatment showed better fertilization rate and embryo quality. Folic acid also restored ovulation in a few women (17).

7. May Control Hair Loss

Individuals with alopecia or hair loss were found to be deficient in folate and vitamin B12. Folate helps in producing red blood cells and facilitates oxygen transport to your body. It might do the same to the hair building tissues (18).

Folate could stimulate the proliferation of the hair follicle cells. It might prevent graying of hair and regulate the functioning of sebum glands in the scalp.

Having beets, kale, Brussels sprouts, green peas, white beans, asparagus, kohlrabi, and eggs can boost folate levels in women.

Supplementing your diet with 400-1000 μg of folic acid is another way to stop hair fall (19).

But, a few studies show no significant difference in serum folate levels of patients with alopecia. This shows that folic acid supplementation may or may not control hair loss. You might have to look at other vitamins like biotin, vitamin B12, vitamin D, etc. (20).

8. Helps Cope With Depression And Anxiety

One of the main functions of folate is to bring about methylation reactions. Most biomolecules need to be methylated to be biologically active. The active form of folate/folic acid, 5-methyl THF, adds methyl residues and kick starts such reactions (21).

The neurotransmitters in your central nervous system (CNS) also need to be methylated after their synthesis. You will need enough folate at this stage. It has been proven that low folate levels can cause severe and prolonged episodes of depression and anxiety (21).

Another way in which folate comes to the rescue is by reducing homocysteine levels.

Elevated homocysteine levels in your body cause oxidative stress on your brain and CNS (21). Folic acid supplementation can bring down homocysteine and oxidative stress levels.

It can prevent neurological damage that could lead to depression and Alzheimer’s disease. You tend to respond better to antidepressants if you have enough folate (21).

9. May Heal Kidney Diseases And Improve Kidney Function

May Heal Kidney Diseases And Improve Kidney Function Pinit

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Hyperhomocysteinemia (accumulation of homocysteine) occurs in 85% of patients with chronic kidney disease. This happens because of impaired renal function. Hyperhomocysteinemia is also an indicator of poor cardiovascular and kidney health (22).

One way to control hyperhomocysteinemia is through folic acid supplementation. Folic acid or folate is important in the conversion of homocysteine to methionine (another amino acid). If folate is deficient, there is not enough conversion, and homocysteine levels rise, ultimately affecting your kidneys (22).

Studies state that folic acid supplementation might only reduce the level of homocysteine but not normalize it. You can also find conflicting evidence in this regard.

Trials monitored over three years showed no effect of high folic acid doses on renal health. Hence, such supplementation can only reduce the severity but not prevent or cure kidney diseases (22).

10. Boosts Fertility In Men

Abnormal folate metabolism or its deficiency could be a cause of male infertility. Folate is critical for DNA synthesis and methylation, two steps that are crucial for spermatogenesis.

Men with infertility were found to have significantly lower serum folate levels (23).

In a study, a large group of sub fertile men was given zinc sulfate (66 mg) and folic acid (5 mg) daily for 26 weeks. There was a 74% increase in their total normal sperm count. It was also noted that zinc levels have a direct impact on the absorption and metabolism of dietary folate (24).

Other studies have mixed results regarding the role of folate in male infertility. They state that folic acid supplementation does not affect overall semen quality (23).

In a nutshell, folic acid is the driving force behind a multitude of physiological processes. Did you ever wonder what would happen if you didn’t have enough folate in your body? Scroll down for more information.

How Will You Know That You Have Folate Deficiency? What Happens If Your Folate Level Is Low?

The total body content of folate is estimated to be 15 to 30 mg. About half of this amount is stored in the liver and the remainder in blood and body tissues.

When the serum folate concentrations are above 3 ng/mL, it indicates adequacy.

Inadequacy of folate or its malabsorption can trigger a cascade of disorders/abnormalities. From your heart to kidneys, blood to the brain, infertility to stillbirths, insufficient folate can wreak havoc in your body. A few symptoms/disorders are listed below (25):

  • Cardiovascular diseases like atherosclerosis and coronary artery disease
  • Megaloblastic anemia
  • Chronic kidney disease
  • Childbirth issues like preterm birth, miscarriages, and stillbirths
  • Depression and anxiety
  • Sterility
  • Skin pigmentation
  • Ulcers in the mouth and GI tract
  • Lethargy
  • Weakness
  • Fatigue
  • Shortness of breath

What can we do to protect ourselves from these conditions?

Consider folic acid supplementation.

This may happen only when it is recommended by a healthcare professional. But what is it that you can do almost immediately?

Increase your dietary folate intake. How? By choosing folate-rich foods.

What are they? Check out the next section!

What Foods Are Rich In Folate?

What Foods Are Rich In Folate Pinit

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Folate is present in a variety of foods like green leafy vegetables, nuts, beans, seafood, eggs, grains, etc.

Here are the top sources of dietary folate (26):

FoodMicrograms
(mcg) per
serving
Beef liver, braised, 3 ounces215
Spinach, boiled, ½ cup131
Black-eyed peas (cowpeas), boiled, ½ cup105
Breakfast cereals, fortified with 25% of the DV†100
Asparagus, boiled, 4 spears89
Brussels sprouts, frozen, boiled, ½ cup78
Lettuce, romaine, shredded, 1 cup64
Avocado, raw, sliced, ½ cup59
Spinach, raw, 1 cup58
Rice, white, medium-grain, cooked, ½ cup†54
Broccoli, chopped, frozen, cooked, ½ cup52
Mustard greens, chopped, frozen, boiled, ½ cup52
Green peas, frozen, boiled, ½ cup47
Kidney beans, canned, ½ cup46
Spaghetti, cooked, enriched, ½ cup†45
Wheat germ, 2 tablespoons40
Tomato juice, canned, ¾ cup36
Crab, Dungeness, 3 ounces36
Orange juice, ¾ cup35
Bread, white, 1 slice†32
Turnip greens, frozen, boiled, ½ cup32
Peanuts, dry roasted, 1 ounce27
Orange, fresh, 1 small29
Papaya, raw, cubed, ½ cup27
Banana, 1 medium24
Yeast, baker’s, ¼ teaspoon23
Egg, whole, hard-boiled, 1 large22
Cantaloupe, raw, cubed, ½ cup17
Vegetarian baked beans, canned, ½ cup15
Fish, halibut, cooked, 3 ounces12
Milk, 1% fat, 1 cup12
Ground beef, 85% lean, cooked, 3 ounces7
Chicken breast, roasted, 3 ounces3

Hope you picked your favorites from the list. It’s a pleasant surprise to see so many daily foods we eat on the list, isn’t it?

Now that you know what foods contain folate, the next question would be, how much of it should you eat? Or how much of the folic acid supplementation would you need?

We have that sorted as well! Just keep scrolling!

What Is The Recommended Dietary Allowance (RDA) For Folic Acid/Folate?

The expert committee sets the RDA for folic acid or folate at the Food and Nutrition Board (FNB).

At least 85% of folic acid is estimated to be bioavailable when taken with food. But, only about 50% of folate naturally present in food is bioavailable. Hence, the RDA values are also set accordingly (26):

AgeMaleFemalePregnancyLactation
Birth to 6 months*65 mcg DFE*65 mcg DFE*
7–12 months*80 mcg DFE*80 mcg DFE*
1–3 years150 mcg DFE*150 mcg DFE*
4–8 years200 mcg DFE*200 mcg DFE*
9–13 years300 mcg DFE*300 mcg DFE*
14–18 years400 mcg DFE*400 mcg DFE*600 mcg DFE500 mcg DFE
19+ years400 mcg DFE*400 mcg DFE*600 mcg DFE500 mcg DFE

Here,
1 mcg DFE = 1 mcg food folate
1 mcg DFE = 0.6 mcg folic acid from fortified foods or dietary supplements consumed with foods
1 mcg DFE = 0.5 mcg folic acid from dietary supplements taken on an empty stomach

Wrapping It Up…
Folate is mandatory for growth, development, and survival. Folate/folic acid has a major role in DNA and RNA synthesis, methylation of biomolecules, and new RBC generation.

Insufficient folate levels can lead to NTDs in newborns, megaloblastic anemia, CVDs, kidney diseases, etc. Hence, all women of childbearing age should consume 400 micrograms of folic acid a day. If you are pregnant, you might need 600 micrograms of it in the first trimester itself.

Make your meal plans picking your favorites from the folate-rich foods list. Or consult your healthcare provider for assistance on folic acid supplementation.

You can also post your questions for our expert advice. Use the comments box below to send your feedback, suggestions, and queries.

Until next time, focus on your folate!

References

  1. Folate” Micronutrient Information Center, Linus Pauling Institute, Oregon State University.
  2. Folic Acid Supplementation for the Prevention…”Recommendation Statement, US Preventive Services Task Force.
  3. Neural Tube Defects, Folic Acid and Methylation” International Journal of Environmental Research and Public Health, US National Library of Medicine.
  4. Homocysteine and atherosclerosis” Current Opinion in Lipidology, US National Library of Medicine.
  5. Low dietary folate intake is associated with an excess incidence…” Circulation, US National Library of Medicine.
  6. Effect of folic acid supplementation on the progression…” Atherosclerosis, US National Library of Medicine.
  7. Folate and Its Impact on Cancer Risk” Current Nutrition Reports, US National Library of Medicine.
  8. Folate deficiency causes uracil misincorporation into human…” Proceedings of the National Academy of Sciences of the United States of America, US National Library of Medicine.
  9. Pooled analyses of 13 prospective cohort studies on folate intake…”Author transcript, HHS Public Access, US National Library of Medicine.
  10. Folate and risk of breast cancer: a meta-analysis.” Journal of the National Cancer Institute, US National Library of Medicine.
  11. Prevalence of Anaemia, Deficiencies of Iron and Folic…” Journal of Health, Population and Nutrition, US National Library of Medicine.
  12. Physiology of Folic Acid in Health and Disease” Current Drug Metabolism, Bentham Science Publishers Ltd.
  13. Folate-Deficiency Anemia” Health Encyclopedia, University of Rochester Medical Center.
  14. Folic Acid Supplementation and Pregnancy: More…” Reviews in Obstetrics & Gynecology, US National Library of Medicine.
  15. Folic Acid for a Healthy Baby” Health Encyclopedia, University of Rochester Medical Center.
  16. Quantitative assessment of nutrition in patients with…” Roczniki Państwowego Zakładu Higieny, US National Library of Medicine.
  17. Management of women with PCOS using myo-inositol…” Hormone Molecular Biology and Clinical Investigation, US National Library of Medicine.
  18. Nutrition of women with hair loss problem during…” Menopause Review, US National Library of Medicine.
  19. The Role of Vitamins and Minerals in Hair Loss: A Review” Dermatology and Therapy, US National Library of Medicine.
  20. Diet and hair loss: effects of nutrient deficiency and supplement use” Dermatology Practical & Conceptual, US National Library of Medicine.
  21. Use of folic acid and vitamin supplementation among adults…” Nutrition Journal, US National Library of Medicine.
  22. Folic Acid and Homocysteine in Chronic Kidney Disease…” CardioRenal Medicine, US National Library of Medicine.
  23. Folate and vitamin B12 in idiopathic male infertility” Asian Journal of Andrology, US National Library of Medicine.
  24. Effects of folic acid and zinc sulfate on male factor subfertility…” Male Factor, Fertility and Sterility, American Society for Reproductive Medicine.
  25. Pathology of Folate Deficiency” Pathology of Vitamin Abnormality, Section of Medicine, Experimental Medicine & Therapeutics with Section of Pathology.
  26. Folate” Health Information, Office of Dietary Supplements, National Institutes of Health.

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