Folic acid, a water soluble vitamin, also known as Vitamin B9, is essential for numerous bodily functions, especially during the phase of rapid cell division and growth, such as in infancy and pregnancy. The words ‘Folate’ and ‘Folic acid’ are often used interchangeably but there are important differences between them. Folate is the naturally-occurring form, whereas folic acid is the synthetic form of the vitamin which is used in most supplements and in fortified foods. Folic acid and folate work alike in the body, with one exception: the synthetic form (folic acid) is better absorbed by the body than the natural form.
Folic acid is of immense importance for numerous vital functions and processes taking place within our body, such as cell division and growth, synthesis and repair of DNA, protein metabolism and proper functioning of the brain.
Folic acid is the key component in the production of red blood cells. It is required by the body to produce ‘heme’, the component of haemoglobin, which is responsible for carrying iron. Deficiency of this vital nutrient can cause anaemia, which can adversely affect the maturation of young red blood cells and its manifestation is in fatigue and excessive tiredness. In addition, for the body’s defense mechanism, the white blood cells are also manufactured in the presence of folate supplements.
The adequate and appropriate development of an unborn child’s brain and spinal cord is dependent on the folate level of the mother. Lack of folate during pregnancy can lead to gaps in the development of the spinal cord, which can result in paralysis, brain damage, or a stillborn child.
The brain is another recipient of folic acid’s great benefits. Low levels of folic acid are linked to higher levels of homocysteine. High levels of homocysteine are associated with stroke, osteoporosis, blood vessel disease, cervical cancer and even macular degeneration. It has also been found to improve the efficacy of the antidepressant drug and has been helpful in treating major depression.
Cognitive function declines with age, especially cognitive domains related to information processing speed and memory. Such changes in cognitive function have been linked to risk of dementia in old age. Low folate and raised homocysteine concentrations in the blood are important risk factors associated with poor cognitive performance. Hence adequate consumption of folic acid is very vital for improved cognitive functions.
Reduced cancer risk
A lack of folic acid in the diet has been linked to increased incidence of a number of cancers, including colon, cervix, rectum, lung, brain, pancreas and oesophageal cancers. This is because cancers like these are due to mutation and/or damage to DNA. Folic acid helps to synthesize and repair RNA and DNA. Taking adequate amount of folic acid via fruits and vegetables can have protective effects against cancers.
Thwarting heart disease
Folic acid supplements also help the heart stay healthy and function optimally. Folate deficiency can lead to an increased risk of heart disease, coronary complications, and strokes in patients. Folic acid also helps remove homocysteine, a toxic compound that can lead to severe artery damage if not eliminated from the blood.
Since folic acid is a vitamin that is not produced by the body, it is required to provide the body with folic acid on a timely basis. The dosage will depend on the health condition of the person. For example, a healthy person requires 400 mcg per day, children between the ages of 1 and 13 need about 150 mcg to 300 mcg of folic acid per day. About 600 mcg of folic acid is required by pregnant and breastfeeding women. These doses are just approximations; the exact dosage will depend on the deficiency and the health condition of the person.
Overdose of folic acid is virtually not recognized from the natural sources, under normal circumstances, and hence the risk of toxicity is relatively low. Yet one has to be cautious when taking it as supplementation from the synthetic forms. Taking folic acid supplements should be done under the care of a healthcare professional, especially when the person is associated with anaemia or pregnancy.
Moreover, high doses of folic acid can also mask the Vitamin B12 deficiency. Folic acid from the supplement will treat the anaemia caused by vitamin B12 deficiency; however, the nerve damage associated with the deficiency will go undetected. An overdose of the nutrient is also seen to inactivate the effect of certain medications and also indirectly harm the body, by not allowing the detection of another deficiency.
Folate occurs naturally and abundantly in a variety of different foods. Fruits and vegetables take care of more than half the daily requirement. Grain products, legumes, nuts and seeds contribute the remaining. Foods that contain small amounts of folate but are not considered good sources can contribute to significant amounts of folate to an individual’s diet if these foods are consumed often or in large amounts.
Some of the common food sources include whole grains, cereals, lentils, beans, peas, sunflower seeds, dark leafy greens like spinach, asparagus, broccoli, citrus fruits like papaya, orange, and veggies like okra, cabbage, cauliflower, beets, corn and carrot. Although less common in the diet, chicken liver and beef liver are also moderate sources of folate.
Folic acid supplementation
Folic acid supplementation is required before, during and after pregnancy, when the body’s demand for folate increases. Cell reproduction is the fastest in a developing foetus. The baby’s neural tube takes shape within the first 28 days of pregnancy, long before any sign shows up. Sufficient folate must be provided during this period to ensure the proper development of your baby’s brain, skull and spinal cord and prevent irreversible neural damage and birth defects. This is why it is a good idea to start taking extra folate before conception.
An additional noteworthy point is that men who are planning for fatherhood can also benefit from folate supplementation. Studies have shown that extra folate can increase male fertility and reduce chromosomal defects in sperms.
Folate supplementation needs to continue throughout pregnancy, the lack of which significantly heightens your chance of preterm labour and abnormal foetal development. Babies born to mothers who do not take extra folate during pregnancy are more likely to suffer from low birth weight, cleft lips, congenital heart and limb defects and mental retardation. Extra folate is also necessary for nursing mothers. Folate is delivered to your newborn through breast milk. Insufficient folate provision can stunt a baby’s growth and increase the potential for childhood leukaemia.
The other instance for additional folate requirement is when you need to replenish your blood. Extra folate promotes red blood cell production and increases the oxygen-carrying capacity of your blood. This is why drinking a glass of orange juice after you donate blood is found to reduce the possible side effects like dizziness and fainting. You should take a supplementary dose of folate to help speed up your recovery after blood donation, surgery or any other case of severe blood loss.
If you eat a variety of ample amounts of fruits, vegetables, nuts and beans, then you are sure of meeting the daily requirement, without depending on the supplements.
(The author is a Chennai based nutrition consultant. Mail in your queries to [email protected])