Folic Acid

by | Oct 14, 2020 | Last updated Feb 25, 2023

Folic acid is a B vitamin found in foods like leafy green vegetables, broccoli, Brussel’s sprouts, and kidney beans, to name a small few. More importantly, it is a useful and important water-soluble B vitamin with numerous health roles and benefits.

What is Folic Acid?

Folic acid is a form of vitamin B9. This vital nutrient is also known as a complex B vitamin that is similar to vitamin B12. 

This vitamin plays many roles in the body – primarily in supporting red blood cell growth, healthy cell growth, and improved cell function. As such, there is much research connecting this acid to improved heart health. It is also thought to play an essential role in preventing certain heart conditions and diseases by controlling homocysteine hormone levels. 

Besides heart health, folic acid also plays a significant role in women’s health, particularly concerning pregnancy. Although this compound is known to promote cell growth in an adult body, it is also vital to creating the neural tube during the early development of a fetus. With proper supplementation of folic acid, specific congenital disabilities caused by the neural tube’s improper formation can be prevented. 

Since this compound is crucial to health, individuals can easily find it added to many different products, like cereals and grains. Naturally, folic acid can be found in hardy fruits and vegetables. 

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Folic Acid Uses

Folic acid is useful for several important tasks in the body, including creating red blood cells, creating and repairing DNA and RNA, assisting rapid cell division and growth, preserving brain health in infants, and preventing age-related hearing loss.

Like those treating rheumatoid arthritis, certain medications may lead to the removal of folate in the body. In this case, folic acid supplementation may support healthy levels of folate. Additionally, folic acid was found to reduce the gastrointestinal effects of the medications by 79%. 

Current medical research published in Reviews in Obstetrics & Gynecology supports folic acid use one month before and during early pregnancy, as it is intrinsic to the child’s healthy development.

Additionally, preliminary research suggests “[p]ericonceptional folic acid [one month before conception and during early pregnancy] may reduce [autism spectrum disorder] risk in those with [insufficient] folate metabolism.”

Even more research concludes that folic acid supplementation during pregnancy may lead to a reduced chance of cleft palate development.

Foods Containing Folic Acid

While dark green vegetables are good sources of folic acid, you should not overcook them. Most vegetables are more nutritious when prepared al dente since nutrient levels are known to fall exponentially as the temperature rises.

Foods high in folate include: 

  • Asparagus
  • Baker’s yeast
  • Broccoli
  • Brussel’s sprouts
  • Cabbage
  • Cauliflower
  • Egg yolk
  • Jacket potato
  • Kidney
  • Lentils 
  • Lettuce
  • Liver
  • Papaya
  • Kiwi
  • Milk
  • Oranges
  • Parsnips
  • Peas
  • Spinach
  • Sunflower seeds
  • Whole wheat bread, usually fortified 

It is important to note that it is not recommended that liver is consumed during pregnancy.  Though folic acid supplements are beneficial one month before getting pregnant, during pregnancy, and when used to treat certain conditions, it is always a better option to get nutrients from natural food sources rather than supplements. 

Add in some of the foods from the above list to boost your folate intake, whether you are looking for folic acid foods for pregnancy or otherwise.

Many individuals also mix these foods into regular recipes to create folate-rich meals. Some choose to make smoothies out of foods like grapefruit, banana, mango, and lime. Some protein powders also contain folic acid and can be added to shakes, smoothies, and soups. 

Since many leafy greens and beans contain healthy amounts of this compound, other popular folate-rich recipes include salads, soups, and roasted vegetables. 

Folic Acid and Your Health

Folic Acid For Men

Healthcare providers have advised women to take folic acid during pregnancy for some years. Still, the nutrient has recently shown an improvement in men’s health, specifically when it comes to virility. Folic acid is linked to a higher genetic quality of sperm.

A cross-sectional study that made the link involved 89 healthy, non-smoking males. Researchers found a link between taking folic acid and the corresponding frequency of abnormalities in sperm. 

Another study noted that supplementation of both zinc and folic acid could increase sperm count in fertile and subfertile men. 

However, there is more recent research that shows this may not be true. One study published in JAMA found that “Among a general population of couples seeking infertility treatment, the use of folic acid and zinc supplementation by male partners, compared with placebo, did not significantly improve semen quality or couples’ live birth rates.”

The study was funded by the National Institutes of Health, the Environmental Protection Agency, and the United States Department of Energy. It was published in Human Reproduction, a peer-reviewed medical journal.

Folic acid is used to not only treat fertility in men, but also the prevention of heart disease and the prevention and/or treatment of depression and anemia. However, research doesn’t fully support the notion that folic acid plays a role in preventing coronary heart disease, so more research may be needed to confirm this claim. 

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Folic Acid For Women

Though pregnancy is the most prominent topic for women and folic acid, several other health benefits include treatment for heart disease, anemia, and vitamin or nutrient deficiency. When paired with iron, vitamin D, or other complementary supplements, folic acid can improve nutrient profile in some individuals. 

When it comes to folic acid and women’s health, most of the research concentrates on its ability to reduce the risk of neural tube defects before and during pregnancy. The European Journal of Clinical Nutrition notes that a once-a-week supplement of folic acid could reduce NTDs when taken at least 12 weeks before conception. 

Another study echoed these findings, noting that, “All women of childbearing age, but especially those who are obese or diabetic, should be encouraged to take folic acid daily to reduce the risk of neural tube defects.”

However, folic acid isn’t just effective at reducing the incidence of NTDs. Additionally, folic acid has also been found to reduce the risk of developing hypertension in a study published in JAMA with over 150,000 women aged 23 to 70. Another study noted that women with depression could benefit from folic acid supplementation. 

Folic Acid for Pregnancy

Folic acid for pregnancy and conception has long been recommended due to its proven ability to promote the fetus’s healthy development. This acid’s importance is also exemplified in its prevention of neural tube defects (NTD) – the most common spina bifida.

Folic acid also prevents more rare and severe defects such as anencephaly. According to research published in the Journal of Prenatal Medicine: An International Journal of Prenatal Diagnosis and Fetal Maternal Medicine, individuals can prevent 70% of NTD congenital disabilities with the consumption of 0.4 mg per day before conception and during the first trimester of pregnancy.

However, folic acid can only prevent NTD congenital disabilities during the first trimester so that unplanned pregnancies may go unprotected. If a woman has had a pregnancy that resulted in an NTD previously, she should visit her healthcare provider before conceiving to receive a prescription dose of folic acid. 

This is because folic acid is so essential for developing the fetus’s spinal cord and is one of the first parts to develop. According to the Pathological Society of Great Britain and Ireland, “Folic acid supplementation is an effective method for primary prevention of a proportion of NTDs, in both humans and mice, although the embryonic mechanism of folate action remains unclear.”

Folic Acid Treatment for Depression

There is an association between depression and low levels of folate and/or B12. Low folate levels are also linked to an inadequate response to antidepressants, according to research published in the Journal of Psychopharmacology (Oxford, England), so folic acid treatment will better the response to these medications. 

More research found that there need to be more studies investigating the connection between folic acid and depression. In fact, one study noted that “There is an important need for additional studies on folate and depression, the most pressing of which is larger studies on the ability of folate to potentiate the action of standard antidepressant therapies.” This same study also noted that 1-2 mg supplementation of folate combined with vitamin B12 might have some beneficial effects on depression.

Research published in the Journal of Epidemiology & Community Health from the British Medical Association noted that low folate levels were associated with depression. This suggests that regular folate supplementation to meet these nutritional needs could improve mood status. 

According to other research, “Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy.”

Folic Acid Treatment for Hair Loss

Folic acid and iron both help to carry oxygen to the red blood cells. When you are deficient in either, this may mean the cells in your scalp do not have enough oxygen to produce hair growth. 

According to Dermatology Practical & Conceptual, “Folic acid is found in leafy greens, and many foods are fortified with folic acid, making deficiency uncommon. Deficiency mainly results in megaloblastic anemia, without manifestation of hair loss.” Another study noted that folic acid played an important part in preventing hair loss

The deficiency in men may also limit the cells’ ability to create ATP, a chemical responsible for hair growth.

This acid also contributes to hair color and thickness, so hair loss caused by vitamin deficiency may be treated with folic acid. In a study at the Ontario Veterinary College and published in The Veterinary Record, a calf suffering brown, hairless patches was given iron and folic acid. After continuous supplementation, the calf recovered from the hair loss.

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Folic Acid Treatment for Anemia

Folate deficiency anemia is defined as the lack of folic acid in the blood. As discussed previously, folic acid facilitates the production of red blood cells. When you don’t have enough red blood cells in your body, this can cause anemia, one of the common folic acid deficiency symptoms. 

While research published in the Journal of Health, Population and Nutrition noted that a lack of folic acid and iron might lead to anemia, another study from the American Society for Clinical Nutrition indicated that a lack of folic acid and vitamin B12 led to anemia, saying that, “In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.”

As previously discussed, a lack of oxygen to the scalp can cause hair loss. This lack of oxygen can be due to low levels of red blood cells, indicating they will not be prevalent in the rest of your body.

Without the oxygen needed, your body cannot do what it needs to do.

Having low levels of folic acid can also lead to megaloblastic anemia, which causes red blood cells to grow in size and become oval-shaped instead of round. This means there are fewer cells that tend not to live as long as healthy red blood cells. Although megaloblastic anemia is dangerous, it is easily prevented with a healthy diet of folic acid rich foods.

People may develop folate deficiency anemia and other folic acid deficiency symptoms if they do not eat enough foods containing folate, like dark green leafy vegetables, fruit, yeast, meat, and fortified grains. This deficiency may also develop if the individual has celiac disease, consumed too much alcohol, takes seizure medication, are pregnant, or has difficulty absorbing folate. 

Anemia symptoms include pale skin, decrised appetite, irritability, malaise or fatigue, diarrhea, or a smooth and tender tongue. You may have other signs and should ask your healthcare provider if you are concerned. They will look at your history, do a physical exam, and perhaps do some bloodwork.

Your healthcare provider will consider your age, health, and history as well as how bad your condition is, your tolerance of medicine, treatment or therapies, the estimated length of the condition, and your input.

The treatment may include vitamin and mineral supplements, diet changes, medicines, treatment of an underlying disease, and folic acid pills or injections. The diet change of adding in foods high in folate and decreasing your use of alcohol will make an impact as well.

Folic Acid Treatment of Anxiety

The results of multiple studies have suggested that folate deficiency may cause symptoms of depression. More research looked at the use of folic acid and vitamin supplements included in treating people with mental health disorders. 

Researchers have also looked at how often those with depression and anxiety use folic acid or vitamin supplements instead of those without a mental health condition. The results show that taking folic acid or vitamin supplements varied without any reliable conclusions to be drawn about depression and anxiety being a predeterminer for taking folic acid and vitamins. 

Overall, the research shows us that those with certain mental health disorders would improve their circumstance by taking folic acid. 

More research found that “The prevalence and the likelihood of taking folic acid and vitamin supplements varied substantially by a history of diagnosed depression among both men and women and by a history of diagnosed anxiety among men, but not by presence of elevated depressive symptoms in either sex.” 

Folic acid may have a beneficial effect on mood disorders when combined with other vitamin supplements as well. Research on vitamin B12 and folic acid shares that, “In conclusion, two-year supplementation with vitamin B12 and folic acid in older adults with hyperhomocysteinemia showed that lowering Hcy concentrations does not reduce depressive symptoms, but it may have a small positive effect on HR-QoL [quality of life].” 

Overall, vitamin supplementation can positively affect depression and anxiety, as per Integrative Medicine Insights. Unfortunately, not all science supports this fact. Research found that “results do not provide evidence for a causal effect of circulating folate or vitamin B12 on the risk of depression or anxiety. However, we cannot rule out small to moderate effects, and thus large scale studies are needed.” 

Folic Acid and Medications

Folic Acid with Methotrexate

Methotrexate is a commonly used medication for rheumatoid arthritis. This medication helps arthritis but also depletes the body of folic acid. 

When taking methotrexate, it is good to take folic acid supplements and eat foods high in folate. The folic acid functions as a balancer. Consult with your healthcare provider about the importance of folic acid in the treatment of rheumatoid arthritis.

According to research published in the Journal of Clinical Rheumatology, “Folate supplementation can reduce the incidence of hepatotoxicity and gastrointestinal side-effects of MTX [methotrexate] in patients with RA [rheumatoid arthritis]. It can also reduce patient withdrawal from MTX treatment.” Therefore, folic acid should be used daily while on this medication.

However, some research suggests not consuming folic acid while also consuming methotrexate. According to one study, continuous supplementation of folic acid may reduce the effectiveness of this arthritis mediation. Another study published in Arthritis and Rheumatism found the same results. 

Folic Acid with Iron and B12

Iron and folic acid pills are both essential in pregnancy. Both also fight anemia and are also blood-building nutrients. On the other hand, vitamin B12 is an important nutrient supporting healthy blood cell production, energy levels, and nerves. 

There is plenty of research connecting iron, folic acid, and vitamin B12. In particular, a deficiency of all three is associated with an increased incidence of anemia, according to Archivos Latinoamericanos de Nutricion. Additionally, research found that supplementation of iron, folic acid, and vitamin B12 can reduce these incidences of anemia

Even further research found that “Data from our work suggest that iron deficiency could affect many metabolic pathways, including vitamin B12, folate, and some lipids. These changes normalize after iron therapy, even in women with baseline low levels of serum vitamin B12.”

Folic Acid with DHA

We have seen a theme of iron, folic acid, and B vitamins, but there are a few more nutrients important for a healthy body. One is DHA or “docosahexaenoic acid.” DHA is a polyunsaturated omega-3 fatty acid and is found throughout the body.

It is a significant structural fat in the brain and eye, especially the retina. Fish oil is an excellent source of DHA. Pregnant and nursing mothers are especially encouraged to take DHA to lead to healthy brain development in the fetus, baby, and child. Post-natal consumption may improve vision and cognitive function, according to research published in Nutrients and again in Nutrients in 2016. 

Some research suggests there may be a connection between folate, folic acid, and DHA. According to one study from the European Journal of Nutritional Sciences, low amounts of DHA and folate are associated with cardiovascular disease and certain emotional disorders. 

Another study found that DHA and folic acid were also associated with decreased inflammation and could potentially benefit certain emotional disorders, including dementia and depression. When it comes to DHA and folic acid during pregnancy, Nutrients found that “Maternal supplementation within recommended safe intakes in populations with dietary deficiencies may prevent many brain and central nervous system malfunctions and even enhance brain development and function in their offspring.”

Folic Acid with Vitamin D

The last vitamin to be discussed is vitamin D. Vitamin D is commonly thought of as the sunlight or milk vitamin. It is important to prevent or manage hypertension, facilitate bone health and growth, and assist in a healthy pregnancy along with a reduction in risk of cows’ milk allergy in the resulting infant. 

In general, Nutrients supports folic acid and vitamin D during pregnancy, as they can provide some health benefits. 

Some research suggests a combination of folic acid and vitamin D may play a beneficial role with hypertension in specific individuals with diabetes. The combination may be helpful to individuals taking anticonvulsant medications as well

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Folic Acid vs. Folate

The marked difference between folic acid and folate is that folic acid is included in supplements, and folate is found in the foods we eat. Folate is the general term for water-soluble B-vitamins, while folic acid refers to a synthetic compound used in supplements or food fortifications. Additionally, folate naturally occurs in foods.

Folate can be metabolized in the small intestine, while folic acid must be reduced and converted in the liver. The liver enzyme used to convert folic acid to an ingestible substance is not prevalent in the liver. This means, when you combine a high intake of folic acid with low enzyme production, you will likely end up with unnatural levels of unmetabolized folic acid in your system circulation.

It is common to find unmetabolized folic acid in the blood after consuming fortified foods or supplements. According to the Centers for Disease Control, the mandatory fortification was introduced in 1998 as a precaution because folic acid consumption protects early pregnancies from ending or resulting in neural tube defects in newborns. 

Folic Acid vs. Iron

Iron is a mineral; folic acid is a nutrient. However, they are essential to the body’s normal and healthy function and have much to do with circulation and red blood cells.

There is also plenty of research showing that iron and folic acid combined could provide individuals some health benefits. For example, the International Journal of Reproductive Medicine found that pregnant women often need iron and folic acid supplementation to prevent anemia. However, research also noted that some populations of pregnant women have a hard time continuing this supplementation. 

Research published in The American Journal of Clinical Nutrition also noted that iron and folate supplementation is best done earlier in the pregnancy to prevent further issues. 

Folic Acid vs. Folinic Acid

A folinic acid is a next-generation form of folic acid as it does not require enzyme conversion in the liver. It can be found naturally in high folic acid foods. Folinic acid is often used as a replacement for folic acid.

When combined, folinic acid and folic acid have been found to reduce the side effects of those with arthritis. The Cochrane Database of Systematic Reviews found that a combination of folic and folinic acid may reduce the side effects of taking methotrexate for rheumatoid arthritis. 

Another study noted that this combination specifically reduced gastrointestinal toxicity caused by methotrexate medication usage. The Journal of Evidence-Based Medicine came to the same conclusion. 

Folic Acid vs. Ferrous Sulfate

Ferrous sulfate is used like iron supplements to help the body produce normal, healthy red blood cells. It can be used to treat or prevent iron-deficiency anemia.

Together, they have been shown to have some health benefits. For example, one study from the European Academy of Nutritional Sciences found that folic acid and ferrous sulfate could increase children’s weight gain. 

There is also some research suggesting the combination of folic acid and ferrous sulfate could reduce anemia. One study found that children who consumed a combination of folic acid and ferrous sulfate could lower anemia prevalence and increase hemoglobin levels. 

Prescription Folic Acid

Prescription folic acid may be used to treat depression but is also commonly used in pregnancy when the mother has a MTHFR A1298C polymorphism. This genetic mutation is associated with Down syndrome pregnancies and neural tube defects, anencephaly, and microcephaly.

The mutation may also contribute to the development of major depressive disorder or just as a predictive marker. For most people, high folic acid foods should be sufficient. 

Folic Acid Deficiency

Besides anemia and congenital deformities, folic acid deficiency can lead to a higher risk of developing clinical depression, memory and brain function problems, a higher tendency to develop allergies or allergy diseases, and a higher tendency towards low bone density, according to research published in Handbook of Clinical Neurology and StatPearls

Overall, folic acid is essential for heart and bone health.

A deficiency can also occur in sickle cell anemia or in people with conditions that affect folate absorption (including alcohol abuse or kidney disease). Symptoms of deficiency can include fatigue, weakness, mouth sores, brain fog, irritability, appetite loss, or unintended weight loss

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Folic Acid Dose

The folic acid dose varies depending on your needs. Usually, a 400mcg folic acid tab is given to men and women 14 years and older. The upper limit for men is 1mg, although some researchers noted that folic acid supplementation could be up to 5mg. It is best if this amount is reached by consuming foods high in folate. If you do use supplements, as a man, the dose should not exceed 1000mcg or 1mg of folic acid per day. Folic acid overdose can be just as dangerous as a deficiency. 

Specifically, “In addition to the fortification of dietary staples with folic acid, women of reproductive age should supplement before conception with 0.4‐1.0 mg of folic acid daily as part of their multivitamins,” according to the Journal of Clinical Pharmacology from the American College of Clinical Pharmacology. 

Other research suggests women need about 400mcg unless they are pregnant or breastfeeding. Pregnant women need 600mcg, and lactating women need 500mcg. The elderly dosage will vary depending on the advice of the individual’s healthcare provider. 

In the elderly population, it is important to test B12 levels before beginning any folic acid treatment as the folic acid can mask B12 deficiency – a common problem in the elderly population. Folic acid boosts memory and mental agility, but the help is outweighed by the negative if B12 is not there to support it. The cognitive decline will not be helped if B12 is not also in the body.

Folic Acid Effects on Weight Loss

Folic acid does not benefit weight loss and has adverse effects such as energy and lipid metabolism disturbance. The results of recent studies suggest that excess folic acid in the diet may exacerbate weight gain, fat accumulation, and inflammation in a high-fat diet

Some studies suggest a diet containing folic acid can lead to reduced weight gain. One study found that “Following a hypocaloric diet could lead to a better folate status through increased intake, but especially among those who lose the most body weight.”

Another study claims, Enrichment of PR diet with vitamin B or folic acid caused a tendency to further suppression of weight gain, and in case of vitamin B(6), these differences were statistically significant. However, such body weight (BW) suppression was not observed when all studied vitamins were used together.” 

Folic Acid Side Effects

There are usually no side effects from the regular supplementation of folic acid. Up to 1000mcg or 1mg, the water-soluble folic acid will be passed in the urine. If taken long-term in large doses, excessive folic acid may cause abdominal cramps, diarrhea, rash, sleep disorders, irritability, confusion, nausea, stomach upset, behavior changes, skin reactions, seizures, gas, and excitability, according to Indian Pediatrics

Taking a high dose, long term may also be linked to the increased risk of a heart attack in people with past heart health problems, while other research links the high doses to an increased risk of lung or prostate cancers. 

However, one study found that folic acid did not have a significant impact on cardiovascular health or cardiovascular diseases, with researchers saying, “Our meta‐analysis indicated a 10% lower risk of stroke and a 4% lower risk of overall CVD with folic acid supplementation. A greater benefit for CVD was observed among participants with lower plasma folate levels and without preexisting CVD and in studies with larger decreases in homocysteine levels. Folic acid supplementation had no significant effect on the risk of coronary heart disease.” 

If you are only taking a low dose, this should prevent any side effects. With your folic acid deficiency, the risks are much higher. 

Folic Acid Pros and Cons

While folic acid has been linked to the increased growth of cancer in those with cancer, as long as you do not take a long-term, high dose, you should be fine. However, when it comes to the research, the connection between folic acid and cancer is mixed. 

One study published in Current Nutrition Reports noted that specific populations experienced increased cancer risk with folate consumption, while other people experienced the exact opposite. 

Another study published in Current Opinion in Clinical Nutrition and Metabolic Care found that “Although folate intake at sufficient levels appears to be an effective cancer chemopreventive strategy, high dose supplementation of folate has not been effective in reducing recurrence of cardiovascular events or colorectal adenomas in clinical intervention trials. Although controversial, high folate status achieved through folate fortification or supplementation may increase the risk of certain chronic diseases among certain individuals, possibly by interfering with the homeostasis of one-carbon metabolism.”

Folic acid benefits outweigh the cons as folic acid is linked to the fetus’s healthy development, boosts heart health, and lowers the risk of heart disease, cancer, and Alzheimer’s disease.

It is also thought to help with depression or mood disorders while preventing cognitive decline in the elderly. Folic acid uses are varied and beneficial.

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The Final Take on Folic Acid

Folic acid benefits everyone from young to old. It is an excellent supplement and one that should be used if you cannot get enough folic acid-rich foods in the regular diet. The development of this supplement and the subsequently-created fortified foods cause a significant decline in neural tube defects in newborns. 

Aside from this, folic acid function helps or resolves a myriad of health issues and gives us the ability to perform better physically and mentally.