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WHAT IS FOLIC ACID & WHAT DOES IT PREVENT?
Folic acid is considered a brain food and is needed for energy production and the formation of red blood cells. It strengthens immunity by aiding in the proper formation and functioning of white blood cells. Because it functions as a coenzyme in DNA and RNA synthesis, it is important for healthy cell division and replication. It is involved in protein metabolism, and has been used in the prevention and treatment of folic acid anemia. This nutrient may also help depression and anxiety. It may be effective in the treatment of uterine cervical dysplasia.
Folic acid is very important in pregnancy. It helps to regulate embryonic and fetal nerve cell formation, which is vital for normal development.
Folic acid is a B vitamin that can help prevent the vast majority of birth defects of the brain and spinal cord called neural tube defects (NTDs), such as spina bifida and anencephaly, when taken before pregnancy and in the early weeks of pregnancy. It may also prevent premature birth.
To be effective, a folic acid regimen must begin before conception and continue for at least the first three months of pregnancy. If a woman waits until she knows she is pregnant, it may be too late, because critical events in fetal development occur during the first six weeks of pregnancy - before most women know they have conceived.
Since NTDs originate in the first month of pregnancy, before many women know they are pregnant, it is important for a woman to have enough folic acid in her system before pregnancy. Folic acid is recommended for all women of childbearing age because 50 percent of pregnancies in this country are unplanned.
Studies show that women who consume the recommended amount of this vitamin, beginning before conception and continuing into the first month of pregnancy, reduce their risk of having a baby with certain birth defects of the brain and spine called neural tube defects (NTDs).
The neural tube is the embryonic structure that develops into the brain and spinal cord. This structure, which starts out as a flat pancake of cells, normally folds into a tube by the 29th day after conception. When the neural tube does not close completely, the baby has a neural tube defect. About 2,500 babies are born with NTDs each year, and many other affected pregnancies end in miscarriage or stillbirth.
The most common NTDs are spina bifida and anencephaly. Spina bifida is a leading cause of childhood paralysis. Affected children have varying degrees of lower-body paralysis and bladder and bowel control problems. Anencephaly is a fatal condition in which a baby is born with a severely underdeveloped brain and skull.
Studies also suggest that folic acid may help prevent some other birth defects as well, including cleft lip and palate.
FOLIC ACID DOSAGE BEFORE & DURING PREGNANCY
Researchers, midwives and health care providers recommends that all women who can become pregnant consume a multivitamin containing 400 micrograms of folic acid daily, in addition to eating a healthy diet including foods rich in folic acid. This is the only sure way a woman can get all the folic acid and other vitamins she needs. Most women get only about 200 micrograms of folic acid a day from their diets. Folic acid works best when combined with vitamin B-12 and vitamin C.
If a woman has been on oral contraceptives, she may have an increased need for folic acid. Alcohol also can act as an enemy to folic acid absorption.
Foods that are naturally rich in folates (the natural forms of folic acid found in foods) include: oranges, orange juice, other citrus fruits and juices, leafy green vegetables, beans, peanuts, legumes, broccoli, asparagus, peas, split peas, lentils, barley, bran, brewer's yeast, brown rice, cheese, chicken, dates, lamb, liver, milk, mushrooms, pork, root vegetables, salmon, tuna, wheat germ, wheat and whole-grain products. Multivitamins, fortified breakfast cereals, and enriched grain products contain a synthetic form of folic acid that is more easily absorbed by the body than the natural form (which must be broken down by the body into a usable form). It is not yet known whether consuming 400 micrograms of folate from foods every day provides the same level of protection against birth defects as 400 micrograms of the synthetic form. This is because cooking and storage can destroy some of the folate in foods, and the amount of usable folic acid the body can obtain from different foods varies widely.
The body can absorb almost 100 percent of the synthetic form of folic acid. This is why the March of Dimes, the Centers for Disease Control and Prevention (CDC), and the Institute of Medicine recommend that women who could become pregnant consume 400 micrograms a day of the synthetic form. Because some fortified breakfast cereals contain 400 micrograms of folic acid in one bowl, a woman also could get the recommended amount of synthetic folic acid this way, or she can take a multivitamin. However, a 1997 March of Dimes survey showed that only 30 percent of women take a multivitamin containing folic acid before pregnancy.
The Institute of Medicine also recommends that women should increase their intake of synthetic folic acid to 600 micrograms a day once their pregnancy is confirmed. Most midwives and health care providers recommend a prenatal vitamin that contains at least this amount of folic acid. However, women should not take more than 1,000 micrograms (or 1 milligram) without their midwife or health care provider's advice.
If a woman has already had a baby with an NTD, she should consult her midwife or health care provider before her next pregnancy about the amount of folic acid she should take. Studies have shown that taking a larger dose of folic acid daily (4 milligrams), beginning at least one month before pregnancy and in the first trimester of pregnancy, reduces the risk of having another affected pregnancy by about 70 percent.
WHERE IS FOLIC ACID FOUND?
Foods high in folic acid are eggs, yeast & brewer's yeast, mushrooms, oranges, orange juice, other citrus fruits and juices, leafy green vegetables, beans, peanuts, legumes, broccoli, asparagus, peas, split peas, lentils, barley, bran, brown rice, cheese, chicken, dates, lamb, liver, milk, mushrooms, pork, root vegetables, salmon, tuna, wheat germ, wheat and whole-grain products.
As of January 1, 1998, the U.S. Food and Drug Administration has required the addition of 140 micrograms of folic acid per 100 grams of grain to cereals, breads, pastas, and other foods labeled "enriched." (Only a few cereals contain 400 micrograms per serving.) This makes it a little easier for women to obtain folic acid from their diets. However, the amount added to enriched foods is small, and most women will not be able to obtain enough folic acid from their diet alone. It is estimated that the addition of this amount of folic acid to enriched foods will prevent only about 5 to 20 percent of folic acid-preventable NTDs.
The FDA did not require that more folic acid be added to enriched foods because of the concern that folic acid might mask one sign of a potentially dangerous condition called pernicious anemia, that is seen mainly in elderly people. Since high doses of folic acid could possibly correct the anemia, diagnosis of serious neurological symptoms that accompany it could be delayed. The level of fortification the FDA currently requires is believed to be safe for everyone.
FOLIC ACID & NTD PREVENTION
How folic acid prevents Neural Tube Defects (NTDs) is not well understood. Some studies suggest that it may correct a nutritional deficiency, while others suggest that supplemental folic acid helps compensate for inborn errors in how the body processes folates.
For example, a recent study found that as many as one in seven people may carry a genetic mutation (change) that causes them to have a deficiency in folic acid, even if they are consuming a diet that contains the recommended amount of folates. These people have problems breaking down folates found in food to forms of folic acid the body can use, resulting in lower folic acid levels in the blood. Studies suggest that women with this gene mutation may be at increased risk of having a baby with an NTD. However, taking folic acid appears to raise levels of the vitamin in the blood, and thereby reduce the risk of having an affected baby.
Besides helping to prevent certain birth defects, folic acid plays other important roles during pregnancy. A pregnant woman needs extra folic acid to help her to produce the additional blood cells she needs. Folic acid also is crucial to support the rapid growth of the placenta and fetus. This vitamin is needed to produce new DNA (genetic material) as cells multiply. Without adequate amounts of folic acid, cell division could be impaired, possibly leading to poor growth in the fetus or placenta. One study found that women who were deficient in folic acid were more likely to have a baby who was premature and of low birthweight (less than 5-1/2 pounds).
FOLIC ACID HEALTH BENEFITS
In recent years, midwives and health care providers have come to realize that folic acid is very important for everyone in maintaining health. It has long been known that folic acid plays an important role in production of normal red blood cells, and that individuals who were deficient in folic acid sometimes developed a form of anemia called megaloblastic anemia (characterized by a reduced number of red blood cells).
More recent studies suggest that folic acid also may help prevent heart disease and stroke. It appears that individuals who have a high level of a substance called homocysteine in their blood have an increased risk of heart disease and stroke. When these people take folic acid, the level of homocysteine in their blood drops, possibly decreasing their risk of cardiovascular diseases. (Researchers also are looking at the role of high homocysteine levels in causing birth defects.) Other studies suggest that folic acid also may help prevent certain cancers, especially colon cancer. While these studies are preliminary, they suggest that many people, besides women of childbearing age, may benefit from taking folic acid.
FOLIC ACID RESEARCH
The March of Dimes has several research grantees who are seeking to improve understanding of how folic acid prevents NTDs. Because most NTDs are believed to be caused by a combination of genetic and environmental factors (including nutritional factors like folic acid), other grantees are trying to identify genes that increase a woman's risk of having a baby with an NTD. One of these researchers is focusing on 5 genes that play a key role in how the body breaks down food folates, to see if mutations in any of these genes increase the risk of spina bifida. Another researcher is looking at how folic acid is transferred from the placenta to the fetus, and trying to identify any factors that could interfere with this process. These studies could lead to ways to identify women who are at increased risk of having a baby with an NTD, and to improved ways to treat them, with the goal of preventing even more NTDs than is currently possible.
HELPFUL RELATED LINKS
MoonDragon's ObGyn Information: Anemia - A Holistic-Dietary Guideline
REFERENCES
Centers for Disease Control and Prevention. Knowledge and use of folic acid by women of childbearing age – United States, 1997. Morbidity and Mortality Weekly Report, volume 46, number 31, August 8, 1997, pages 721-723.
Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. Morbidity and Mortality Weekly Report, volume 41, number RR-14, September 11, 1992.
Locksmith, G.J., and Duff, P. Preventing neural tube defects: the importance of periconceptional folic acid supplements. Obstetrics and Gynecology, volume 91, number 6, June 1998, pages 1027-1034.
Molloy, A., et al. Thermolabile variant of 5,10-methylenetetrahydrofolate reductase associated with low red-cell folate: implications for folate intake recommendations. The Lancet, volume 349, May 31, 1997, pages 1591-1593.
Schwarz, R.H., and Johnston, R.B., Jr. Folic acid supplementation, when and how. Obstetrics and Gynecology, volume 88, number 5, November 1996, pages 886-887.
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: Folate, Other B Vitamins, and Choline. Washington, D.C., National Academy Press, April 7, 1998.
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