Folic acid and Folate are water-soluble B vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Foods that are naturally high in folate include leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice.
Folic acid is used for preventing and treating low blood levels of folate (folate deficiency), as well as its complications, including anemia and the inability of the bowel to absorb nutrients properly (e.g. Celiac sprue and Crohn’s disease). Folic acid is also used for other conditions commonly associated with folate deficiency, including ulcerative colitis, liver disease, alcoholism, and kidneydialysis.
Women who are pregnant or might become pregnant take folic acid to prevent miscarriage and “neural tube defects,” birth defects such as spina bifida that occur when the fetus’s spine and back do not close during development.
Folic acid is used for memory loss, Alzheimer’s disease, age-related hearing loss, preventing the eye disease age-related macular degeneration (AMD), reducing signs of aging, weak bones (osteoporosis), jumpy legs (restless leg syndrome), sleep problems, depression, nerve pain, muscle pain, AIDS, a skin disease called vitiligo, and an inherited disease called Fragile-X syndrome. It is also used for reducing harmful side effects of treatment with the medications lometrexol and methotrexate.
Causes of Folic Acid Deficiency:
- Inadequate dietary intake of folic acid due to:
- Limited consumption of fresh, minimally cooked food
- Chronic alcoholism
- Long-term need for intravenous nutrition (total parenteral nutrition)
- Goat milk, which has no folic acid
- Inadequate absorption of folic acid due to:
- Malabsorption syndromes (e.g. Celiac disease)
- Inflammatory bowel disease (e.g. Crohn’s disease)
- Drug interactions, (e.g. anticonvulsant medicines “phenytoin” and oral contraceptives)
- Bariatric surgery
- Increased need for folic acid due to:
- Malignancy, such as cancer
- Hemodialysis due to increased loss of folic acid
- Impaired use that can occur from certain medications, such as methotrexate
- Rheumatoid arthritis (RA)
Signs and Symptoms of Folic Acid Deficiency:
- Loss of appetite and weight loss
- Sore tongue,
- Heart palpitations,
- Irritability, and behavioral disorders.
- In adults, anemia (macrocytic, megaloblastic anemia) can be a sign of advanced folate deficiency.
- Slow growth rate in infants and children,
- Low birth weight premature infants, and infants with neural tube defects in pregnant women,
- Stroke due to high level of homocysteine levels.
Laboratory findings for Folic Acid Deficiency:
- Megaloblastic Anemia
- Increased Lactate Dehydrogenase (LDH)
- Increased indirect bilirubin levels
- Decreased reticulocyte count (folic acid is required for cell devision and production of new cells)
- Hypercellular bone marrow (bone marrow tries to compensate for the decrease reticulocyte count)
- Increased homocysteine levels
References for Folic Acid Deficiency Mnemonic: