Undoubtedly, folic acid holds an immense significance. Despite being largely recognized for its influence on prenatal wellness and the growth of neural tubes, this crucial B vitamin plays a role in various other areas.
Ensuring adequate intake of folic acid, a water-soluble nutrient, is crucial as it contributes to both heart health and brain function. What are the benefits of folic acid? What are its functions within the body? Why should one consider taking it?
The Significance of Folic Acid
Vitamin B9 or folate is a significant vitamin that dissolves in water and contributes to various aspects of well-being. Its functions involve facilitating cell division, copying and generating DNA to form new blood cells, and assisting the body in utilizing vitamin B12 and particular amino acids.
The findings demonstrate that inadequate folate levels can lead to severe outcomes such as exhaustion, discomforting oral ulcers, and a higher likelihood of congenital anomalies such as cardiac issues, neural tube malformations, spina bifida, and anencephaly.
Prenatal vitamins, supplements, and fortified products typically contain folic acid, which is a man-made version of folate. Many doctors advise expectant mothers to take folic acid during pregnancy to fulfill their folate requirements and reduce the likelihood of complications related to pregnancy.
The Centers for Disease Control and Prevention advised women to start taking 4,000 micrograms of folic acid every day when planning a pregnancy if they had previously experienced neural tube defects during pregnancies. This recommendation was made in 1991.
In 1992, the U.S. Public Health Service recommended that women who could become pregnant consume a minimum of 400 micrograms of folic acid or folate each day from food, supplements, or folic acid-fortified products.
Many countries globally have regulations in place to prevent harmful birth defects caused by folate deficiency. These regulations require food companies to fortify specific products with folic acid. In 1996, the United States fully authorized the fortification of enriched cereal grains with folic acid. The country fully implemented this measure two years later, in 1998.
Currently, mandatory fortification of wheat flour is enforced in 53 nations worldwide as a measure to lower the chances of birth defects.
Research has shown that folate has a positive correlation with enhanced cognitive abilities, safeguards against depression and Alzheimer’s disease, and can reinforce bone density, reduce symptoms of restless legs syndrome, and bolster the nervous system.
Are folate and folic acid identical? If not, how do they differ? Despite being frequently used interchangeably, folate and folic acid exhibit distinct dissimilarities.
Folates can be obtained from natural sources such as fruits, legumes and vegetables, while folic acid is a synthetic variation primarily obtained through fortified foods like enriched flour, bread, pasta, and rice, or through supplement intake.
It is noteworthy that certain studies reveal folic acid to be better absorbed than folate obtained from food sources. According to the American Journal of Clinical Nutrition, a study shows that the bioavailability of folate in food is around 78% when compared to folic acid.
In case you consume a considerable amount of foods rich in folate, there’s no need to exceed the U.S. Food and Drug Administration’s recommendation of providing 100 percent or more of your daily folic acid requirement through supplements. For supplements containing folic acid, taking approximately 15 percent to 20 percent of the daily recommended folic acid is adequate.
It is also better to use folic acid that has been fermented. Fermentation is a form of partial digestion that has the potential to prevent the accumulation of unmetabolized folic acid.
Opting for folate-rich sources when filling up your plate is the ideal way to fulfill your daily requirements, as these foods contain a plethora of essential nutrients that are vital for your well-being.
Although folic acid supplementation can aid in averting deficiency for certain individuals, consuming an adequate amount of nutrient-rich foods high in folate and folic acid can satisfy the daily folate needs for most people and also furnish essential vitamins and minerals.
Food Sources
It is recommended that a significant portion of folate should come from whole, natural sources such as legumes, fruits and vegetables. These types of foods are rich in various vitamins and minerals, in addition to providing folate.
If you are unable to obtain enough folate from your diet or have difficulty absorbing it due to a medical condition, your doctor may suggest taking dietary supplements containing folic acid or increasing your intake of fortified foods that are high in folic acid. Examples of such fortified foods are healthy cereals, whole grain products, enriched breads, pastas, and rice.
Fruits, vegetables, and legumes such as spinach, asparagus, avocados, and beans contain folate. Additionally, beef liver, which is a nutrient-rich food, provides up to 54 percent of the recommended daily folate intake.
Enriched products contain folic acid which has been incorporated into the final product in order to enhance its nutritional value. Rice, bread, pasta, and cereal are among the leading sources of folic acid.
Most dietary supplements typically provide between 25% to 50% of the recommended daily intake, however, there could be variations. If you have higher requirements for nutrients or are experiencing difficulty with nutrient absorption, taking supplements may become necessary.
If you choose to take supplements, choose L-methylfolate over folic acid tablets as it is the active form of folate and studies indicate that it may help reduce the risks associated with excessive folic acid consumption.
Moreover, make sure you incorporate a variety of fruits and vegetables that are rich in folate into your diet to guarantee that you fulfill your micronutrient requirements.
The RDA for folate is expressed in DFEs, which consider the variations in absorption of folate from natural sources and folic acid from fortified foods and supplements.
Natural folate is absorbed by your body at approximately 50% of the rate of folic acid in supplements. An adult typically requires approximately 400 mcg DFE of folate on a daily basis, with increased requirements during pregnancy and breastfeeding. The recommended daily allowance for folate during pregnancy is 600 mcg DFE.
Your liver and tissues contain 15-30 mg of folate with a small amount found in your bloodstream. The recommended daily allowance of folate for infants, children, and adolescents is:
- Birth to 6 months: 65 mcg DFE
- Ages 7–12 months: 80 mcg DFE
- Ages 1–3: 150 mcg DFE
- Ages 4–8: 200 mcg DFE
- Ages 9–13: 300 mcg DFE
- Ages 14–18: 400 mcg DFE
Each day, adults require a daily intake of approximately 400mcg DFE of folate.
Supplements utilize both folic acid and folate, which treat similar conditions, however, are processed differently in the body and have varying impacts on one’s health.
Outlined below are some typical purposes and advantages of taking folic acid supplements.
Treating folate deficiency
There are various reasons why one could experience a deficiency of folate. Some factors that could lead to insufficient levels of folate include:
- a lack of folate in your diet
- diseases or surgeries that affect how your body absorbs folate, including celiac disease, short bowel syndrome, and gastric bypass surgery
- no stomach acid (achlorhydria) or low stomach acid (hypochlorhydria)
- drugs that affect folate absorption, including methotrexate and sulfasalazine (Azulfadine)
- alcohol use disorder
- pregnancy
- hemolytic anemia
- dialysis
Insufficient intake of folate may result in complications such as anemia, developmental issues in the fetus, cognitive impairment, weakened immune system, and depressive symptoms. Elevating your levels by consuming folic acid or folate supplements can avert these complications.
Preventing birth defects and pregnancy complications
In order to prevent neural tube defects such as spina bifida and anencephaly, it is recommended to take folic acid supplements. Adequate folic acid intake during pregnancy can decrease the likelihood of your child being born with these conditions.
Taking folic acid supplements not only reduces the likelihood of fetal developmental problems but also decreases the risk of pregnancy complications such as preeclampsia.
Maintaining brain health
Having low levels of folate in the blood is associated with impaired cognitive function and a higher likelihood of developing dementia. Even if the folate levels are within the normal range but lean towards the lower end, the risk of cognitive decline in older individuals may still increase.
Sufficient consumption of folate can also offer safeguard against Alzheimer’s illness.
A study conducted in 2019 consisting of 180 adults who had mild cognitive impairment showed that taking a daily dose of 400 mcg folic acid supplements for 2 years enhanced brain function measures and lowered levels of proteins that contribute to Alzheimer’s disease in their bloodstream.
Another study looked at 121 people with newly diagnosed Alzheimer’s disease who were being treated with the medication donepezil (Aricept). Those who also took 1,250 mcg of folic acid per day for 6 months had improved thinking ability and less inflammation than those who took Aricept alone.
Treating mental health conditions
The production of neurotransmitters, which are essential brain chemicals, involves folate. Having inadequate folate levels has been associated with mental health issues such as depression and schizophrenia. Individuals with depression may have lower folate levels in their bloodstream compared to those who do not suffer from depression.
According to research conducted in 2022, folic acid and folate supplements may be beneficial in alleviating symptoms of mental health disorders like postpartum depression, bipolar disorder, and schizophrenia. Individuals who incorporate folate supplements into their antidepressant medication regimen may experience a greater reduction in depression symptoms than those who only take antidepressants.
Seven studies reviewed revealed that including folate supplements in the treatment regimen along with antipsychotic medication may enhance symptom management in individuals with schizophrenia in comparison to the use of antipsychotic medication alone. Nonetheless, additional studies of greater size and strength are required to validate the outcomes of these findings.
Reducing heart disease risk factors
Supplements containing folate, such as folic acid, could potentially enhance cardiovascular well-being and diminish the likelihood of developing heart ailments.
Elevated levels of the amino acid homocysteine are believed to elevate the danger of heart disease. Inadequate folate can result in high homocysteine levels, also known as hyperhomocysteinemia, since folate aids in the decomposition of homocysteine.
Taking folic acid supplements can aid in reducing homocysteine concentrations and potentially decrease the chance of developing cardiovascular disease.
To illustrate, a meta-analysis encompassing 30 studies and over 80,000 individuals demonstrated that the addition of folic acid resulted in a 4% decrease in the risk of developing heart disease and a 10% decrease in the risk of stroke.
Additionally, the combination of folic acid supplements and antihypertensive medications can result in a greater reduction of high blood pressure compared to the use of antihypertensive medications alone. Moreover, in individuals with heart disease, folic acid supplements may enhance blood vessel function.
Other possible benefits
In addition, taking folic acid supplements might also provide assistance for these alternative medical concerns:
- Diabetes. Folate supplements may help improve blood sugar regulation and reduce insulin resistance in people with diabetes. Because the diabetes drug metformin can lower folate levels, you may need a supplement if your levels are low.
- Fertility issues. Folate can improve egg quality and help eggs grow and implant in the uterus. Taking folate may increase the chance of getting pregnant and carrying a baby to term. People who use assisted reproductive technology to conceive may be more likely to have a baby if they have a higher intake of supplemental folate.
- Inflammation. Inflammation plays a role in many diseases. Folic acid and folate supplements have been shown to reduce markers of inflammation such as C-reactive protein.
- Kidney disease. The kidneys usually filter waste out of the blood, but when the kidneys are damaged, homocysteine can build up. About 85% of people with chronic kidney disease have too much homocysteine in their blood. Folic acid supplements may help reduce homocysteine levels and heart disease risk in people with kidney disease.
Further research is required to verify the advantages of taking folate supplements, and the benefits of folic acid are not limited to those listed here. Folks may have other motives for using folate-containing supplements.
If the conversion of folic acid into the active form, 5-methyltetrahydrofolate (5-MTHF), is not speedy enough, there can be an accumulation of folic acid in your bloodstream. However, consuming foods with 5-MTHF can avert this issue.
Foods that have 5-MTHF in their composition comprise:
- leafy greens
- beans and lentils
- asparagus
- avocado
Changes in certain genes impact the body’s utilization of folate. The breakdown of homocysteine is carried out by an enzyme known as Methylenetetrahydrofolate reductase (MTHFR). Mutations in the code for MTHFR can result in alterations in folate levels within the body, thus affecting your overall health.
The MTHFR mutation C677T is prevalent and leads to reduced enzyme activity that aids in homocysteine metabolism. Consequently, individuals with this variation may develop elevated homocysteine levels, thereby increasing their vulnerability to heart disease.
Having this variant in a pregnant individual can elevate the likelihood of neural tube abnormalities in an unborn child. Although there are tests for MTHFR variants, they are deemed unnecessary for most individuals.
Simply having an MTHFR mutation does not automatically indicate a susceptibility to health issues or necessitate medical intervention. However, in the event of elevated homocysteine levels, a healthcare provider may suggest supplement usage.
Certain genetic mutations may affect the folate levels in your body.