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Folic Acid and Anemia


Folic acid

Folic acid, or rather folates, are water-soluble vitamins whose biologically active form is represented bytetrahydrofolic acid (THF).
Folic acid is found mainly in offal and in some foods of plant origin (of these, especially in beans, tomatoes and oranges). Some studies (carried out in different areas of the national territory) have highlighted the collective tendency to take insufficient quantities of folic acid; this condition, in itself disadvantageous, worsens significantly in the elderly and especially in men: deficiency estimated at 12% in women and 20% in men.
Folic acid is thermolabile; is absorbed in the intestinal portion of the fast and mainly in manner active (via a carrier) at pH 6, but also passively at higher pH. The metabolic function of folic acid is to originate coenzymes useful for the transport of monocarbon units in the metabolism of amino acids and in the synthesis of nucleic acids, interacting biochemically with cobalamin (vit. B12); in short, folic acid participates in the production of nucleic acids (DNA and RNA – the defect of which causes anemia), in the transformation of homocysteine ​​into methionine and in the metabolism of other amino acids.
It can be deduced that the reduction of the metabolic activity of folic acid can cause various imbalances, among which the most relevant is undoubtedly the reduction of the synthesis of DNA and RNA; due to the reduced ability to replace “old” or damaged cells with “new” cells, tissues that need turnover more frequent (cell turnover) are subjected to serious functional alterations. This condition has heavy repercussions on the nervous tissue and in particular on the development of the spinal cord of the fetus (spina bifida) and on the brain degeneration of the elderly; furthermore, the reduced ability to synthesize nucleic acids also significantly affects erythropoiesis by the bone marrow (the production of red blood cells) causing or worsening theanemia .
The recommended intake of folic acid is 200 µg/day, which doubles for pregnant women (in order to prevent neural complications in the newborn). Some studies carried out on undernourished patients have demonstrated good collective tolerance even at doses reaching 5mg/day, albeit with the risk of hiding the deficiency manifestations due to cobalamin (vit. B12) insufficiency.

L’anemia it is one of the reflex complications attributable to the reduced metabolic functionality of folic acid and/or cobalamin (vit. B12). Such a condition can arise for various reasons:

  1. Dietary folic acid deficiency: as anticipated, folic acid is contained both in offal and in foods of plant origin. It is true that it is a vitamin sensitive to heat, therefore, it can be deduced that its integrity is lost when food is cooked. Therefore, the contributions deriving from cooked offal or stewed legumes should not be fully considered, while the folates deriving from raw vegetables should be more integral; a final consideration must be made regarding the bioavailability of folic acid in foods. Some studies on the absorption capacity of folic acid have shown that VEGETABLE foods also contain chelating molecules capable of hindering the uptake of these vitamins; for example, beans have a bioavailability of folates that reaches 80% while oranges only 20%. To guarantee the minimum amount of folate and avoid the onset of anemia, it is recommended to consume RAW foods of plant origin daily.
  2. Alteration of folic acid absorption: it is generally rare but frequent in patients subject to surgical resections of one or more parts of the digestive tract, who often manifest anemia.
  3. Use of drugs that hinder the metabolism of folic acid: some molecules such as metotrexatei barbiturates they contraceptives are responsible for the metabolic alteration involving folic acid. In the case of similar pharmacological therapy, the subject must take greater care of the nutritional intake of folates in order to avoid the onset of anemia.


Anemia caused by the ineffectiveness of folic acid is characterized by the medullary production of NON-mature, larger, more colored and less efficient erythrocytes.
The characteristic symptoms of this anemia are overlapping and often concomitant with those of cobalamin deficiency; in addition to the generalized exhaustion typical of all anemic forms, there is evidence of involvement of the gastrointestinal system (presence of anti-mucosal antibodies) but above all of the nervous system, through the manifestation of numbness, absence of reflexes and lack of motor coordination.

Wanting to classify folic acid deficiency anemia, one could define that:

while making an appropriate distinction of the etiological cause, it is a set of symptoms and clinical manifestations that overlap with pernicious and/or megaloblastic anemia. In fact, folic acid acts synergistically with cobalamin in the synthesis of nucleic acids and therefore the deficiency of one, the other or both often favors the appearance of an almost similar clinical picture.

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