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Folic Acid Deficiency – Folic Acid Supplements


See also: excess folic acid – folic acid – folic acid quiz – folic acid in pregnancy

The shortage Of folic acid – a micronutrient also known as vitamin B9 or folacin – is still a rather widespread condition, especially in some areas of the globe.

The body's inability to synthesize this vitamin justifies the extreme importance of an adequate dietary intake.

The body's reserves of folic acid amount to approximately 12-15 mg, stored mainly in the liver and only sufficient to compensate for a few weeks of lack of food intake.

Health Risks

Folic acid, like vitamin B12, is essential for adequate cell proliferation and maturation; therefore, the deficiency of this nutrient firstly affects tissues with a high degree of proliferation, such as the bone marrow and those of the embryo-fetus. This explains the origin of the two most well-known and widespread consequences of folic acid deficiency, represented by macrocytic – megaloblastic anemia and spina bifida in the unborn child.

Folic Acid Deficiency Anemia

In macrocytic – megaloblastic anemia the red blood cells become excessively large, taking on an abnormal shape and a very short life. Consequently, the subject lacking folic acid complains of weakness and easy fatigue, both physical and mental (insomnia, irritability and difficulty concentrating).

Neurological suffering is also due to the essentiality of folates in the synthesis of some neurotransmitters, such as glutamic acid (an excitatory amino acid released in the central nervous system).

Spina Bifida

If a pregnant woman does not take adequate quantities of folic acid, irreversible damage to the fetus may result, with an increased risk of defects of the neural tube (embryonic structure from which the central nervous system originates), the most common of which is precisely spina bifida. The fetus, in turn, takes away a large part of the folic acid from the mother, which justifies supplementation from when the pregnancy is still sought until its end. In fact, it is the first stages of development of the embryo-fetus that have the most intense proliferation rate. In a child with spina bifida, the spinal cord is not well enclosed between the vertebrae and can be damaged to the point of causing paralysis of the legs.

Homocysteine ​​and Cardiovascular Risk

A deficiency of folic acid raises the subject's cardiovascular risk, increasing the levels of circulating homocysteine, which in turn increases the possibility of suffering cardiovascular pathologies. This condition is common in people who contrast an excessive intake of protein foods (dairy products, meat, legumes, eggs) with a low consumption of fresh vegetables.

Other Possible Disorders

Severe folic acid deficiencies have also been linked to depression, lesions of the skin and mucous membranes, growth and ossification disorders, greater susceptibility to infections, infertility (both male and female), mental retardation and atrophy of the lymphatic organs.

Folic Acid in the Diet

Recommended daily intake

The recommended daily intake of folate is 200-300 µg in adults, 400 µg during pregnancy and 350 µg during breastfeeding.

It is estimated that a balanced diet provides between 100 and 300 µg of folic acid per day.

Foods rich in Folic Acid

Vegetables – especially green leafy ones (cabbage, spinach, watercress, etc.) – fruit, whole grains, legumes, liver and brewer's yeast are particularly rich in this vitamin.

Normally, approximately 40-60% of folic acid from food sources is absorbed, while that taken as a supplement or pharmaceutical product is approximately 80% absorbed.

Vitamin B9 is also synthesized by the intestinal bacterial flora.

Losses during cooking

Cooking losses vary from 50 to 95% (unfortunately, the most generous food sources, such as cauliflower, Brussels sprouts and spinach, are the ones that are cooked the longest).

High temperatures, prolonged soaking and annealing/reheating of already cooked vegetables almost eliminate the folic acid content of fresh food.

Subjects at Risk of Deficiency

In our latitudes, in industrialized countries, folic acid deficiencies of food origin are quite rare and mostly affect elderly people who follow monothematic and repetitive diets, particularly low in fresh fruit and vegetables, for example due to lack of appetite, social problems, chewing difficulties, etc.

Excessive cooking of food, the intensive use of food warmers (a typical problem of canteen meals) and the intake of folic acid antagonist drugs (in particular some antibiotics and chemotherapeutics), represent further factors predisposing to folate deficiency. Prolonged exposure to light also depletes the folic acid content of foods.

Folic acid deficiencies are more frequent among alcoholics eh drug addicts; smoking also has a negative effect. They are also typical of malabsorption syndromeswhere the intestine's ability to absorb nutrients is limited by various diseases and conditions, such as celiac disease (celiac disease), intestinal infections, pancreatic diseases, the Crohn's disease and surgical bowel resections.

Deficiency is also frequent in poor tropical and sub-tropical countries (where it is often associated with other nutritional deficits) and in those of the far north, where the supply of fresh vegetables is limited for most of the year.

Supplements: When Are They Necessary?

Folic acid supplements are only indicated in deficiency states, as there are no deficiency problems in healthy adults who follow a balanced diet.

They deserve a separate discussion pregnant and breastfeeding womenin which supplementation with folic acid is prescribed by the doctor and must take place under his control and according to the indications given.

For further information, read: folic acid during pregnancy.

Folic acid supplements are justified in low-calorie diets, in alcoholic or malnourished elderly people, in alcoholics and in patients with malabsorption. They can also be prescribed in high-level athletes with the aim of solving anemia problems.

In some supplements or pharmaceutical products, folic acid is combined with iron, as the association between the two types of deficiency, possibly ascorbic acid and vitamin B12, is not uncommon (with the aim of providing the body with the micronutrients necessary for optimal synthesis of red blood cells).

The normally recommended intake doses for folic acid supplements are equal to 400mcg per day.

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