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You may be familiar with folic acid as a supplement that women are advised to take during pregnancy. But it’s important for all of us to get enough folic acid: It’s an essential nutrient for the formation of red blood cells and the healthy growth and function of cells.
Folic acid is actually a synthetic version of folate, a B-vitamin present in vegetables (particularly in such dark green leafy vegetables as spinach), legumes (peas, beans, lentils), and fortified cereals and fruit juices. Although we can obtain folate from these foods, the B-vitamin it provides may be obtained more easily from folic acid.
Let’s take a look at the multiple ways that folic acid can benefit our bodies.
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Folic Acid and Pregnancy
Pregnant women are advised to start taking a folic acid supplement at least one month before they become pregnant and to continue taking it in the first three months of their pregnancy, when the neural tube—which develops into the brain and spinal cord—is forming. Folic acid helps to prevent neural tube defects such as spina bifida and anencephaly.
Spina bifida occurs when the neural tube doesn’t close properly around the spinal cord. Anencephaly causes a baby to be born without a proper brain and skull. Taking folic acid supplements can prevent up to 70 percent of these birth defects.
Research also suggests that folic acid can help prevent other birth defects, including cleft lip and palate, as well as heart problems. It also may help to protect pregnant women against pre-eclampsia, a potentially life-threatening complication that can develop in the third trimester. Preeclampsia causes extremely high blood pressure and damages the kidneys.
Folic Acid and Brain Health
Low folic acid levels have been linked to a greater risk for cognitive decline in old age. Unfortunately, no studies have shown that supplementing with folic acid can help benefit cognitive function in older adults, but trials are ongoing.
Folic Acid and Anemia
The role of folic acid in the formation of red blood cells means that you’re at risk of a certain type of anemia—called megaloblastic anemia—if you do not get sufficient folic acid.
Megaloblastic anemia occurs because too few red blood cells are formed, and those that do form are large and oval-shaped instead of round. These deformed blood cells don’t live very long, which reduces oxygen levels in the blood.
Folic Acid and Depression
Studies suggest that folic acid also may help alleviate depression, since low folate levels are associated with a greater risk for depression. Its effect on depression may be related to the fact that folic acid helps to prevent the formation of homocysteine, an amino acid we get from eating meat. If homocysteine levels are elevated, this can impede the production of certain brain chemicals that are believed to regulate mood and sleep, including serotonin (the “feel-good” hormone), and dopamine.
While folic acid is not thought to treat depression, it is thought to help depressed people respond better to antidepressants.
Folic Acid and Cancer
Low folate levels also may be linked to a greater risk for cancers of the breast, colon, ovaries, lungs, pancreas, and esophagus, among others. Its protective mechanism is thought to be related to its role in DNA metabolism—but supplementing with high doses of folic acid has not so far been shown to influence cancer incidence.
Folic Acid and Cardiovascular Health
High levels of homocysteine are associated with a greater risk for blood clots and heart disease—it isn’t clear exactly why, but it may be because homocysteine damages the walls of arteries, raising the risk of atherosclerosis (narrowed arteries).
The fact that folic acid interferes with homocysteine suggests that it could help cardiovascular health. Although research has pointed to natural folate being beneficial when it comes to reducing the risk of heart attack, there isn’t any strong evidence when it comes to synthetic folic acid having the same protective effect. But a new study (Journal of the American College of Cardiology, May 7, 2018) suggests that some people with high blood pressure may reduce their risk of stroke if they supplement with folic acid.
The four-year study included 10,000 older adults. All had high blood pressure, but none had ever suffered a heart attack or stroke. They all were given blood-pressure-lowering medications, but half also received 800 micrograms (mcg) of folic acid each day. At the end of the study, the researchers analyzed a subgroup of participants who were considered to be at particularly high risk of stroke due to high levels of homocysteine.
In this subgroup, 1.8 percent of participants who took folic acid along with the blood-pressure medication had a stroke, compared to 5.6 percent of those who did not take folic acid along with the blood-pressure medication.
However, these data don’t necessarily mean that people should supplement with folic acid, mainly because the study was carried out in China, where food is not supplemented with folic acid and people are more likely to have low levels of the nutrient. The fact many foods in the United States are supplemented with folic acid means that Americans are less likely to have low levels.
How Much Folic Acid Should You Be Getting?
According to the National Institutes of Health, most people should aim to consume 400 mcg of folic acid per day. Most multivitamins contain this amount, and single folic acid supplements are also available at drugstores. You also can get this amount by eating a bowl of fortified cereal for breakfast each morning (check that one serving contains 100 percent of the recommended daily value of folic acid). Pregnant women and those who are breastfeeding should aim to get 600 mcg of folic acid per day.
As a rule, if you eat a nutritious diet, you should be obtaining as much folate and/or folic acid as you need from your food. However, if you have a disease that affects your body’s absorption of nutrients (for example, Crohn’s disease or celiac disease), you may not be getting enough. Some drugs also can interfere with the absorption of nutrients, especially those that treat autoimmune diseases, such as rheumatoid arthritis. If you have these conditions, you also may need to take a folic acid supplement.
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