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Photograph of doctor holding a sign with FOLIC ACID

Folic Acid Supplementation

By: Rebecca Kyle, Pharm.D.

Folate is a water soluble B vitamin also known as vitamin B9.  Folate refers to the vitamin as it is found naturally in foods. The man made version of it, often found in multivitamins, is known as folic acid. Folate is found in a variety of foods including dark green leafy vegetables, citrus fruits, beans and peas, organ meats, and eggs. Folic acid, the synthetic form is added to enriched grain products such as breads, cereals, pasta, and flour.

Below are a few example of dietary sources of folate for comparison:

Spinach 1 cup 263 mcg
Collard Greens 1 cup 177 mcg
Romaine Lettuce 1 cup 76 mcg
Asparagus 1 cup 262 mcg
Orange 1 fruit 50 mcg
Papaya 1 fruit 115 mcg
Lentils 1 cup 358 mcg
Pinto Beans 1 cup 294 mcg
Kidney Beans 1 cup 229 mcg
Avocado 1 fruit 90 mcg
Okra 1 cup 37 mcg
Sunflower Seeds ¼ cup 82 mcg
Peanuts ¼ cup 88 mcg
Cauliflower 1 cup 55 mcg
Beets 1 cup 136 mcg
Corn 1 cup 76 mcg
Winter Squash 1 cup 57 mcg
Summer Squash 1 cup 36 mcg

What if I have a Folate Deficiency?

Folate aids in the complete development of red blood cells, reduces the levels of homocysteine in the blood (high levels have been associated with early development of heart disease), and supports nervous system function. Folate deficiency often occurs in conjunction with malnourishment associated with poor diet, alcoholism, and malabsorption disorders. Symptoms of deficiency include weakness and fatigue, shortness of breath, heart palpitations, irritability, headache, and difficulty concentrating. Other signs of deficiency include soreness and ulceration of the tongue and inside of mouth, pigmentation changes of skin, hair, of nails, and increased blood levels of homocysteine. Folate deficiency during pregnancy can lead to neural tube defects in offspring.  Low folate levels have been linked to depression and poor response to antidepressants.

How much Folate do I need?

The FDA recommends a daily intake of 400 mcg for adults and children four years of age and older. It is recommended that pregnant women receive 600 mcg daily.

Folate must be metabolized in the body to its active form. With natural folates this occurs in the small intestine. With folic acid (the synthetic form) this metabolism takes place in the liver. Around 40% of the population have a genetic mutation that does not allow them to metabolize the synthetic form (folic acid). This leads to high levels of unmetabolized folic acid entering the system circulation, leading to toxicity.

Signs of toxicity include digestive problems, nausea, loss of appetite, bloating, gas, a bitter or unpleasant taste in the mouth, sleep disturbances, depression, excessive excitement, irritability, and a zinc deficiency.  More severe signs include psychotic behavior, numbness or tingling, mouth pain, weakness, trouble concentrating, confusion, fatigue, and even seizures. Irreversible neurologic injury may occur when it is given to patients with undiagnosed pernicious anemia.

The active form that the body converts folate into is called L-methylfolate.  Those who do not get enough folate from their diet and who are unable to metabolize folic acid can supplement with L-methylfolate. Sources for L-methylfolate include the prescription form known as Cerefolin as well as quality over-the-counter products including Eye Folate and Ortho Molecular Products.

Because supplemental folic acid can interact with some medications always talk to your pharmacist before adding it or any other supplement to your regimen.