The role of folic acid in the body
Folic acid may be familiar to you if you’ve been pregnant – an essential in the prenatal vitamin line-up. But folic acid plays a bigger role in the body than preventing birth defects. Folic acid, along with vitamin A, riboflavin, niacin, pyridoxine, thiamine, iron and zinc which have been added to flour and maize in South Africa for over 20 years, also plays a role in cognitive function, cardiovascular health and mental health.
Folic acid is the synthetic form of folate or vitamin B9. This is what manufacturers add to fortify foods, and what is added to multivitamins, B-complex vitamins, and multi-nutrient supplements. Folate or vitamin B9 is what occurs naturally in certain foods.
Why does my body need folate?
Folate plays several important functions in the body:
- It helps produce red blood cells.
- It functions as a coenzyme in the synthesis of nucleic acids (DNA and RNA) and the metabolism of amino acids.
- It helps cells grow, divide, and work properly.
- It prevents birth defects of the neural tube.
- It helps lower the risk of pregnancy complications such as preeclampsia.
- It works with vitamins B6 and B12 to control high levels of homocysteine in the blood. (Elevated homocysteine levels might increase your risk of cardiovascular disease.)
- It is necessary for the biosynthesis of the neurotransmitters serotonin, epinephrine, and dopamine.
Folate deficiency is strongly linked to poor diet, alcoholism, and malabsorptive disorders, and is therefore usually accompanied by other nutrient deficiencies. Folate deficiency can lead to anaemia, an increased risk of heart disease and certain cancers, and neural tube irregularities including malformations of the spine (spina bifida), skull, and brain (anencephaly) in infants. Research has also shown that folate deficiency has been associated with depression, it may hinder the body’s response to anti-depressants and may contribute to a relapse of depression.
Sources
Folate is a water-soluble vitamin – your body does not store it, and excess amounts of the vitamin leave the body through the urine. That means that you need to get a regular supply of the vitamin through the foods you eat or through supplements.
Folate can be found mainly in dark green leafy vegetables, beans, peas and nuts. Good sources of folate include:
- beef liver
- spinach
- black-eyed peas
- asparagus
- brussels sprouts
- romaine lettuce
- avocado
- spinach
- broccoli
- green peas
Folic acid can be found in fortified foods such as bread and ready-to-eat breakfast cereals, and supplements.
Recommended doses
The recommended daily amount of folate is 400 micrograms (mcg) for adults. Adult women who are planning a pregnancy or could become pregnant should be advised to get 400 to 1,000 mcg of folic acid a day.
While you can get all your folate from a balanced diet, folic acid supplements are recommended for those at risk for folate deficiency, such as:
- women who want to become pregnant, are pregnant, or are breastfeeding
- people with mood disorders
- people with alcohol use disorder
- people with conditions that affect nutrient absorption, including irritable bowel disorder (IBD) and celiac disease
- people with MTHFR polymorphism, which is a genetic condition that impairs the ability to convert folate to its active form and leads to elevated levels of an amino acid called homocysteine in the blood.
Certain medications can interact with folate, so speak to your doctor if you are on medication for:
- epilepsy
- type 2 diabetes
- rheumatoid arthritis
- lupus
- inflammatory bowel disease (IBD)
- celiac disease
When choosing your supplement, always check if there is a full list of ingredients on the product, a package insert, a valid company address with contact details and compliance to Good Manufacturing Practices (GMP), which is a prerequisite for health product manufacturing.
References
- Department of Health. 2010. Regulations Relating To The Labelling And Advertising Of Foodstuffs No.R.146. Government Gazette No.32975.
- Fava, M. & Mischoulon, D. (2009). Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. The Journal of Clinical Psychiatry. 70 (5): 12-17. Available from https://doi.org/10.4088/JCP.8157su1c.03
- Felman, A. (2023). What to know about folic acid. Medical News Today [Online]. Accessed on 15 March 2023. Available from https://www.medicalnewstoday.com/articles/219853#fa-qs
- Mayo Clinic. (2021). Folate (folic acid). Mayo Clinic [Online]. Accessed on 15 March 2023. Available from https://www.mayoclinic.org/drugs-supplements-folate/art-20364625
- Medline Plus. (2021). Folic acid in diet. Medline Plus [Online]. Accessed on 15 March 2023. Available from https://medlineplus.gov/ency/article/002408.htm
- Miller A. L. (2008). The methylation, neurotransmitter, and antioxidant connections between folate and depression. Alternative Medicine Review: Journal of Clinical Therapeutic, 13(3), 216–226. https://pubmed.ncbi.nlm.nih.gov/18950248/
- Office of Dietary Supplements. (2022). Folate Fact Sheet for Health Professionals. National Institutes of Health [Online]. Accessed on 16 March 2023. Available from https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
- Watson, S. (2021). Folic Acid: Everything You Need to Know. Healthline [Online]. Accessed on 15 March 2023. Available from https://www.healthline.com/nutrition/folic-acid#benefits-uses
- WebMD. (2022). Heart Disease and Homocysteine. WebMD [Online]. Accessed on 6 April 2022. Available from https://www.webmd.com/heart-disease/guide/homocysteine- risk#:~:text=In%20fact%2C%20a%20high%20level,as%20well%20as%20renal%20disease.
- Yusufali,R.,Sunley,N.,deHoop,M.,& Panagides,D.(2012).Flour fortification in SouthAfrica: post- implementation survey of micronutrient levels at point of retail. Food and Nutrition Bulletin. 33(4), S321–S329. https://doi.org/10.1177/15648265120334S308