Why doctors recommend folate (folic acid)?

Folate is the naturally occurring form of vitamin B9 which may be measured by your healthcare provider to assess your folic acid levels. 

Folate is physiologically essential to make DNA and other genetic material according to the National Institute of Health.  

Some sources state that 1 in 10 Americans are deficient in folic acid. Doctors may test your folic acid levels as part of a general screening or if you show signs of folic acid deficiency (Anemia).  

  • weakness
  • fatigue
  • trouble concentrating
  • irritability
  • headache
  • heart palpitations
  • shortness of breath
  • open sores on the tongue and inside of the mouth
  • changes in color of the skin, hair, or fingernails

It is especially important for women who are pregnant to get enough folate (600 mcg Dietary Folate Equivalents) according to NIH. For this reason prenatal vitamins most often include this essential vitamin.

NIH summarizes key points from folate research including:

  • Neural tube defects: Taking folic acid before becoming pregnant helps prevent neural tube defects in babies.
  • Cancer: Folate naturally present in food may decrease the risk of certain forms of cancer. However taking the right amount at the right time is an important factor. Folic acid taken before cancer develops might decrease cancer risk. On the other hand, taking too much folic acid after cancer (especially cautious with colorectal cancer) speeds up its progression. Caution is given for taking supplements with upper limits of 1000 mcg.  More research is required to understand the effects of dietary folate and folic acid supplements in cancer.
  • Depression: People with low blood levels of folate may be more likely to have depression. Antidepressants may be less effective as well. Folate supplements may make some antidepressants more effective. More research is required to understand the role of folate in depression and whether or not combination therapy is clinically effective.
  • Heart Disease and stroke: Folic acid supplements lower levels of homocysteine, an amino acid in the blood linked to higher risk of heart disease. Though these supplements don't directly decrease the risk of heart disease. Some studies have shown a combination of folic acid with other B-vitamins does help prevent stroke.
  • Preterm birth, congenital heart defects, and other birth defects Taking folic acid might reduce the risk of having a premature baby or a baby with birth defects, such as certain types of heart problems. But more research is needed to understand how folic acid affects the risk of these conditions.
  • Autism Spectrum Disorder (ASD): ASD affects communication and behavior, usually beginning by age 2. People with ASD have limited interests, repetitive behaviors, and difficulty communicating and interacting with others. Some studies have shown that taking recommended amounts of folic acid before and during early pregnancy may help reduce the risk of ASD in the child. However, because the study results are inconclusive, more research is needed to understand the potential role of folic acid in lowering the risk of ASD.

There are precautions to consider before taking high dose folic acid supplements above 1000mcg for adults (19+). Taking high doses of folic acid may mask underlying vitamin B12 deficiency which can lead to nerve damage. Vitamin B12 deficiency can lead to permanent damage of the brain, spinal cord, and nerves. Large doses of folate supplements might also worsen the symptoms of vitamin B12 deficiency.

Folate supplements can interact with certain medications. Some examples include:

  • Folate supplements could interfere with methotrexate (Rheumatrex®, Trexall®) when taken to treat cancer.
  • Taking anti-epileptic or anti-seizure medications, such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®) and valproate (Depacon®), could reduce blood levels of folate. Also, taking folate supplements could reduce blood levels of these medications.
  • Taking sulfasalazine (Azulfidine®) for ulcerative colitis could reduce the body’s ability to absorb folate and cause folate deficiency.

Tell your doctor, pharmacist, and other healthcare providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Disclaimer

This article is based on a fact sheet created by the Office of Dietary Supplements (ODS) provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. 

 

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