B complex vitamin, folacin, folate, folic acid, folinic acid, pteroylglutamic acid, pteroylmonoglutamic acid, pteroylpolyglutamate, vitamin B9, vitamin M.
Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid is well-tolerated in amounts found in fortified foods and supplements. Sources include cereals, baked goods, leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), legumes, yeast, mushrooms, organ meat (beef liver, kidney), orange juice, and tomato juice. Folic acid is frequently used in combination with other B vitamins in vitamin B complex formulations.
Folate deficiency will occur if the body does not get the adequate amount of folic acid from dietary intake. Folic acid has been shown to be effective in the treatment of megaloblastic and macrocytic anemias due to folate deficiency.
Megaloblastic anemia - due to folate deficiency:
Folate deficiency can cause megaloblastic (or macrocytic) anemia. In this type of anemia, red blood cells are larger than normal, and the ratio of nucleus size to cell cytoplasm is increased. There are other potential causes of megaloblastic anemia, including vitamin B12 deficiency or various inborn metabolic disorders. If the cause is folate deficiency, then treatment with folate is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause.
Prevention of pregnancy complications:
Studies have proven that folate consumption during pregnancy prevents deficiency and anemia in pregnant women. Low folate levels during pregnancy may contribute to birth defects and pregnancy loss.
Consuming a high dietary intake of folate and taking folic acid supplements orally during pregnancy reduces the risk of neural tube birth defects or cleft palate in the infant.
Folate supplementation is beneficial in patients being treated with long-term, low-dose methotrexate for rheumatoid arthritis (RA) or psoriasis. Development of folate deficiency is associated with increased risk of certain side effects including gastrointestinal effects, stomatitis, alopecia, abnormal liver function tests, myelosuppression, megaloblastic anemia, and increased homocysteine levels, which are associated with cardiovascular disease. People who have experienced side effects may need to continue taking folic acid for the duration of methotrexate therapy. Patients receiving methotrexate for cancer should avoid folic acid supplements, unless recommended by their oncologist. There is some evidence that folic acid supplements reduce the efficacy of methotrexate in the treatment of acute lymphoblastic leukemia, and theoretically they could reduce its efficacy in the treatment of other cancers.
Preliminary evidence indicates that low folate concentrations might be related to Alzheimer's disease. Well-designed clinical trials of folate supplementation are needed before a conclusion can be drawn.
Arsenic poisoning (arsenic-induced illnesses):
Folate may lower blood arsenic concentrations and thereby contribute to the prevention of arsenic-induced illnesses. Additional research is needed in this area.
Preliminary evidence surrounding the use of folate seems promising for decreasing the risk of breast, cervical, pancreatic, and gastrointestinal cancer. However, currently there is insufficient evidence available to recommend folate supplementation for any type of cancer prevention or treatment. Please follow the advice of a qualified healthcare provider in this area.
Chronic fatigue syndrome:
Some patients with chronic fatigue syndrome (CFS) also have decreased folic acid levels. Daily injections of a combination of folic acid, bovine liver extract, and vitamin B12 for three weeks were not beneficial for CFS in one study.
Combined B vitamin supplementation did not delay cognitive decline among women with CVD or CVD risk factors. The possible cognitive benefits of supplementation among women with a low dietary intake of B vitamins warrant further study.
Coronary artery disease (prevention of nitrate tolerance) :
Folic acid might prevent nitroglycerin-induced nitrate tolerance and cross tolerance to endothelial nitric oxide, which plays a role in blood pressure control. These conditions need to be treated by a qualified healthcare provider.
Folic acid deficiency has been found among people with depression and has been linked to poor response to antidepressant treatment. Folate supplements have been used for enhancing treatment response to antidepressants. Limited clinical research suggests that folic acid is not effective as a replacement for conventional antidepressant therapy. Depression should be treated by a qualified healthcare provider.
Folate deficiency in alcoholics:
Folate deficiency has been observed in alcoholics. Alcohol interferes with the absorption of folate and increases excretion of folate by the kidney. Many alcohol abusers have poor quality diets that do not provide the recommended intake of folate. Increasing folate intake through diet, or folic acid intake through fortified foods or supplements, may be beneficial to the health of alcoholics.
Hearing loss (age-associated hearing decline):
Folic acid supplementation slowed the decline in hearing of speech frequencies associated with aging in a population from a country without folic acid fortification of food. The effect requires confirmation, especially in populations from countries with folic acid fortification programs.
High blood sugar/glucose intolerance:
In individuals with high blood sugar, folic acid in combination with enalapril resulted in a greater reduction in blood glucose levels compared to enalapril alone. More trials are needed before a recommendation can be made.
High blood pressure associated with pregnancy:
A combination therapy, including folate, in women with high blood pressure during pregnancy made it possible to maintain pregnancy until delivery was beneficial for both the mother and child. More well-designed studies are needed to examine the role of folate monotherapy in this condition.
Phenytoin-induced gingival hyperplasia:
Early evidence shows that applying folic acid topically may inhibit gingival hyperplasia (overgrowth of gum tissue) secondary to phenytoin therapy. Oral folic acid supplementation has not been proven to be beneficial. More research is needed in this area.
Based on preliminary data, applying folic acid topically may improve gingivitis in pregnant women. Well-designed clinical trials are needed to confirm these results.
Study results are mixed for the use of folate in stroke patients. Further research is needed in this area before a strong recommendation can be made.
Vascular disease / hyperhomocysteinemia:
Elevated homocysteine levels may be a marker of vascular disease. Preliminary data suggests that folic acid lowers homocysteine levels and might reduce the risk of vascular disease (cardiac, peripheral, or cerebral). Large randomized controlled trials are needed before a firm conclusion can be drawn.
Based on preliminary data, folic acid and vitamin B12 may improve the symptoms of vitiligo. Further research is needed to confirm these results.
One study does not show a protective effect of folic acid on heart anomalies among infants with Down's syndrome.
Folic acid supplementation does not seem to reduce toxicity from the cancer drug lometrexol.
Fragile X syndrome:
Folic acid supplementation has been shown not to improve symptoms of fragile X syndrome.