Folic acid: use and indications

In Latin "folium" means leaf. The literal translation is related to the origin of folic acid. It was isolated from spinach leaves in the form of folacin. The substance itself is not biologically active, but when it enters a living organism, it undergoes transformations. There are about 5–10 mg of folate in the human body. Half of them are located in the liver, the other part in the kidneys, bone marrow, red blood cells and tissues.

The normal concentration of folic acid in blood plasma is considered to be 4.5-30 nmol/l. This amount enters the body from food. Exceeded norms indicate a lack of absorption of vitamin B9. It remains in its original, unprocessed form.

Folic acid (folates) in Moscow from day 1

from 600 ₽

Vitamin B12 in Moscow from day 1

from 500 ₽

25-OH Vitamin D total (25-hydroxycalciferol) in Moscow from day 1

from 990 ₽

Folic acid is needed by the body to maintain its essential metabolic processes. Without the vitamin, a coherent DNA chain cannot be built, the supply of microelements to the brain is disrupted, and red blood cells are not produced in the required quantities.

Vitamin B9 is necessary for the health of every person, because:

reduces the risk of stroke;
normalizes the level of homocysteine in the blood, which reduces the risk of diseases of the cardiovascular system;
prevents cancer;
Helps avoid diabetes by maintaining normal blood glucose levels and reducing insulin resistance;
softens inflammatory processes by reducing the number of inflammatory markers and C-reactive protein;
helps fight bad mood, reduces the risk of depression;
prevents the development of serious diseases such as dementia and Alzheimer's disease.

Beneficial properties of folic acid

Folic acid, a water-soluble B vitamin, takes part in the synthesis of immune blood cells, activation of metabolism, and helps normalize the function of the digestive tract.
Vitamin B9 is involved in the synthesis of DNA and RNA molecules, in which genetic information is stored. Its presence in the body is also necessary for protein biosynthesis.

With insufficient levels of vitamin B9, the likelihood of developing defects in the fetus increases significantly.

Folic acid is also necessary for a woman's reproductive system. It is especially important for pregnant women, as it participates in the formation of the nervous system of the fetus. In addition, it is necessary for the normal formation and functioning of the placenta.

Cell division occurs with the participation of folic acid; in addition, the following benefits for the body are noted:

positive effect on brain function;
normalization of homocysteine levels;
improving the appearance of hair and nails;
improved skin regeneration;
production of sufficient amounts of methionine, norepinephrine, glycine, serotonin, thereby reducing the likelihood of developing anemia and depression.

As a rule, folic acid is prescribed for additional use when planning pregnancy and during gestation. For an adult, deficiency of this important element can be avoided by taking 200 mg of the drug daily. For pregnant and breastfeeding women, the dose should be increased to 400-600 mcg.

Folic acid supplementation is usually combined with vitamin B12 supplementation.

Folic acid: when, to whom and why should it be prescribed?

Folic acid or vitamin B9 is one of the most essential vitamins. Its deficiency affects about 90% of the world's population, including children.

Translated from Latin, “folium” means “leaf”. Folic acid is so named because it was first isolated from spinach leaves in 1941. Moreover, in order to isolate it for the first time, scientists needed 4 tons of spinach!

It is important to note that this vitamin is easily destroyed when heated, does not accumulate and is not synthesized in the body, and enters the body only with food or medications containing folic acid. Unfortunately, our diet does not provide the necessary concentration of folic acid in the body, so its deficiency occurs in most of the population of developed countries.

Folic acid consists of 3 structural units: pteridine residue, para-aminobenzoic and glutamic acids. The pteridine ring is not synthesized in the human body, so meeting the need for vitamin B9 completely depends only on external intake.

Synthetic folic acid is inactive and must be converted to the active metabolite 5-MTHF (5-methyl-tetrahydrofolate or L-methylfolate) to have its effect, so supplements containing methylfolate are most effective for replenishing folic acid deficiency.

A concentration of 4.5-30 nmol/l is considered normal. Most of the vitamin must come from food. Folic acid is found in all types of cabbage, citrus fruits, liver, yeast, nuts (especially peanuts), asparagus, and beans.

Its main functions are participation in:

— formation of red blood cells and hemoglobin, regulation of cell division;

- DNA repair;

- in the regulation of the synthesis of adrenaline and norepinephrine, the metabolism of serotonin (stabilizes the emotional background);

- in the synthesis of lymphocytes.

The effect of folic acid and its deficiency on the body is varied and is currently being closely studied by the global scientific community

Outside of pregnancy and its planning, folic acid deficiency leads to an increase in the level of homocysteine, which is a toxic product and increases the risk of developing cardiovascular diseases (stroke, heart attack, thrombosis). Hyperhomocysteinemia may be an independent factor in the occurrence of acne in women of reproductive age, without any additional causes.

Large studies (2 meta-analyses over the past 5 years) have shown that adding folate to the diet reduces the risk of developing depression.

A 2021 meta-analysis showed that folate-containing supplements can improve glucose metabolism and have a positive effect on insulin resistance.

Folic acid is a substance necessary for everyone, regardless of gender and age, but it becomes especially important during pregnancy.

What are the dangers of folic acid deficiency when planning pregnancy?

– is a risk factor for congenital malformations of the fetus, including neural tube defects (spina bifida), anencephaly (absence of the brain), herniation of the meninges;

– is a risk factor for malformations of the fetal cardiovascular system;

– is a risk factor for the development of anemia in a child;

– has long-term consequences – cognitive impairment in children.

The frequency of neural tube defects (NTD), congenital malformations of the central nervous system of the fetus, ranges from 0.2 to 2.0 per 1000 newborns. About 3% of miscarriages are associated with NTDs. With these defects, there is a sharp increase in the level of alpha-fetoprotein in the blood, which is detected during mandatory biochemical screening, and NTD can also be detected during ultrasound screening from 10-14 weeks. One of the reasons is a genetically determined disorder of folic acid metabolism, which can be judged by elevated levels of homocysteine. WHO recommends the use of a prophylactic dose of folic acid 400 mcg/day for all women planning pregnancy 2-3 months before conception and during the first trimester of pregnancy. In the presence of genetic defects in folate metabolism, the recommended dose of folate is 800 mcg/day. Prophylactic doses of folic acid can be used long-term without risks.

The experience of a number of countries shows that the use of folic acid reduces the number of NTDs and other folate-dependent defects in the fetus, such as congenital heart defects, limb reduction, and chromosomal syndromes. In the USA and England, in particular, this number is reduced by 30% compared to the years when folic acid was not used when planning pregnancy.

It is possible to use large dosages only as prescribed by a doctor for diabetes mellitus, obesity (BMI more than 30), in the presence of gastrointestinal diseases with malabsorption (Crohn's disease, celiac disease), if the woman or her partner has defects in the neural tube in a personal history or during previous pregnancies, while taking antiepileptic drugs.

Signs of folic acid deficiency

Signs of vitamin B9 deficiency may include symptoms that are often attributed to other diseases:

depression, irritability;
memory impairment;
headache;
general weakness and poor appetite;
discomfort and loss of sensitivity in the limbs;
inflammation of the mucous membrane of the tongue, accompanied by pain and the formation of ulcers in the oral cavity;
diarrhea;
difficulty breathing;
delayed puberty in girls;
early manifestation of gray hair and menopause;
megaloblastic anemia.

Megaloblastic anemia due to folic acid deficiency

Folate deficiency megaloblastic anemia most often develops in women during menopause. However, this problem cannot be ruled out at any other age. The development of the disease is primarily indicated by a large number of megaloblasts in the bone marrow and the presence of the following symptoms:

fast fatiguability;
headache;
absentmindedness;
dyspnea;
increased heart rate;
bright red color of the tongue.

Even in the absence of these symptoms, women over 50 years of age will also benefit from supplemental vitamin B9.

Why do pregnant and nursing mothers need folate?

Vitamin B9 is required whenever cells need to divide. Since during pregnancy cells divide constantly and intensively, vitamin B9 is also needed constantly and in large quantities. What happens if there is not enough of it?

The main danger of vitamin B9 deficiency during pregnancy is neural tube defects (NTDs) of the fetus. It is a developmental disorder of the fetus that causes many birth defects. Not all of them are compatible with life. The neural tube closes on the 28th day after conception, when a woman may not yet know about her pregnancy. That is why the need for folic acid must be replenished at the stage of preparation for conception.

Vitamin B9 should be taken throughout pregnancy, since its deficiency in later stages leads to disturbances in the development of the cardiovascular and urinary systems, hematopoiesis and other problems. In addition, taking vitamin B9 during pregnancy helps a woman endure pregnancy more easily, reducing unpleasant phenomena such as hair loss, deterioration of skin condition, etc.

Indications for taking folic acid

Indications for taking vitamin B9 when planning pregnancy and conception

Folic acid is required by the body at all periods of life, but during planning and conceiving a child, it is most important for the formation and development of a healthy fetus. Additional intake of folic acid in various preparations helps maintain normal levels of homocysteine, an amino acid that is especially important during pregnancy.

This increases the likelihood of pregnancy and successful pregnancy.

If one of the spouses is deficient in vitamin B9, pregnancy is unlikely.

It is important to remember that folic acid is needed in the earliest stages of embryonic development. In the first weeks after conception, the embryo actively grows and all important systems and organs are formed. Folic acid is necessary for the embryo to form new tissues. Already in the second week, the fetus’s nervous system begins to form. A lack of vitamin B9 at this point can lead to malformations and anomalies in the development of the fetus and will significantly increase the risk of delayed development of the child in the future.

That is why gynecologists recommend drinking folic acid even at the stage of pregnancy planning, without waiting for a delay in menstruation. So, by the time of ovulation, the expectant mother’s body will not lack vitamin B9 and will be able to ensure the normal development of the embryo in the earliest stages of gestation.

With folic acid deficiency, the following negative consequences are possible for the fetus:

slowing down the process of fetal development;
spontaneous abortion;
placental abruption;
premature birth;
preeclampsia;
heart defects;
palate defects and cleft lip;
anomaly of the genitourinary tract;
underweight newborn.

Folic acid plays an equally important role for the body of the expectant mother, which works in an intensive mode during the period of bearing a child. The functioning of the hematopoietic system, the growth and development of the placenta, the strengthening of the vascular network in the uterus - all this will not be ensured properly without the required amount of folic acid.

Due to problems with the development of the placenta or inferiority of the uterine vessels, spontaneous termination of pregnancy is possible. Therefore, doctors recommend that both future parents start taking folic acid during pregnancy planning, even before conception. If pregnancy has been detected after the fact, the drug should be started immediately and not stopped during the entire period of bearing the child. Since vitamin B9 is water-soluble, it is impossible to have an excess of it in the body.

Taking vitamin B9 is necessary not only for the fetus and ensuring the processes of its development and formation.

Is it possible to avoid taking folic acid during pregnancy?

According to statistics, most pregnancies are unplanned. A very small percentage of couples undergo a full examination before planning a child. Often a woman finds out about pregnancy at 2 months of fetal development. And there should be enough folic acid in the body already in the first days of conception.

If the couple of expectant parents are generally healthy, then the level of vitamin B9 may be sufficient and such an omission will not create problems for either the fetus or the expectant mother.

However, one should not hope for luck in such an important case, so taking folic acid is recommended by doctors at least three months before pregnancy. In some countries, folate supplements are used by all women with preserved reproductive function.

Indications for taking folic acid for men

Folic acid is beneficial not only for the developing fetus and the female body, but also for men. The quality of sperm depends to a large extent on adequate levels of vitamin B9. Therefore, when planning pregnancy before conception, not only women, but also men need to take folic acid supplements.

In the male body, vitamin B9 performs the following functions:

reduces the number of chromosomal defects in sperm and reduces the risk of congenital pathology in the child;
increases the activity and viability of sperm, which increases the chances of successful conception;
activates the immune system and improves the overall tone of the body.

Taking folic acid by both partners increases the chances of a successful pregnancy and birth of a healthy child and significantly reduces the risk of gestational complications.

Indications for taking vitamin B9 in adulthood

Given the characteristics of a mature organism, after 50 years of age, a sufficient level of folic acid should be maintained in the body. The fact is that folic acid has an estrogen-like effect, which improves well-being during menopause. The severity of negative symptoms decreases:

sweating and feeling of heat decrease;
increased heartbeat is eliminated;
the frequency of hot flashes and their severity decreases;
sleep is normalized;
mental state improves;
blood pressure is normalized.

Vitamin B9 not only has a generally positive effect on the body during menopause, but also protects against diseases associated with the destruction of the retina and deterioration of visual acuity.

You should eat more foods containing folic acid.

Lack of folic acid, causes and consequences

Health problems due to a lack of folic acid mostly arise from poor diet. It is with food that folate comes in, which is further converted into vitamin B9. With a good diet, poor absorption of the vitamin from the stomach and intestines may also occur. This may be due to impaired absorption from the gastrointestinal tract. With accelerated metabolism in the case of liver disease or kidney failure, folic acid quickly breaks down and is excreted. This also leads to its deficiency.

Folic acid during pregnancy

A lack of folic acid during pregnancy leads to a disruption in the creation of a DNA chain and new cells. At the stage of rapid growth and formation of the fetus, the embryonic neural tube, heart and circulatory system of the baby are formed. A lack of B9 increases the likelihood of:

miscarriage;
premature birth;
heart disease in the unborn child;
cerebral hernias;
spinal column malformation, anencephaly;
autism.

First of all, a woman must improve her diet and give up bad habits. You need to monitor your folate levels to avoid hypovitaminosis. It is advisable, even at the planning stage of pregnancy, to begin to monitor the content of folic acid in food and make up for its deficiency.

For women

The older a woman is, the worse folic acid is absorbed by the body. The shortage is acutely felt closer to 50 years of age and in old age. Absorption can also be impaired if a woman abuses alcohol, smoking, a sedentary lifestyle, or is very overweight.

Lack of B9 leads to impaired blood circulation in the brain, its functions are reduced. In addition, there is a high risk of developing Alzheimer's disease. The first symptoms of negative manifestations of deficiency already appear on the 30th day. This is why it is so important to eat foods rich in folic acid every day.

A sure sign of vitamin deficiency is severe anemia, in which the level of red blood cells drops sharply. Dizziness, weakness, and drowsiness occur. Nausea may increase, leading to decreased appetite and irritability. A serious danger is the manifested state of leukopenia, when the body is attacked by various infectious diseases.

For men

The main function of vitamin B9 is its effect on potency. Its deficiency contributes to a decrease in the level of active sperm, which leads to male infertility. In addition, folic acid maintains normal levels of digestion. A deficiency leads to the deposition of atherosclerotic plaques, and fatty infiltration of the liver develops.

After 50 years, a lack of folic acid is especially dangerous for men. This is associated with a greater risk of mental disorders, poor blood clotting and heart valve pathologies. If a man is a heavy smoker and often drinks alcohol, then the absorption of the vitamin decreases many times. No matter how many healthy foods the body receives, half of the nutrients simply cannot be absorbed due to the effects of alcohol and nicotinic acid.

Vitamin deficiency in men most often manifests itself in damage to the mucous membrane of the oral cavity, intestinal tract and stomach. The smallest scratches take a long time to heal, hair falls out, and the tongue may become inflamed.

An increase in low-grade fever, chills and headaches can often be observed. The emotional background also suffers. Unreasonable worries and worries about trifles appear, which can develop into depressive deviations. Against this background, memory deteriorates and the nervous system suffers.

In children

If there is a lack of B9, the baby's growth and development is delayed. This is due to poor protein synthesis and disruption of the nervous system. Children with deficits almost always have problems:

Indigestion. Most of the problems are related to the intestines. The child cannot go to the toilet or has diarrhea.
Impaired mental function. If in infancy this is not very noticeable, then in adolescence, when the child goes to school, disturbances in thinking and coordination will appear in all their glory.
Megaloblastic anemia. Improper formation of red blood cells makes the blood cells large. This does not allow them to carry the required amount of oxygen through tissues and organs. The capillaries narrow, a chronic feeling of fatigue, irritability appears, lethargy and weakness occur.

Uses of folic acid

Since folic acid is an important element for the normal course of pregnancy, it is advisable to conduct a test for vitamin B9 deficiency in the body before planning conception. If this results in a significant deficiency of folic acid, medications containing folacin are prescribed.

If no acute problems with a deficiency of this element were found, the doctor may recommend taking vitamin complexes and increased nutrition with foods rich in vitamin B9.

The most folic acid is found in the following foods:

liver and other offal;
yeast;
sunflower seeds;
vegetables and leafy greens - lettuce, turnips, spinach, asparagus;
legumes – lentils, peas;
chicken egg yolk;
semi-finished products made with the addition of folic acid.

Liver is one of the most valuable sources of vitamin B9; this product also contains many useful components and nutrients for the body.

Vitamin B9, folates and folic acid - what is the difference and which is better?

There are three main forms of vitamin B9: folic acid, methyltetrahydrofolates (or methylfolates for short), and formyltetrahydrofolic acid (often called folinic acid).

Folic acid is well absorbed, but is slowly metabolized, that is, it is included in the fulfillment of its biological role in the body. Methyltetrahydrofolates are absorbed much better than “regular” folic acid. And their effectiveness is much higher, which is confirmed by research. Folinic acid is comparable to methylfolates in effectiveness.

What vitamins contain folic acid?

Special multivitamins for pregnant women contain a loading dose of folin, so you cannot take such drugs on your own without a doctor’s recommendation.

To prevent possible problems for the expectant mother, doctors prescribe special medications containing vitamin B9:

"Folic acid" - one tablet contains 1000 mcg of vitamin B9.
"Foliber" with vitamin B12. Each tablet contains 400 mcg of folic acid.
"Folic acid" with B6 and B12. One tablet contains 600 mcg of folic acid, 5 mcg of vitamin B12, and 6 mg of vitamin B6. This drug is a dietary supplement.
Complex vitamin preparations with folic acid containing: “Multi-tabs perinatal” (400 mcg), “Pregnavit” (750 mcg), “Elevit” (1000 mcg), “Vitrum Prenatal” (800 mcg), “Materna” (1000 mcg).

“Folio” with iodine contains 400 mcg of B9 and 200 mcg of iodine.

Problems with genes

Absorption of regular folic acid and natural folates from food takes two to five hours. To begin the absorption process, the body produces the enzyme MTHF reductase. Under its influence, folic acid is converted into tetrahydrofolate and methyltetrahydrofolate. It is the latter compound that is absorbed from the intestine and then participates in many biochemical reactions.

But it turns out that not all people absorb folic acid the same way. Approximately half of the world's population are carriers of a defective MTHF reductase gene. This means that they produce less of the enzyme than is necessary to absorb the folic acid entering the body, and they live with a constant deficiency of this substance. And approximately 5–25% of people have two copies of the defective gene. And they do not produce the enzyme necessary to absorb this acid at all. Genetic disorders in the absorption of the substance explain why even normally nourished women are deficient in vitamin B9. However, everyone needs folic acid, regardless of their ability to absorb it.

The solution is to take methylfolate, which does not require additional enzymes for its absorption. After all, methylfolate is an active form of folic acid that is ready to work in the body. In recent years, preparations containing vitamin B9 in the form of methylfolate have also appeared in Russia, for example, the Pregnoton Mama complex, intended for expectant mothers. After all, if in everyday life a woman may not even notice a lack of folate, then during pregnancy a deficiency of vitamin B9 is associated with very serious problems!

Features of the intake and absorption of folic acid

Vitamin B9 deficiency is often accompanied by a number of diseases of the gastrointestinal tract - celiac disease, gastritis, malabsorption, since this element is poorly absorbed in this case. A lack of folic acid for the same reason can occur when using certain medications:

glucocorticosteroids,
aspirin,
antacids,
nitrofurans,
contraceptive drugs.

The following diseases require special attention from a doctor when prescribing folic acid supplements:

disorders of the kidneys;
anemia;
overweight with a BMI of 30 or higher;
history of spontaneous miscarriages from previous pregnancies;
diabetes mellitus, both type 1 and type 2;
taking medications, one of the components of which is valproic acid;
alcohol abuse.

Be sure to tell your doctor if you have at least one of these aggravating circumstances. He will adjust the dosage and dosage regimen in accordance with the existing diseases.