FOLIC ACID Overview Information

Folic acid is a water-soluble B vitamin. Since 1988, it has been added to cold cereals, flour, breads, pasta, bakery items, cookies, and crackers, as required by federal law. Foods that are naturally high in folic acid include leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice.

Folic acid is used for preventing and treating low blood levels of folic acid (folic acid deficiency), as well as its complications, including “tired blood” (anemia) and the inability of the bowel to absorb nutrients properly. Folic acid is also used for other conditions commonly associated with folic acid deficiency, including ulcerative colitis, liver disease, alcoholism, and kidney dialysis.

Women who are pregnant or might become pregnant take folic acid to prevent miscarriage and “neural tube defects,” birth defects such as spina bifida that occur when the fetus’s spine and back don’t close during development.

Some people use folic acid to prevent colon cancer or cervical cancer. It is also used to prevent heart disease and stroke, as well as to reduce blood levels of a chemical called homocysteine. High homocysteine levels might be a risk for heart disease.

Folic acid is used for memory loss, Alzheimer’s disease, age-related hearing loss, reducing signs of aging, weak bones (osteoporosis), jumpy legs (restless leg syndrome), sleep problems, depression, nerve pain, muscle pain, AIDS, a skin disease called vitiligo, and an inherited disease called Fragile-X syndrome. It is also used for reducing harmful side effects of treatment with the medications lometrexol and methotrexate.

Some people apply folic acid directly to the gum for treating gum infections.

Folic acid is often used in combination with other B vitamins.

How does it work?

Folic acid is needed for the proper development of the human body. It is involved in producing the genetic material called DNA and in numerous other bodily functions.

FOLIC ACID Uses & Effectiveness What is this?

Effective for:

* Treating and preventing folic acid deficiency.


Likely Effective for:

* Lowering homocysteine levels in people with kidney disease. About 85% of people with serious kidney disease have high levels of homocysteine. High levels of homocysteine have been linked to heart disease and stroke. Taking folic acid lowers homocysteine levels in people with serious kidney disease.
* Lowering homocysteine levels (“hyperhomocysteinemia”) in people with high amounts of homocysteine in their blood. High levels of homocysteine have been linked to heart disease and stroke.
* Reducing harmful effects of a medicine called methotrexate, which is sometimes used to treat rheumatoid arthritis and psoriasis. Taking folic acid seems to reduce nausea and vomiting, which are possible side effects of methotrexate treatment.
* Decreasing the risk of certain birth defects (neural tube defects) when taken by pregnant women.


Possibly Effective for:

* Reducing the risk of getting colorectal cancer. Getting more folic acid from the diet and supplements seems to lower the chances of developing colon cancer, but does not seem to help people who already have colon cancer.
* Reducing the risk of breast cancer. The benefit is greater when women get extra vitamin B12 and vitamin B6 in their diet in addition to folic acid.
* Depression, when used with conventional antidepressant medicines. Limited research suggests that folic acid alone won’t help with depression.
* Treating a skin disease called vitiligo.
* Gum problems due to a drug called phenytoin when applied to the gums.
* Treating gum disease during pregnancy, when used in mouthwash.
* Reducing the risk of pancreatic cancer.


Possibly Ineffective for:

* Reducing the risk of heart attack, stroke, and other related conditions in people with coronary heart disease.
* Reducing the possibility of another stroke.
* Reducing harmful effects of a medicine called lometrexol.
* Chronic fatigue syndrome.


Likely Ineffective for:

* Treating an inherited disease called Fragile-X syndrome.


Insufficient Evidence for:

* Preventing re-blockage of blood vessels after angioplasty, a procedure to open a closed blood vessel. Taking folic acid plus vitamin B6 and vitamin B12 might actually interfere with healing in cases where a device (stent) is inserted in the blood vessel to keep it open.
* Alzheimer’s disease. Limited evidence suggests that elderly people who get more folic acid than the recommended dietary allowance (RDA) appear to have a lower risk of developing Alzheimer’s disease than people who get less folic acid.
* Memory and thinking skills in older people. There is conflicting evidence about the role of folic acid in age-related decline in memory and thinking skills.
* Preventing cervical cancer. There is some evidence that increasing folic acid intake from dietary and supplement sources, along with thiamine, riboflavin, and vitamin B12, might help to prevent cervical cancer.
* Male infertility. Some research suggests that taking folic acid plus zinc sulfate daily can increase sperm count in men with low sperm counts.
* Lung cancer. There does not appear to be a relationship between low levels of folic acid and lung cancer.
* Restless leg syndrome. Taking folic acid seems to reduce symptoms. Researchers are studying whether folic acid deficiency causes restless leg syndrome.
* Cancer due to a disease called ulcerative colitis. Taking folic acid might help to keep people with ulcerative colitis from getting cancer.
* Liver disease.
* Alcoholism.
* Age-related hearing loss.
* Sickle cell disease.
* Weak bones (osteoporosis).
* Other conditions.

More evidence is needed to rate folic acid for these uses.

FOLIC ACID Side Effects & Safety

Folic acid is LIKELY SAFE for most people. Most adults do not experience any side effects when consuming the recommended amount each day, which is 400 mcg. Don't take more than 400 mcg per day unless directed by your healthcare provider.

High doses of folic acid might cause abdominal cramps, diarrhea, rash, sleep disorders, irritability, confusion, nausea, stomach upset, behavior changes, skin reactions, seizures, gas, excitability, and other side effects.

Preliminary research suggests folic acid might increase the risk of heart attack in people who have heart problems. Other preliminary research suggests high doses might increase the risk of cancer. There is also concern that taking large amounts of a multivitamin plus a separate folic acid supplement, or folic acid supplements higher than the recommended daily amount, might increase the chance of developing prostate cancer in men.
Special Precautions & Warnings:
Pregnancy and breast-feeding: When used in recommended amounts, folic acid is LIKELY SAFE for pregnant or breast-feeding women. For pregnant women, 300-400 mcg per day is recommended to prevent neural tube defects in the baby.

Anemia: Folic acid can hide a condition called pernicious anemia. This can prevent appropriate treatment with vitamin B12 and result in nerve damage. If you think you may have some sort of anemia, don’t take folic acid. The type of anemia you have needs to be identified first.

Seizure disorder: Folic acid, especially in high amounts (over 1000 mcg), might trigger seizures in people who tend to have seizures. Don’t use more folic acid than the recommended amounts.

Heart disease: Taking folic acid along with vitamin B6 might increase the chance of having a heart attack in people who have heart disease. Until more is known, avoid folic acid in doses higher than the recommended daily amount if you have heart disease. If you also have folic acid deficiency, folic acid supplementation needs to be supervised by your healthcare provider.

Cancer: Larger doses of folic acid might increase the risk of cancer. Until more is known, avoid folic acid in doses higher than the recommended daily amount if you have ever had cancer.

FOLIC ACID Interactions What is this?

Moderate Interaction Be cautious with this combination

* Fosphenytoin (Cerebyx) interacts with FOLIC ACID

Fosphenytoin (Cerebyx) is used for seizures. The body breaks down fosphenytoin (Cerebyx) to get rid of it. Folic acid can increase how quickly the body breaks down fosphenytoin (Cerebyx). Taking folic acid along with fosphenytoin (Cerebyx) might decrease the effectiveness of fosphenytoin (Cerebyx) for preventing seizures.
* Methotrexate (MTX, Rheumatrex) interacts with FOLIC ACID

Methotrexate (MTX, Rheumatrex) works by decreasing the effects of folic acid in the body's cells. Taking folic acid pills along with methotrexate might decrease the effectiveness of methotrexate (MTX, Rheumatrex).
* Phenobarbital (Luminal) interacts with FOLIC ACID

Phenobarbital (Luminal) is used for seizures. Taking folic acid can decrease how well phenobarbital (Luminal) works for preventing seizures.
* Phenytoin (Dilantin) interacts with FOLIC ACID

The body breaks down phenytoin (Dilantin) to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin (Dilantin). Taking folic acid and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.
* Primidone (Mysoline) interacts with FOLIC ACID

Primidone (Mysoline) is used for seizures. Folic acid might cause seizure in some people. Taking folic acid can along with primidone (Mysoline) might decrease how well primidone works for preventing seizures.
* Pyrimethamine (Daraprim) interacts with FOLIC ACID

Pyrimethamine (Daraprim) is used to treat parasite infections. Folic acid might decrease the effectiveness of pyrimethamine (Daraprim) for treating parasite infections.


FOLIC ACID Dosing

BY MOUTH:

* For folic acid deficiency: the typical dose is 250-1000 mcg (micrograms) per day.
* For preventing neural tube defects: at least 400 mcg of folic acid per day from supplements or fortified food should be taken by women capable of becoming pregnant and continued through the first month of pregnancy. Women with a history of previous pregnancy complicated by such neural tube defects usually take 4 mg per day beginning one month before and continuing for three months after conception.
* For reducing colon cancer risk: 400 mcg per day.
* For treating high levels of homocysteine in the blood:
o 0.5-5 mg (milligrams)/day has been used, although 0.8-1 mg/day is appears to be more effective.
o In people with end-stage renal disease, high homocysteine levels may be more difficult to treat, and doses of 0.8-15 mg/day have been used. Other dosage plans such as 2.5-5 mg 3 times weekly have also been used. Doses higher than 15 mg daily do not seem to be more effective.

* For improving the response to medications for depression: 200-500 mcg daily has been used.
* For vitiligo: 5 mg is typically taken twice daily.
* For reduction of toxicity associated with methotrexate therapy for rheumatoid arthritis (RA) or psoriasis: 1 mg/day is probably enough, but up to 5 mg/day may be used.

The adequate intakes (AI) for infants are 65 mcg for infants 0-6 months and 80 mcg for infants 7-12 months of age. The recommended dietary allowances (RDAs) for folate in DFE, including both food folate and folic acid from fortified foods and supplements are: Children 1-3 years, 150 mcg; Children 4-8 years, 200 mcg; Children 9-13 years, 300 mcg; Adults over 13 years, 400 mcg; Pregnant women 600 mcg; and breast-feeding women, 500 mcg. The tolerable upper intake levels (UL) of folate are 300 mcg for children 1-3 years of age, 400 mcg for children 4-8 years, 600 mcg for children 9-13 years, 800 mcg for adolescents 14-18 years, and 1000 mcg for everyone over 18 years of age.

APPLIED TO THE SKIN: No typical dose.

View clinical references for this vitamin or supplement Sources

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