Folic acid, also known as vitamin B9, is an essential nutrient that plays many important roles in the body. Taking a folic acid supplement every day can have several health benefits, but also some potential side effects to be aware of.
What is Folic Acid?
Folic acid is a B vitamin that is naturally found in many foods. It helps the body produce and maintain new cells. This is especially important during periods of rapid cell division and growth, such as in infancy and pregnancy. Folic acid is also necessary for making DNA and various neurotransmitters that regulate mood and other processes.
Some of the top food sources of folate include:
- Leafy green vegetables like spinach, kale, and romaine lettuce
- Broccoli
- Asparagus
- Okra
- Beans and lentils
- Oranges and orange juice
- Nuts and seeds
- Eggs
- Beef liver
- Enriched breads, cereals, pasta, and rice
Since 1998, folic acid is added to all enriched breads, cereals, flours, cornmeal, pasta, and rice produced in the U.S. This fortification helps increase folic acid intake and prevent deficiencies, which are common.
Taking a supplement can ensure adequate folic acid intake, especially for those with increased needs or difficulty absorbing this nutrient from foods.
Recommended Folic Acid Intake
The recommended daily intake for folic acid depends on age:
| Age | Recommended Amount |
|---|---|
| Birth to 12 months | 65-150 mcg/day |
| Children 1-3 years | 150 mcg/day |
| Children 4-8 years | 200-300 mcg/day |
| Children 9-13 years | 300-400 mcg/day |
| Adolescents 14-18 years | 400-600 mcg/day |
| Adults | 400 mcg/day |
| Pregnant women | 600 mcg/day |
| Breastfeeding women | 500 mcg/day |
As you can see, the requirement increases during pregnancy and lactation to support fetal and infant development. Many doctors recommend prenatal vitamins with at least 600 mcg folic acid for women trying to conceive and throughout pregnancy.
Benefits of Taking Folic Acid Daily
Here are some of the top evidence-based benefits that may be achieved by taking a folic acid supplement regularly:
May Prevent Birth Defects
Getting sufficient folic acid is crucial during pregnancy to help prevent major birth defects of the baby’s brain and spine. Spina bifida and anencephaly are neural tube defects caused when the fetal spinal cord and brain do not develop properly early in pregnancy.
Folic acid helps form the neural tube during the first month of pregnancy. According to the Centers for Disease Control and Prevention, taking 400 mcg of folic acid daily before and during early pregnancy can reduce the risk of neural tube defects by 50-70%.
May Lower Heart Disease Risk
Several studies show that taking folic acid supplements may reduce the risk of heart disease. A meta-analysis published in JAMA found that folic acid supplementation decreased the risk of stroke by around 10%.
Folic acid helps lower levels of homocysteine, an amino acid linked to an increased risk of heart attack and stroke when elevated in the blood. It may also help improve nitric oxide levels and blood flow.
May Prevent Anemia
Folic acid helps the body produce healthy red blood cells and prevents anemia. This is especially important during periods of rapid growth, such as infancy, adolescence, and pregnancy. A study found that giving iron and folic acid supplements to pregnant women reduced anemia risk by around 40%.
Supports Brain Health
Folic acid plays a critical role in brain and cognitive health at all stages of life. It helps generate neurotransmitters that regulate cognition, mood, and other brain functions. Folate deficiency has been liked to a higher risk of cognitive decline and impairment with aging.
A review from JAMA Psychiatry found that older adults with low folic acid levels were more likely to experience difficulty concentrating, forgetfulness, and other symptoms of dementia.
May Prevent Cancer
Some evidence indicates folic acid may help prevent certain types of cancer, especially when taken in combination with vitamin B12. One meta-analysis found that higher blood folate levels were associated with a reduced risk of breast cancer.
Other studies link increased folic intake and blood levels to a lower risk of colorectal, ovarian, pancreatic, and lung cancers. More research is needed to determine the relationship between folic acid and cancer prevention.
Helps Make DNA and RNA
Folic acid is necessary for DNA replication and repair within cells. It provides methyl groups used to form the building blocks of DNA called nucleotides. Without sufficient folic acid, DNA synthesis is impaired.
Supports Healthy Pregnancy
In addition to reducing birth defect risk, folic acid is important for placenta and fetal growth and development during pregnancy. It helps increase blood volume and iron levels to prevent anemia.
Studies show that folic acid deficiency in pregnant women is linked to higher rates of preeclampsia, restricted fetal growth, preterm delivery, and low birth weight babies.
Potential Side Effects
For most healthy individuals, up to 1000 mcg per day of folic acid is considered safe. While it’s water-soluble and any excess will be excreted in urine, there are some potential adverse effects to be aware of with supplementation.
Masking Vitamin B12 Deficiency
High supplemental doses of folic acid can mask a vitamin B12 deficiency. Vitamin B12 works together with folic acid in many essential body processes like making red blood cells and maintaining nerve function.
Taking folic acid without adequate vitamin B12 could potentially lead to neurological symptoms over time. Adults over 50 should have vitamin B12 levels assessed before starting a supplement since deficiencies become more common with age.
Seizures
There is some concern that high amounts of folic acid could trigger seizures in people taking anticonvulsant medications for epilepsy. However, this risk appears to be low at doses under 5000 mcg per day.
Cancer Risk
Research on how folic acid influences cancer development has been mixed. Some studies suggest excess supplementation may promote the growth of abnormal cells and tumors.
However, a clinical trial found that even at doses up to 5000 mcg per day, folic acid did not increase the risk of prostate, colorectal, lung, or other cancers over a 5-10 year period.
Interactions with Medications
Folic acid may interact with certain medications like anticonvulsants, antibiotics, antifungals, and more. Those taking any regular medications should speak with their doctor before starting supplementation.
Special Considerations
While folic acid is generally very safe, some people should consult their doctor before taking a supplement:
- Pregnant women or those planning a pregnancy
- People with anemia from vitamin B12 deficiency
- Celiac disease or IBD patients with malabsorption issues
- Patients with certain cancers, like leukemia and lymphoma
- Anyone taking medications that may interact with folic acid
Additionally, people with a MTHFR gene mutation have difficulty converting folic acid into an active form in the body. Methylfolate is a better alternative supplement for these individuals.
Folic Acid Supplement Forms
Folic acid is available in several supplemental forms:
- Folic acid – The synthetic form used in supplements and fortified foods. Less expensive but requires a conversion process before the body can use it.
- Folate – The natural form found in foods. More expensive as a supplement but doesn’t require conversion.
- Methylfolate – The active form which is optimal for those with MTHFR gene mutations.
For people without absorption issues, folic acid supplements are efficient and affordable. Folate and methylfolate supplements may be preferable for those with certain genetic mutations or health conditions.
How to Supplement with Folic Acid
Folic acid is one of the main ingredients in all standard prenatal vitamins. For pregnant women or those trying to conceive, a prenatal vitamin containing at least 600 mcg folic acid is recommended.
Folic acid is also commonly available as a standalone supplement in pill or tablet form. The dosages typically range from 400-1000 mcg, which is considered safe and effective for most adults.
Folic acid is best absorbed when taken with food and in combination with vitamin B12. Taking your daily supplement consistently is important to maintain adequate blood levels.
Food Sources of Folic Acid
In addition to supplementation, you can help ensure optimal folic acid intake through food sources like:
- Fortified grains and cereals
- Beans, lentils, and peas
- Leafy greens
- Asparagus
- Broccoli and okra
- Citrus fruits and juices
- Nuts and sunflower seeds
- Beef liver
Choosing a variety of folate-rich foods is the best way to meet your daily needs naturally. However, supplementation is often recommended for groups at higher risk of deficiency.
Signs of Folic Acid Deficiency
Symptoms of folic acid deficiency may include:
- Fatigue and weakness
- Heart palpitations
- Shortness of breath
- Headaches
- Irritability
- Difficulty concentrating
- Forgetfulness and confusion
- Glossitis (swollen tongue)
- Anemia
Deficiency is especially concerning for pregnant women, as it greatly raises the risk of neural tube defects and other complications. If you suspect you may not be getting enough folic acid, ask your doctor for a blood test.
Folic Acid and Methylation
Folic acid is vital for proper methylation, which is essential for DNA synthesis and many bodily processes. Methyl groups supplied by folic acid allow DNA to be expressed and regulated appropriately.
Impaired methylation due to low folic acid has been associated with a wide range of health problems. These include birth defects, heart disease, stroke, dementia, and certain cancers like colorectal cancer.
Folic Acid During Pregnancy
It’s recommended that all women who may become pregnant take 400-800 mcg of folic acid daily, from fortified foods and/or supplements. After becoming pregnant, the dose should be increased to 600 mcg.
Taking folic acid before and during early pregnancy is crucial for reducing neural tube defect risk, which occurs within the first month. Many doctors recommend continuing supplementation throughout pregnancy to support fetal development.
In addition to a supplement, pregnant women should aim to consume folate-rich foods like green leafy vegetables, citrus, beans, and lentils.
Folic Acid While Breastfeeding
The recommended intake of folic acid increases to 500 mcg per day while breastfeeding. Nursing women should continue taking a prenatal vitamin or folic acid supplement.
Folic acid passes into breastmilk and helps ensure adequate intake for the baby as rapid development continues after birth. Getting sufficient folic acid from the mother’s milk helps prevent deficiencies in the infant.
Folic Acid for Men
Folic acid is just as important for men as women, especially for fertility and offspring health. The recommended intake is 400 mcg daily.
One study found that men consuming at least 500 mcg of folic acid a day significantly improved sperm count and motility. Another study showed that male folic acid supplementation helped reduce birth defects in their offspring.
Even when not actively trying to conceive, taking a multivitamin or folic acid supplement may benefit men’s reproductive health and prevent father-to-child transmission of birth defects.
Conclusion
Getting adequate folic acid from supplements, fortified foods, and folate-rich dietary sources can provide many health perks. Regular folic acid intake is crucial for pregnant women and those trying to conceive due to its vital role in fetal development and preventing neural tube defects.
Folic acid is also beneficial for heart health, cancer prevention, cognitive function, and preventing anemia and birth defects. For healthy individuals, up to 1000 mcg per day from supplements and food appears to be safe and potentially beneficial.
However, some people should exercise caution with folic acid, especially those with vitamin B12 deficiencies, seizures disorders, and certain cancers. Speak to your healthcare provider to determine if folic acid supplementation is right for you based on your medical history and health status.