Vitamin B9 ( folic acid / folate )

Folate (also known as folacin and folic acid) plays an important role in many of the systems which are vital to maintaining our position on the continuum.

Though folate's exact role in metabolism is not yet fully known, we know it's necessary for the synthesis of essential nucleic acids, DNA and RNA. These proteins are required for cell reproduction and division, so it doesn't take much imagination to realize how devastating a deficiency of this vitamin could be. The "hardest hit" target organs are those that depend on rapid proliferation of new cells: bone marrow, hair, fingernails, immune system, certain mucous membranes, and red blood cells.

The classic symptoms of a folate deficiency anemia are weakness, inflamed and sore tongue, numbness or tingling in the hands and feet, indigestion, diarrhea, depression, irritability, pallor, drowsiness, and slow, weakened pulse. These are also the symptoms of pernicious anemia, which is due to a deficiency of cobalamin (B12).

As with most of the other vitamins and minerals, these "classic" symptoms are revealed experimentally by means of severe deprivation. Remember that the continuum contains a wide range of illness and health. There is no cut-off point where a difference between supply and demand suddenly becomes severe enough to be called a deficiency and cause these symptoms. As soon as supply does not meet demand, there is going to be a biochemical effect. The adverse effect on optimum health may be slight, but it will occur nevertheless. Wounds may not heal as fast as they should. Hair might fallout in greater than normal volume. Infections might take hold more frequently than before. Then, some of the "classic" symptoms may show up.

Folate apparently helps maintain normal blood sugar levels. Folate-supplemented rats had higher blood sugar levels after a forty-eight-hour fast than rats which did not fast but received no folate. Apparently this effect has therapeutic value for some people who suffer from chronic low blood sugar.

Pregnancy raises the body's requirement for folate. A deficiency can result in insomnia, irritability, and depression. Furthermore, we know that folate can also come to the aid of women who have a tendency toward spontaneous abortion and miscarriage. Folate supplementation can enable these women to carry a fetus to term and deliver a healthy baby.

Because it is required for the manufacture of new tissue, folate is vitally important to not only the health of the pregnant woman but also to the proper development of the fetus. A folate deficiency during pregnancy can have devastating effects.

One of the relatively minor effects, however, is something called "restless legs" syndrome. The symptoms-insomnia and leg numbness and cramps which are relieved by movement and massage of the calves-generally come during the night. One study found restless legs syndrome was directly associated with low dietary and blood levels of folate. Out of a group of twenty-one pregnant women, nine had restless leg syndrome. Only one of these women had received a folate supplement. Of the other twelve, who didn't have restless leg syndrome, ten had taken folate supplements.

Oral contraceptives can cause folate deficiencies, and the deficiencies can linger for many months after contraceptives are no longer taken.

Many commonly used medications interfere with folate metabolism and could cause deficiencies. Oral contraceptives increase the removal of folate from the blood plasma; methotrexate, a medication used for immunosuppression in cancer and psoriasis, is a folate antagonist. Other medications which can interfere with folate are aminopterin, the antimalarial medication pyrimethamine, pentamidine, trimethoprim, phenytoin, primidone, phenobarbitone, isoniazid and cycloserine combination therapy, alcohol, diphenylhydantoin, barbiturates, estrogens, anticonvulsants, and phenothiazines.

Folate depletion occurs rapidly after injury or trauma. Absorption of folate is impaired by a systemic bacterial infection. And people with sickle cell anemia frequently have a folate deficiency. Folate absorption from the intestine is impaired in a zinc deficiency. Vitamin C is necessary for the conversion of folate to its biologically active form, so folate deficiency can occur as a result of a vitamin C deficiency.

Where is it found ?

Rich natural sources of folate include organ meats, dark green leafy vegetables, asparagus, lima beans, yeast, whole grains, wheat germ, lentils, and orange juice. From fifty to ninety-five percent of folate can be destroyed by cooking, canning, processing, or storage, since the vitamin is sensitive to sunlight, heat, and acids.

Who is likely to be deficient ?

Most people do not consume the recommended amount of folic acid. Recently, scientists have found that many people with heart disease have elevated blood levels of homocysteine, which is often controllable with folic acid. This suggests that many people in Western societies have a mild folic acid deficiency. In fact, increasing folic acid intake could potentially prevent an estimated 13,500 deaths from cardiovascular diseases each year. Folic acid deficiency is also common in alcoholics, people living at poverty level, those with malabsorption disorders, and women taking the birth control pill. Recently, elderly people with hearing loss have been reported to be much more likely to be folic acid deficient than healthy elderly individuals.

How much to take

The RDA for folate ranges from .05 mg. for infants up to.8 mg. for pregnant women. For adults, the RDA is .4 mg. Reference books admit that the human requirement has not yet been adequately determined. But the same could be said for just about any vitamin, considering the wide variations in individual needs. It seems much more folate is generally needed to overcome individual deficiencies. And it would appear that a great many people need to overcome deficiencies.

Side effects

Folic acid is not generally associated with side effects. However, folic acid supplementation can interfere with the laboratory diagnosis of vitamin B12 deficiency, possibly allowing the deficiency to progress undetected to the point of irreversible nerve damage. Although vitamin B12 deficiency is uncommon, no one should supplement with 1,000 mcg or more of folic acid without consulting a nutritionally oriented doctor.

Vitamin B12 deficiencies often occur without anemia (even in people who don't take folic acid supplements). Some doctors do not know that the absence of anemia does not rule out a B12 deficiency. If this confusion delays diagnosis of a vitamin B12 deficiency, the patient could be injured, sometimes permanently. This problem is rare and should not happen with doctors knowledgeable in this area using correct testing procedures.

Folic acid is needed by the body to utilize vitamin B12. Proteolytic enzyme and antacids inhibit folic acid absorption.  People taking either of these are advised to supplement with folic acid.

Folic acid-containing supplements may interfere with methotrexate therapy in people with cancer. People using methotrexate for cancer treatment should ask their prescribing doctor before using any folic acid-containing supplements. Until recently, methotrexate was believed to help people with rheumatoid arthritis also by interfering with folic acid metabolism. However, recent research has shown that this is not so. In fact, people with rheumatoid arthritis taking methotrexate should supplement large amounts of folic acid. The same now appears to be true for people with severe psoriatic arthritis who are taking methotrexate. However, high levels of folic acid should not be taken without clinical supervision.

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