Folic Acid Deficiency

Folic acid, an essential micro-nutrient, can be derived from food resources. Dried yeast, liver, and wheat germ are the rich sources. Whole cereals, legumes, green leafy vegetables are good sources, while milled cereals, other vegetables, milk, & fruits are fair sources.

It is required for synthesis of nucleic acids, & formation of the heam component of hemoglobin in red blood cells. It is readily absorbed from the small intestines through the portal vein, & passed on to tissues through the general circulation. However, its excess intake is not stored in the tissues. It is water soluble B vitamin, & regularly excreted through the urine. Daily recommended enteral intake in normal adults is 400 micrograms.

To assess the deficiency at an early stage is very difficult, because it takes months to manifest its clinical signs & symptoms. Megaloblastic anemia, glossitis, & diarrhea are the major consequences. The attributed causes for deficiency are, such as, decreased intake often associated with alcoholism, malabsorption, & increased utilization in cases of, hemolytic anemia, pregnancy. In addition, some anticonvulsant & oral contraceptive drugs may lead to perturbed folate metabolism.

Megaloblastic anemia is an irreversible disease condition, which can be treated with supplements of folic acid & vitamin B12. However, folic acid deficiency during pregnancy invokes neural tube defects resulting in malformation of the spine (spina bifida), skull, & brain (anencephaly) of the fetus. Therefore, antenatal regime involving supplements of folic acid & vitamin B12 is highly recommended.

Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, niacin, & resolves with the correction of the underlying condition.

Diarrhea occurs due to infections, or rather of celiac disease can be treated with medication, nutritional diets, & electrolyte therapy.

Deficiency of folic acid can be diagnosed by analyzing serum folate & red blood cells (RBC) folate levels. A serum folate of 3 microgram/L, or lower indicates deficiency. Serum folate level reflects folate status, but RBC folate level reflects better.

Recent studies reveal the significance of folic acid supplements in cases of dementia, malignancy, heart disease, pregnancy & during menopause. Folate, a naturally occurring B vitamin is needed in the brain for the synthesis of nor epinephrine, serotonin, & dopamine. Its supplements help to improve cognitive function & reducing depressive symptoms in elderly patients with dementia & folate deficiency. Localized folate deficiencies of the skin are likely consequences of ultraviolet exposure, which permutes a permissive environment for genomic instability, an early event in the process of skin carcinogenesis. The effects of folate restriction even in severely depleted growth arrested keratinomytes were reversible by repletion with folic acid. The supplements may improve the integrity of the vascular endothelium, & therefore its consumption before & during pregnancy may reduce the risk of heart defects in infants. Clinical evidence suggests the benefits of supplements in pregnant women can avoid spontaneous abortion, & pregnancy complications, such as placental abruption & preeclampsia. It help relieve hot flushes in postmenopausal women. Just like estrogen hormone replacement therapy, folic acid interacts with neurotransmitters (nor-epinephrine, serotonin) in the brain to reduce hot flushes.