Folic Acid and Anemia

Folic acid is a vitamin from group B that is essential for the synthesis of red blood cells, therefore, a dietary deficiency or a relative digestive-metabolic defect can cause anemia .

Folic acid

Folic acid, or rather folates, are water-soluble vitamins whose biologically active form is represented by tetrahydrofolic acid (THF).

Folic acid is found mainly in offal and in some foods of vegetable origin (of these, especially in beans, tomatoes and oranges). Some studies (carried out on different areas of the national territory) have highlighted the collective tendency to assume insufficient quantities of folic acid; this condition, which in itself is disadvantageous, is significantly aggravated in the elderly and especially in the male: a deficiency estimated at 12% in women and 20% in men.

Folic acid is thermolabile; it is absorbed in the intestinal portion of the jejunum and mainly in an active way (through a carrier) at pH 6, but also passively at a higher pH. The metabolic function of folic acid is to originate coenzymes useful for the transport of monocarbonous units in the metabolism of amino acids and in the synthesis of nucleic acids, biochemically interacting with cobalamin (vit. B12); in a nutshell, folic acid participates in the production of nucleic acids (DNA and RNA - the defect of which causes anemia), the transformation of homocysteine into methionine and the metabolism of other amino acids.

It follows that the reduction of the metabolic activity of folic acid can cause several imbalances, among which the most relevant is undoubtedly the reduction of DNA and RNA synthesis; due to the reduced ability to replace "old" or damaged cells with "new" cells, tissues that require more frequent turnover (cell turnover) are subjected to severe functional alterations. This condition has serious repercussions on the nervous tissue and in particular on the development of the spinal cord of the fetus (spina bifida) and on the cerebral degeneration of the elderly; furthermore, the reduced ability to synthesize nucleic acids significantly affects erythropoiesis by the bone marrow (the production of red blood cells), determining or aggravating anemia.

The recommended intake of folic acid is 200 µg / day, which is doubled for pregnant women (in order to prevent neural complications in the newborn). Some studies carried out on malnourished patients have shown a good collective tolerance even at doses that reach 5 mg / day, although with the risk of hiding the deficient manifestations of cobalamin insufficiency (vit. B12).

Folic acid deficiency anemia

Anemia is one of the reflex complications attributable to the reduced metabolic function of folic acid and / or cobalamin (vit. B12). Such a condition can occur for several reasons:

Food deficiency of folic acid : as anticipated, folic acid is contained both in offal and in foods of vegetable origin. It is true that it is a heat-sensitive vitamin, therefore, it can be deduced that its integrity is lost with cooking. Therefore, the contributions deriving from cooked offal or stewed legumes should not be considered fully, while the folate deriving from raw vegetables should be more intact; a final consideration should be made regarding the bioavailability of folic acid in foods. Some studies on the absorption capacity of folic acid have shown that VEGETABLE foods also contain chelating molecules that can hinder the uptake of these vitamins; for example, beans have a bioavailability of folates that reaches 80% while the orange only 20%. To guarantee the minimum level of folate and avoid the onset of anemia, it is advisable to consume RAW foods of vegetable origin daily.
Alteration of folic acid absorption : it is generally rare but frequent in patients subjected to surgical resections of one or more parts of the digestive tract, which often manifest anemia.
Use of drugs that hinder the metabolism of folic acid : some molecules such as methotrexate, barbiturates and contraceptives are responsible for the metabolic alteration involving folic acid. In the case of a similar drug therapy, the subject must take greater care of the nutritional intake of folates in order to prevent the onset of anemia.

Symptoms

Anemia caused by the ineffectiveness of folic acid is characterized by the production of non-mature, larger, more colorful and less efficient erythrocytes.

The characteristic symptoms of this anemia are overlapping and often concomitant with those of cobalamin deficiency; in addition to the generalized and typical exhaustion of all anemic forms, there is an involvement of the gastrointestinal system (presence of anti-mucosal antibodies) but above all of the nervous one, through the manifestation of numbness, absence of reflexes and lack of motor coordination.

Wanting to classify anemia from folic acid deficiency, one could define that:

while making an appropriate distinction of the etiological cause, it is a set of symptoms and clinical manifestations similar to pernicious and / or megaloblastic anemia. In fact, folic acid acts synergistically with cobalamin in the synthesis of nucleic acids and therefore the lack of one, of the other or of both, often favors the appearance of an almost similar clinical picture.