See also: excess folic acid - folic acid - quiz about folic acid - folic acid in pregnancy
The lack of folic acid - micronutrient also known as vitamin B9 or folacin - is a condition that is still quite widespread, especially in some areas of the globe.
The inability of the body to synthesize this vitamin justifies the extreme importance of an adequate dietary intake.
The body's folic acid reserves amount to about 12-15 mg, crammed above all in the liver and sufficient only to compensate for a few weeks of missed food intake.
Health risks
Folic acid, as well as vitamin B12, is essential for adequate cell proliferation and maturation; therefore, the lack of this nutrient has repercussions in the first place on tissues with a high degree of proliferation, such as the bone marrow and those of the embryo-fetus. This explains the origin of the two most famous and widespread consequences of folic acid deficiency, represented by macrocytic anemia - megaloblastic and spina bifida in the unborn child.
Deficiency Anemia of Folic Acid
In macrocytic anemia - megaloblastic red blood cells become excessively large, assuming an abnormal shape and very short life. Consequently, the subject lacking folic acid complains of weakness and easy fatigue, both physical and mental (insomnia, irritability and difficulty concentrating).
Neurological suffering is also due to the essentiality of folates in the synthesis of certain neurotransmitters, such as glutamic acid (an excitatory amino acid released in the central nervous system).
Spina Bifida
If a pregnant woman does not take adequate amounts of folic acid, irreversible damage to the fetus can result, with an increased risk of neural tube defects (an embryonic structure from which the central nervous system originates), the most common of which is precisely the spina bifida. The fetus, in turn, removes from the mother a large part of the folic acid, which justifies the integration since the pregnancy is still sought until its conclusion. They are in fact the first stages of development of the embryo-fetus to have the most intense proliferation rate. In a child with spina bifida the spinal cord is not well enclosed between the vertebrae and can be damaged to the point of causing paralysis of the legs.
Homocysteine and Cardiovascular Risk
A folic acid deficiency elevates the subject's cardiovascular risk, increasing the levels of circulating homocysteine, which in turn increases the chances of suffering from cardio-vascular diseases. This condition is common in people who oppose an excessive intake of protein foods (dairy products, meat, legumes, eggs) to a low consumption of fresh vegetables.
Other Possible Disorders
Serious deficiencies of folic acid have also been linked to depression, lesions of the skin and mucous membranes, growth and ossification disorders, increased susceptibility to infections, infertility (both male and female), mental delays and atrophy of the lymphatic organs.
Folic Acid in the Diet
Recommended daily contribution
The recommended daily intake of folate is 200-300 µg in the adult, 400 µg in pregnancy and 350 µg in breastfeeding.
It is estimated that a balanced diet provides daily between 100 and 300 µg of folic acid a day.
Foods rich in folic acid
The vegetables are particularly rich in this vitamin - especially those with green leaves (cabbage, spinach, watercress, etc.) - fruit, whole grains, legumes, liver and brewer's yeast.
Normally about 40-60% of food-borne folic acid is absorbed, while that taken as a supplement or pharmaceutical product is absorbed for about 80%.
Vitamin B9 is also synthesized by the intestinal bacterial flora.
Leak with cooking
Losses with cooking vary from 50 to 95% (unfortunately, the most generous food sources, such as cauliflower, Brussels sprouts and spinach, are those that are used to cook longer).
The high temperatures, the prolonged soaking and the annealing / heating of already cooked vegetables almost cancel the patrimony of folic acid of the fresh food.
Subject to Risk Deficiency
At our latitudes, in industrialized countries, folic acid deficiencies of food origin are quite rare and mostly concern the elderly who follow monothematic and repetitive diets, particularly poor in fresh fruit and vegetables, for example due to loss of appetite, social problems, difficulty in chewing etc..
The excessive cooking of food, the intensive use of food warmers (a typical problem of meals in canteens) and the intake of folic acid antagonists (in particular some antibiotics and chemotherapy drugs), are further predisposing factors for folate deficiency. Even prolonged exposure to light impoverishes the folic acid content of foods.
Folic acid deficiencies are more common among alcoholics and drug addicts ; smoking also has a negative effect. They are also typical of malabsorption syndromes, where the capacity of the intestine to absorb nutrients is limited by various diseases and conditions, such as celiac disease (celiac disease), intestinal infections, pancreatic diseases, Crohn's disease and surgical resections of the intestine.
The deficiency is frequent also in poor tropical and sub-tropical countries (where it is often associated with other nutritional deficits) and in those in the far north, where the supply of fresh vegetables is limited for most of the year.
Supplements: When are they needed?
Folic acid supplements are only indicated in deficiency states, as in healthy adults following a balanced diet there are no deficiency problems.
Women in pregnancy and lactation deserve a separate discussion, in which the integration with folic acid is prescribed by the doctor and must take place under his control and according to the indications given.
To learn more, read: folic acid in pregnancy.
Folic acid supplements find justification in low-calorie diets, in etilitsti or malnourished elderly, in alcoholics and in patients with malabsorption. They can also be prescribed in high-level sportsmen in order to solve anemia problems.
In some supplements or pharmaceuticals, folic acid is combined with iron, as the association between the two types of deficiency, possibly ascorbic acid and vitamin B12, is not rare (with the aim of providing the body with the micronutrients needed for optimal synthesis of red blood cells).
The doses of intake normally recommended for folic acid supplements are equal to 400mcg per day.
