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Overview of folic acid and healthWhat is folic acid? Folic acid, or folate as it is also known, is the B vitamin that helps build healthy cells. Because it is water soluble, it is quickly flushed from the body, which is why it should be taken every day. Also cooking and prolonged storage will deplete foods of folic acid. In addition, some medications may affect the absorption of folic acid. Folic acid comes in two forms: . A natural form - available in foods such as green leafy vegetables, nuts, beans, citrus fruits, beans, meats, orange juice, brewer's yeast (folate). . A synthetic form - found in fortified breakfast cereals, fortified bread and supplements (folic acid). Research has shown that natural folates are less easily absorbed by the body than the synthetic form.6 Folic acid and pregnancy Folic acid is a vital nutrient throughout life, but is particularly important during periods of growth, especially during pregnancy and lactation (breast feeding) as the body's requirement for folic acid doubles. One of the first parts of the baby's body to develop is the central nervous system. The neural tube, from which the spinal cord and brain develop, is formed within the first 28 days of pregnancy. Research has shown that if taken in the correct dose before pregnancy, folic acid can decrease the risk of neural tube defects (NTDs), which are birth defects of the baby's brain (anencephaly and encephalocele) or spine (spina bifida) by up to 50 per cent.4,5 Anencephaly is the incomplete development and exposure of brain matter due to a failure in the formation of the skull vault. These babies are stillborn or die soon after birth. Spina bifida occurs when there is a fault in the spinal column. These babies need to have surgery soon after their birth to repair the fault and prevent further damage. They also may need a shunt or a drain to prevent a build-up of spinal fluid in the brain called hydrocephalus, which occurs in 80 per cent of babies with spina bifida but can also occur independently. Babies with spina bifida may lack feeling in their legs and later develop problems with walking. In addition, these children may develop problems with their bowel and bladder control. They may also have learning and developmental problems. The causes of neural tube defects The causes are not yet fully understood but are associated with both genetic and envi ronmental factors. Women considered to be at higher risk of having a neural tube defect pregnancy include those who have had a previously affected pregnancy, those who have an NTD themselves and those who have a family history of NTD or whose partner has a family history of NTD. Folic acid and other health problems Mounting evidence suggests that folic acid reduces raised levels of homocysteine [a naturally occurring amino acid that when present in raised amounts can cause damage to blood vessels] and helps prevent the build up of atherosclerosis that can cause heart disease and stroke. High homocysteine levels are also thought to affect brain function, digestive processes and bone strength. Research has also suggested that folic acid reduces the risk of Alzheimer's disease, and colon cancer. Research has also shown that taking a daily supplement of folic acid could also protect against the detrimental effects of a high alcohol intake.7 The recommended daily allowance of folic acid Folic acid is the only vitamin supplement that the Department of Health has recommended that people take. Current advice is that all women of child-bearing age should take a 0.4mg daily supplement. Current advice for women who have already had an NTD baby is a prescription dose of 5mg of folic acid (over ten times as much as those without history of an NTD baby). In addition to taking a supplement, a healthy diet and foods rich in folic acid should be eaten. Note: even with a healthy diet, including five portions of fruit and vegetables daily, people are often only obtaining 0.15-0.2mg of folic acid.1,2 In addition, folic acid is easily depleted by factors such as pollution, excessive alcohol, smoking and processed foods. Folic acid has no known toxic level. However, evidence suggests that there is one group of the population for whom a very high intake of folic acid carries a theoretical risk of depressing the symptoms of a rare condition known as pernicious anaemia, a deficiency in vitamin B12. Elderly people severely deficient in vitamin B12 can develop pernicious anaemia, so medical practitioners need to be vigilant. A person taking medication should consult with their GP or pharmacist to ensure that the combination is safe. Some medications, such as the contraceptive pill, can reduce the levels of folic acid. In addition, folic acid may interact with the effectiveness of some medications. How long should pregnant women take folic acid? The Department of Health recommends that women take folic acid from the time they stop using contraception until the end of the 12th week of pregnancy. However, the most critical window is the three months prior to conception and the first six weeks of pregnancy for reducing the risk of NTDs in the unborn child. Since neural tube defects occur early in pregnancy, often before a woman knows that she is pregnant, it is important to take folic acid every day. Who else is at greater risk of having low folic acid levels? Poor lifestyle may cause people to have lower levels of folic acid
in their bodies. It has been found that people in the following
categories have decreased amounts of folic acid and need to remember
to take a folic acid supplement every day: The financial costs of NTDs The average total lifetime cost to society for each infant born with spina bifida has been estimated to be $532,000 in the USA. There are currently no figures available for the UK.
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