B Vitamins -Folic acid (Vitamin B9)

B VITAMINS – FOLIC ACID (VITAMIN B9)

Folic Acid (Vitamin B-9): Folic acid is a B vitamin. Also known as vitamin B9, it occurs naturally as folate in foods. Folic acid is vital for cell growth and development. 

Folic acid is essential for everyone’s health. You need folic acid because: 

• it maintains a healthy nervous system,
• it works with vitamin B12 to form healthy red blood cells (RBC) which carry oxygen around the body
• it helps breakin down, use and create proteins.
• The nutrient is crucial during early pregnancy and need extra folic acid to reduce the risk of birth defects of the brain and spine.

Foods rich in Folic Acid (Vitamin B-9): Folate is readily available in many whole foods, such as:

• Leafy green vegetables such spinach, kale, broccoli, cabbage, and brussels sprouts,
• Beetroot
• Citrus fruits
• Liver (Liver should be avoided by pregnant women, due to the high levels of Vitamin A it contains & too much vitamin A can cause birth defects).
• Beans and legumes such as peas, pinto, cannellini, or garbanzo beans/chickpeas
• Peanuts and walnuts.
• Fortified foods: Cereal, rice, bread, pasta, flour and cornmeal.

Symptoms of Folic Acid (Vitamin B-9) deficiency: A folate deficiency can result from a diet low in fresh fruits and vegetables. Some health conditions like celiac disease and certain medications can also cause it. The common symptoms of folate deficiency can include:  

• Tiredness, fatigue and lethargy
• Muscle weakness
• Neurological signs, such as a feeling of pins and needles, tingling, or burning, or peripheral neuropathy, i.e. a numbness in the extremities
• Psychological problems, such as depression, confusion, memory problems, problems of judgement and understanding
• Gastrointestinal signs, such as nausea, vomiting, abdominal pain, weight loss and diarrhea
• Headache and dizziness
• Pallor
• Shortness of breath.

Headache, dizziness, pallor and shortness of breath are also symptoms of anemia. Anemia, particularly megaloblastic anemia, is often the first sign that there is an underlying folate deficiency.

Less common symptoms of folate deficiency are: 

• Fast heartbeat (tachycardia)
• Fast breathing (tachypnoea)
• Exfoliative dermatitis, a condition which makes the skin red and scaly
• Heart murmur
• Painful swallowing
• A sore tongue (glossitis) and mouth ulcers
• Petechiae
• Angular stomatitis (fissures in the corners of the mouth).
• In children with congenital malabsorption disorders, which are rare, neurological problems might also be present.

Causes for Folic Acid (Vitamin B-9) deficiency - Folate deficiency has a number of potential causes. Most healthy people absorb sufficient folate from their diets & thus avoid deficiency, but in some cases the body may increase demand, which, if supplementation doesn’t occur, may lead to deficiency. In other cases, the body may be unable to absorb enough folate, due to low intake or excessive excretion. Some of the causes for Folic Acid (Vitamin B-9) or Folate deficiency include: 

• Low dietary intake due to medically restricted diets such as those followed by people with phenylketonuria or due to fad diets concentrating on foods that do not contain enough folate. Infants who are fed unfortified goat’s milk will also experience folate deficiency, as folate is not naturally present in goat’s milk.
• Malabsorption, which can be due to age, liver problems or gastrointestinal problems causing chronic diarrhoea, such as sprue, celiac disease or inflammatory bowel disease. Other causes of malabsorption are pancreatitis, bariatric surgery and extensive surgery involving the large or small intestine. Malabsorption is also a risk for people who use drugs that interfere with the absorption of folate, such as proton-pump inhibitors, some anticonvulsants such as carbamezapine, phenytoin, valproic acid, and phenobarbitol. 
• Disorders such as leukaemia, carcinomas and lymphomas, which increase the body’s demand for folate and may consequently lead to deficiency if folic acid supplements aren’t taken.
• Age, which causes changes in the gastrointestinal systems of people more than 65 years of age. These may lead to reduced absorption and reduced dietary intake.
• Alcohol-related damage to the liver, which affects the way in which folate is stored in the liver and increases the amount of folate excreted in urine. People with alcohol dependence may also have a nutritionally insufficient diet.
• Pregnancy and lactation, which raise the body’s demand for folate considerably due to the growth of new tissue in both mother and fetus. Sufficient folic acid supplementation is crucial for pregnant women, as a deficiency may cause birth defects called neural tube defects in babies. Neural tube defects are serious as they affect the spinal cord or brain and they include  (a) Spina bifida is a condition that occurs when a baby’s spinal cord or brain don’t fully develop in the womb. Babies born with spina bifida may require surgery, and often have paralysis and other physical disabilities. (B) Anencephaly is a condition where a baby’s brain and skull don’t completely form in the womb. In most cases, babies with anencephaly are stillborn or die shortly after birth.
• Smoking or exposure to secondhand smoke. 
• Renal dialysis, which affects the amounts of homocysteine in the body and therefore increases the amount of folic acid needed.
• Overcooking your fruits and vegetables, when you overcook, the heat can destroy the naturally occurring folate in your produce.

Side effects of Folic Acid (Vitamin B-9): Oral use of folic acid can cause:

• Bad taste in your mouth
• Nausea
• Loss of appetite
• Confusion
• Irritability
• Sleep pattern disturbance

People with allergies might have a reaction to folic acid supplements. Warning signs of an allergic reaction include:

• Skin rash
• Itching
• Redness
• Difficulty breathing
• Excess folic acid is excreted in urine.

A high folate intake can mask vitamin B-12 deficiency until its neurological effects become irreversible. This can typically be remedied by taking a supplement containing 100 percent of the daily value of both folic acid and vitamin B-12.

Folic Acid (Vitamin B-9) Interactions: The possible drug interactions include:

Anticonvulsants - Taking folic acid with fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek) or primidone (Mysoline) might decrease the drug's concentration in your blood.

• Barbiturates - Taking folic acid with a drug that acts as a central nervous system depressant (barbiturate) might decrease the drug's effectiveness.
• Methotrexate (Trexall) - Taking folic acid with this medication used to treat cancer could interfere with its effectiveness.
• Pyrimethamine (Daraprim) - Taking folic acid with this antimalarial drug might reduce the effectiveness of the drug.

Quantum of Foic Acid (Vitamin B-9): Biotin is a water-soluble vitamin, which means that your body doesn’t store it. As a result, you need to consume it regularly to maintain adequate levels. In order to prevent its deficiency the recommended intakes of  vitamin B7 for:

• Birth to 6 months 65 mcg 
• Infants 7-12 months 80 mcg
• Children 1-3 years 150 mcg
• Children 4-8 years 200 mcg
• Children 9-13 years 300 mcg
• Teens 14-18 years 400 mcg
• Adults 19+ years 400 mcg
• Pregnant teens and adults 600 mcg
• Breastfeeding (chestfeeding) teens and adults 500 mcg.

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