What is folic acid?
An essential vitamin for our cell growth
Folic acid, which is also known as vitamin B9, is essential for the growth of our cells. It plays a role in the synthesis of the components of DNA.
It has an important role in cell renewal, in the production of red blood cells, and it contributes to the synthesis of neurotransmitters, chemical messengers ensuring the transmission of nerve information.
Frequent deficiencies
A folic acid deficiency is observed in cases of insufficient intake, caused by poor intestinal absorption (IBD: inflammatory bowel diseases, celiac disease…), or if the needs are increased (pregnant woman, alcoholism).
In these cases, even a balanced diet does not correct the deficiency.
An inherited malabsorption, a rare genetic disorder affecting folic acid transport, can also be found.
What are its benefits?
A vitamin essential during pregnancy
Folic acid is now systematically prescribed by doctors starting pre-conception, as it is essential for the formation of the fetus.
When the central nervous system of the embryo is forming, folic acid must be present in sufficient amounts as it contributes to the proper closure of the neural tube (the structure of the future spinal cord), as noted in this article.
An anomaly of this tube can lead to a severe disability at birth.
This analysis highlights that a folic acid deficiency during pregnancy can also increase the risk of fetal growth retardation, premature birth, and neonatal mortality related to neural tube defects.
An antioxidant action
Folic acid, or vitamin B9, is part of the family of vitamins known as ‘folates’. They are essential for the synthesis, repair, and proper functioning of genetic material.
It helps prevent the increase of an oxidant molecule called homocysteine, capable of damaging DNA.
This amino acid is a true factor of aging of our body : in case of vitamin B9 deficiency, there is an accumulation of homocysteine in the blood.
The risk of aging of our body accelerates, as does the risk of degenerative diseases.
Thus, a clinical trial with 450 participants concluded that taking folic acid for 8 weeks is beneficial for protecting the body against oxidative DNA damage.
An action on the nervous system
The level of vitamin B9 in the brain is particularly high.
The role of this vitamin on the nervous system is not yet fully defined, but its action on amino acid metabolism and on DNA synthesis is certainly essential.
Numerous studies have observed an association between folate deficiency and the occurrence of neurological diseases: dementia, schizophrenia-type syndrome, insomnia, irritability, forgetfulness, depression…
A trial with 46 patients suffering from severe depression revealed that half of them (52%) showed a significant reduction in folic acid.
Another trial involving 127 patients on antidepressant treatment was conducted: they were given either a placebo (with no therapeutic effect) or 500 mg of folic acid in addition to their treatment.
The antidepressant action of the medication was enhanced by the intake of folic acid, with a significant improvement in depressive symptoms.
Furthermore, a review of studies reveals that a low level of folic acid is a risk factor for dementia and may increase the risk of Alzheimer’s. A recent analysis indicates that sufficient intake is a protective factor.
Finally, this study indicates that long-term supplementation seems to improve cognitive function in healthy elderly individuals.
A contradictory action on cancer
Numerous studies are underway on a possible link between folic acid and the development of cancer. Indeed, it may increase the risk of developing certain cancers while decreasing the risk of others.
A higher folate level would significantly reduce the risk of lung cancer, as shown in this study, and seems to protect against pancreatic cancer (only in women).
Some studies, but not all, indicate that folic acid supplementation protects against the development of colorectal cancer.
This comprehensive analysis reports that folate intake may be associated with a reduced risk of colon cancer, although there is evidence of a possible increase in tumor growth with supplementation, most often at doses higher than physiological doses.
Since current study results are not unanimous, I recommend adhering to the nutritional reference values in case of supplementation and the duration of intake, after consulting with an informed healthcare professional.
What are the food sources of folic acid?
Brewer’s yeast is the most concentrated food source of vitamin B9.
It is then found in leafy vegetables (watercress, lamb’s lettuce, spinach, white cabbage, Swiss chard) and green (broccoli, zucchini, green beans, peas).
It can also be found in red fruits (cherry, strawberry, raspberries), in legumes (chickpeas, red and white beans, lentils), and in red meat. Offal (such as liver) is particularly rich in it.
However, up to 70% of folates can be lost during cooking.
A diet rich in folic acid is particularly important before conception and throughout pregnancy.
In what form?
In capsules
It is indeed the folic acid molecule found in dietary supplements, as natural food folates are unstable during manufacturing.
The capsules contain a powder form.
Manufacturing is easy, so the cost is reasonable, and the dosage is precise. Another advantage is the ease of transport.
The taste is masked, but not completely the odors. Depending on the capsule size, swallowing the hard capsule can be difficult, and I recommend drinking a large glass of water to aid swallowing.
In soft gels
The so-called “soft” capsules contain liquid or pasty forms, mainly vegetable oils.
They have many advantages: the dosing is precise, the unpleasant taste can be hidden.
These forms often contain several active ingredients. In addition, the capsule is quickly opened in the digestive tract, thus improving absorption.
However, they have disadvantages related to storage: the capsules are more sensitive to heat and moisture.
In tablets
Tablets are the cheapest form. Easier to swallow than capsules, they are generally well dosed.
They have superior conservation and are less fragile.
What are the criteria to consider?
1. Different forms of folic acid
Folic acid does not exist naturally: the folates present in our body exist in different forms, including the methyl-tetrahydrofolates, or methylTHF.
Indeed, a portion of the folates is assimilated through food and undergoes a molecular modification (called methylation) in the intestine before being transformed into methylTHF and folic acid.
You will find on the market dietary supplements with products based on folic acid or methylTHF.
Part of the population poorly assimilates it: the liver can only metabolize a certain amount of folic acid.
And the unused portion can remain in the blood and could increase the risk of cancers with long-term intake.
Moreover, the liver enzyme involved can undergo a genetic modification disrupting this conversion into methylTHF.
In people with this mutation, folic acid supplementation can be ineffective!
Therefore, I particularly recommend choosing a product containing a methyl form of vitamin B9 if you want to boost your folate intake.
Nevertheless, it remains a widely used form of supplement, stable, and more affordable in terms of cost.
2. The origin
Folic acid is not a “true” vitamin B9, because this form is not natural. Its health effects do not replace those of natural vitamin B9, but it remains a good supplement.
Although methylTHF exists in a natural form, the products offered in dietary supplements are no more natural than folic acid, as they are made by chemical synthesis.
Thus, there is no naturally occurring folic acid in dietary supplements.
3. Bioavailability
Folic acid is more stable than the methylTHF form.
To stabilize this latter form, and thus achieve optimal absorption, some laboratories combine the active ingredient with glucosamine.
This natural molecule is present in various tissues of the human body, and is used in its salt form.
This combination allows for the protection, transport, and absorption of folate to its site of action.
4. Folic acid dosage
The recommended daily intake of folates is 300 micrograms for women, and 330 micrograms for men.
The recommended intakes are also set on a case-by-case basis, to prevent cardiovascular and cancer risks (especially colon cancer), and the risks of deficiencies during pregnancy.
During supplementation, in cases of anemia, the doctor usually prescribes between 5 and 15 mg per day depending on the situations.
For women wishing to conceive, the recommendations are 400 micrograms of folic acid per day, one month before conception, and up to three months after it.
A supplementation is systematically provided by the doctor or gynecologist.
For women with a history of pregnancies with neural tube defects (history of spina bifida), in cases of diabetes or epilepsy treatment, the doctor prescribes a dose of 5 milligrams per day.
Is there a danger in taking folic acid?
Folic acid supplementation is particularly recommended during pregnancy, where the needs double.
Folic acid can interact with certain medications, particularly with antiepileptics.
Folates also interfere with Methotrexate, a medication used in chemotherapy and in cases of inflammatory diseases (psoriasis, severe dermatitis, rheumatoid arthritis, etc).
The intake of folates opposes the action of the medication.
Finally, a supplementation can mask the symptoms of a vitamin B12 deficiency, which can eventually lead to neurological damage.
It is essential not to supplement long-term without the advice of your pharmacist or doctor.
In summary
To ensure you choose quality folic acid, check:
- The form: choose a supplement based on methyl;
- The origin: there is no natural form found in dietary supplements;
- Bioavailability: combined with glucosamine, methyl is better assimilated by the body ;
- The dosage: for women wishing to conceive, the recommendations are 400 micrograms of folic acid per day, one month before conception, and up to three months after it.
