Vitamin Folic Acid

Current Smoker

See the link between Increased Lung Cancer Risk and this vitamin.

Vitiligo

Ulcerative Colitis

Please see the link between UC and Folic Acid Requirement.

Increased Risk of Stroke

A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13%, respectively, compared with those who consumed less than 136mcg of folic acid per day.

Atherosclerosis

For improved homocysteine metabolism, folic acid (800mcg per day), B6 (50mg per day), B12 (400mg per day), betaine (200 to 1,000mg per day are recommended.

Hydrochloric Acid Deficiency

In cases of low stomach acid (hypochlorhydria) or no stomach acid (achlorhydria), supplemental use of hydrochloric acid normalizes folate absorption.

Cigarette Smoke Damage

Histapenia (Histamine Low)

The rationale underlying this treatment is that folic acid in conjunction with vitamin B12 injections raises the blood histamine while lowering the degree of symptoms.

Histadelia (Histamine High)

Histadelics should avoid supplemental folic acid as it can produce excess histamine. In fact, anti-folate drugs may be required. Folic acid increases depression in histadelic patients and a trial of folic acid could be used to distinguish between histapenics and histadelics. In extreme cases, folic acid in food or in multivitamins is enough to produce the adverse effects.

Elevated Homocysteine Levels

An analysis of 92 studies concluded that higher serum homocysteine concentrations are associated with an increased risk of cardiovascular disease and that daily supplementation with folic acid (800mcg per day) may reduce serum homocysteine levels adequately to reduce the risk of ischemic heart disease, deep vein thrombosis, and stroke. [BMJ 2002;325(7374): pp.1202-6]

A Netherlands study concluded that those people with a genetically reduced capacity to process homocysteine were only at increased risk for heart disease when their folic acid levels were low.

Tendency Toward Postpartum Depression

When postpartum depression occurs with megaloblastic anemia, the depression many times responds extremely well to folate supplementation.

Methylation, Excess

Metabolic Diet Type (Extreme Negative)

Blood Type A

Blood Type AB

Methylation, Insufficient

Restless Leg Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD)

Folic acid at 5-50mg per day (a very large dose) may be helpful when the condition runs in the family; otherwise, it may only help the occasional person. RLS may be an early neurologic manifestation of folate deficiency, the most common of all the vitamin deficiencies. Often the deficiency is not due to a poor diet, but to a genetic factor causing a folate dependency. While not all RLS patients complain of uncomfortable sensations, folate-deficient patients always suffer from them. [Folic Acid in Neurology, Psychiatry and Internal Medicine, New York, Raven Press, 1979]

Folic Acid Requirement

Kidney Failure

Patients with chronic renal failure have homocysteine levels that are significantly elevated at an early stage. Taking 5mg of folic acid daily can significantly lower these homocysteine levels. [Hyperhomocysteinemia: A Role in The Accelerated Atherogenesis of Chronic Renal Failure?, Netherlands Journal of Medicine, 1995;46: pp.244-251]

Hepatitis

Increased Risk of Alzheimer's / Dementia

There is growing evidence suggesting that low blood folate levels can increase the risk of getting Alzheimer’s.

In an ongoing study searching for new clues to the aging process, researchers took blood samples of nuns between the ages of 78-101years old living in a convent in Mankato, Minnesota. After 30 of the nuns died, researchers examined their brains for signs of atrophy and compared the results with previous blood nutrient levels.

In brain samples showing numerous Alzheimer’s disease brain lesions, researchers found that significantly lower blood levels of folate corresponded with more severe atrophy of the neocortex, the region of the brain containing a rich supply of nerve cells.

Although the study was small, and did not attempt to prove a causal effect, it supports previous evidence linking defects in B-vitamin metabolism with age-related dementia and Alzheimer’s. “Optimal folate concentration may in fact be higher in old age or when diseases such as Alzheimer’s are present,” commented the researchers.

Low folate levels can trigger a build-up of the amino acid homocysteine, which has been linked to higher risk of Alzheimer’s and accelerated atrophy of the medial temporal lobe in Alzheimer’s patients.

“There seems little doubt now that there is an association between the evolution of certain brain diseases associated with cognitive decline in the elderly and vitamin deficiencies associated with hyperhomocysteinemia,” a related editorial resounded.

Although the full extent to which B-vitamin metabolism influences the actual causal mechanisms of dementia is still not clear, “the potential therapeutic options [implicated by these discoveries] are exciting”, the authors posited.

The nuns provided a unique population sample to study because they all had similar long-term diet and exercise habits. Researchers found strong evidence of biochemical individuality among the group, despite their similar lifestyle and eating habits. Blood nutrient levels varied widely, reflecting differences in “drug-nutrient and disease-nutrient interactions or differences in the intake, absorption, and metabolism of the nutrients.”

NOTE: As this study suggests, even people with similar diets may show striking differences in nutrient metabolism related to various physiological functions. Assessing each patient is the best way to gauge the effectiveness of nutrient intervention strategies.

Sources:

Snowdon DA, Tully CL, Smith CD, Riley KP, Markesbery WR. Serum folate and the severity of the atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr 2000;71: pp.993-8.

Weir DG, Molloy AM. Microvascular disease and dementia in the elderly: are they related to hyperhomocysteinemia? Am J Clin Nutr 2000;71: pp.859-60.

Increased Risk of Colon Cancer

Long-term use of a multivitamin containing 400mcg of folic acid, found mostly in leafy green vegetables, beans and nuts, may reduce the risk of colon cancer in women by as much as 75%. The investigators in one study found that folic acid obtained from dietary supplements had a stronger protective effect against colon cancer than folic acid consumed in the diet. In other words, although foods naturally high in folate may provide other beneficial micronutrients, consumption of these foods is probably less effective than use of supplements and fortified foods in enhancing folate status. [Annals of Internal Medicine October 1, 1998;129: pp.517-524] [Int J Canc 2002;Vol. 97; pp.864-867]

In studies, a higher folic acid intake needed to occur for many years (15) in order to produce this anticancer effect. Perhaps supplementation with higher doses would produce protective benefits in a shorter period of time.

Increased Risk of Lung Cancer

Folic Acid and vitamin B12 work together in the body to help cells replicate normally. In a double-blind trial, smokers with precancerous changes in the lungs were given a placebo or the combination of 10,000 mcg of folic acid and 500 mcg of vitamin B12 per day for four months. A significant reversal of precancerous changes occurred in those given vitamin supplements compared with those given the placebo. [JAMA 1988;259: pp.1525-30]

Increased Risk of Hypertension

Researchers have discovered that women (especially young women) who consume 800mcg or more of folic acid daily reduced their risk of hypertension by 33% over those consuming less than 200mcg of folic acid per day. The study included more than 150,000 women between ages 26 and 70 and although younger women showed the most dramatic benefits, subject women in the highest age brackets also enjoyed a 13% reduction in hypertension risk from consuming adequate

amounts of folate. The study did not examine whether men would be helped or not. [American Heart Association. News release, October 2004]

Cancer / Risk - General Measures

Increased Risk of Coronary Disease / Heart Attack

A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13%, respectively, compared with those who consumed less than 136mcg of folic acid per day.

Folic acid (1mg per day), along with vitamin B6 (10mg per day), and vitamin B12 (400mcg per day) reduced the incidence of restenosis and major adverse events in a study of over 500 patients who underwent successful angioplasty. [JAMA 2002;288(8): pp.973-979]

Increased Risk of Breast Cancer

Psoriasis

A small study demonstrated that 20mg folic acid given 4 times a day over a 3-6 month course produced marked improvements in patients with long standing psoriasis. Two additional patients experienced worsening of the condition with folic acid use, but they had at some time in the past been treated with methotrexate. Previous methotrexate exposure may make some, but not all, cases of psoriasis worse when being treated with high doses of folic acid. [Cutis 1977;20: pp.39-41]

Colon Polyps

Supplementation with folic acid (2000mcg per day) reduced colonic mucosal cell proliferation in a placebo-controlled study of 11 patients with recurrent adenomatous colon polyps. Supplementation continued for a period of 3 months in this trial.[Gut 2002;51(2): pp.195-199]

Possible Pregnancy-Related Issues

In 1992, the U.S. Public Health Service recommended that all women of childbearing age consume additional folic acid. This means that increased consumption of folic acid is crucial not only during pregnancy, but also before conception. Women should take at least 400mcg of folic acid daily. It has been estimated that if all women of childbearing age met this allowance, the number of neural tube defect cases in the United States could decrease by at least 50%. [CDC. Morbidity and Mortality Weekly Report, 1992; 41(RR-14)]

Although foods such as dark-green leafy vegetables provide a reasonable source of folic acid, most women don’t reach the recommended 400mcg through diet alone. [Johnston RB, Staples DA. 1997. J Am Med Assoc 1997;278 (11): pp.892­93]

Neural tube defects: (spina bifida): In one study, women who consumed 400mcg of folic acid per day cut in half their chances of having babies with birth defects of the brain and spinal cord, such as spina bifida. Whether a baby develops these defects is determined in the first days after conception (the critical time may be day 27-28) – perhaps before a woman knows she is pregnant. Even with food fortification it can be hard to get enough, so health experts recommend that every woman of childbearing age take a daily dietary supplement, such as a multivitamin, containing 400mcg of folic acid.

In another study, one-half of women who had delivered children with spina bifida or anencephaly were found to have had a poor diet during the pregnancy which ended with a child with a neural tube defect. 103 of these women received dietary counseling prior to their next pregnancy while 71 controls received no counseling. Of those who improved their diet, all delivered normal children, while all 8 out of 186 newborns with NTD were born to women who ate a poor diet during their first 6 months of pregnancy [Laurence KM. Nutr Health 2( 3/ 4), 1983].

Scientists currently theorize that women who give birth to babies with neural tube defects are less able to convert homocysteine to methionine, and that high levels of homocysteine may cause birth defects. Folic acid, along with vitamin B12, is required for this biochemical conversion, as well as new tissue production and growth in both baby and mother.

Downs: Mothers with a genetic abnormality that hinders how the body processes folic acid were 2.6 times more likely to have a child with Down syndrome than mothers without that genetic defect. Millions of women appear to have this genetic abnormality, yet the risk of having a child with Down syndrome actually is small – one in 600 births. If you have this mutation and you happen to have a very poor diet, it magnifies the problem; the researchers call this a gene-nutrient interaction. The March of Dimes estimates there are 250,000 Americans with Down syndrome. (American Journal of Clinical Nutrition October 1999)

Cleft palate: Only high pharmacological doses (6mg per day) of folic acid in the critical period of the primary and the secondary palate development seem to be effective for the reduction of clefts. Doses less than 1mg of folic acid cannot reduce these birth defects.

Case Report: After giving birth, a woman developed severe depression, confusion, disorientation and hallucinations. Over the next 19 months, trials with numerous medications and electroshock therapy were unsuccessful. Folic acid deficiency was diagnosed and folate supplementation was started. In 10 days, she was completely cured.

Leukemia

Folic acid supplementation during pregnancy was associated with a reduced risk of acute lymphoblastic leukemia in children in Western Australia. Lancet 2001;358(9297): pp.1935-40 [Lancet 2001;358(9297): pp.1935-40]

Cervical Dysplasia

Folic Acid in high doses of 10 to 50mg per day have been used successfully to return Pap smears to normal. Folic acid supplementation has resulted in improvement or normalization of cytological smears in patients with cervical dysplasia in placebo-controlled and clinical studies. As folic acid is the most common vitamin deficiency in the world, and quite common in women who are pregnant or taking oral contraceptives, it is probable that many abnormal cytological smears reflect folate deficiency rather than “true” dysplasia. This is particularly applicable to cases in which patients are taking oral contraceptives.

Eclampsia / Preeclampsia

Supplementation with folic acid during pregnancy has been associated with a reduced risk of gestational hypertension in a study of 2,100 women in the United States and Canada. [Am J Epidemiol 2002;156(9): pp.806-12]