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Folic Acid

4 January 2021 | 8 mins read | Folic Acid

Folic acid’s peak headline time was in 1991, when taking folic acid (folate) before conception and during pregnancy was shown to prevent certain severe birth defects. You might already know how important taking folic acid is before pregnancy, but did you also know that everyone needs folate throughout their lifespan?

What Is Folic Acid?

Folic acid is a man-made form of vitamin B9, which is also known as “folate”. The terms folate, vitamin B9, and folic acid are sometimes used interchangeably.

Folate helps our bodies to make new cells or to replace the cells we lose every day. Everyone needs enough folate, but women who can become pregnant need extra folate.

Why Is Getting Enough Folate So Important For Women Who Can Become Pregnant?

A woman who is low in folate when she becomes pregnant has a higher chance of having a baby with severe, irreversible birth defects.

These birth defects, called neural tube defects (NTDs) develop early in pregnancy, before most women even know they are pregnant. It can take several weeks to increase blood folate levels to the level needed to prevent neural tube defects, which is too late in an already-existing pregnancy.

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Also, some studies have shown that folic acid may reduce the risk of having a child with autism spectrum disorder.

What Are Neural Tube Defects?

The neural tube helps to form the fetus’s skull, brain, and spinal cord. If the tube does not close properly, the baby is at risk of a neural tube defect. The two most common NTDs are called anencephaly and spina bifida.


Anencephaly is a condition in which only part of the brain develops. Anencephalic babies rarely survive for more than a few hours after birth.

Spina bifida

In one common form of spina bifida, a sac with part of the spinal cord protrudes through an opening in the baby’s back. Damage to the unprotected cord can result in:

  • lower limb numbness, difficulty walking, or paralysis
  • lack of bowel control
  • lack of bladder control
  • sexual dysfunction
  • orthopedic deformities
  • hydrocephalus – a buildup of fluid on the brain

The cord and nerves can be surgically put into place, but the physical disabilities are usually permanent. Complications can include developmental disabilities, seizures, and problems with breathing, sucking, or vision.

Do Men Need Folate? Do Children? What About Older People?

Everyone needs folate because it contributes to ongoing cell growth and development. When folate is low, a person can develop the following conditions:

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  • Megaloblastic anemia
  • Diarrhea, nausea or vomiting, or abdominal pain, particularly after eating
  • Cognitive impairment or dementia
  • Depression

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Conditions related to low folate usually improve when folate levels rise.

In addition to preventing NTDs and megaloblastic anemia, folate is believed to help in:

  • preventing hypertension-related stroke
  • treating depression
  • reducing blood arsenic levels.

How Can I Get Enough Folate?

There are three ways to get folate:

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1) Take a vitamin supplement labeled Folic Acid. All women who can become pregnant should take 400 mcg of supplemental folic acid per day. Folic acid capsules or tablets are available over the counter in most countries.

Women who take 400mcg of folic acid as a supplement can reduce their risk of having a child with a neural tube defect by as much as 72%.

Make sure to get the folic acid you need, especially amongst your other medications and supplements, by setting daily reminders. Apps like Halza help you keep to a routine when it comes to taking medication and supplements on time. Learn more here.

2) Eat foods naturally high in folate. Good sources of naturally occurring folate include:

  • raw leafy green vegetables
  • citrus fruits
  • nuts
  • legumes
  • cooked chicken liver or calf liver.

Cooking reduces the amount of folate in food. This makes it difficult for women to maintain a blood folate level sufficient to prevent NTDs through food alone.

3) When food shopping, look for packaging that says “fortified” or “enriched” with folic acid. At least 62 countries currently require certain foods – mainly wheat-based foods such as cereal, bread, and pasta – to be fortified with folic acid. Folic acid is used because it is less affected by heat than other forms of folate.

Countries that require manufacturers to add folic acid to food have reduced the number of cases of spina bifida by 30% -50%.

How Much Folate Do I Need?

The U.S. Centers for Disease Control (CDC) recommends that all adults get at least 400 mcg of folate per day. However, women who can become pregnant should take a supplement of 400 mcg of folic acid in addition to the folate they get from food. Pregnant and breastfeeding women need at least 600 mcg per day to meet their own needs as well as the needs of their growing fetus or infant.

A woman who has had a previous pregnancy involving a neural tube defect will be advised to take high doses of folic acid when planning subsequent pregnancies.

Do Some People Need More Folic Acid?

Health care practitioners might recommend that their patients take extra folic acid if they have a condition that leads to low levels of folic acid. These conditions include:

  • Impaired intestinal absorption, as in celiac disease, Crohn’s disease, inflammatory bowel disease, or prior stomach or intestinal surgery
  • Significant alcohol consumption.
  • Taking medicines that interfere with folic acid
  • Hemodialysis
  • Having a diet of unfortified foods
  • Older age
  • Cooking foods that are good sources of folate

As your healthcare practitioner has to take your medical history into consideration when recommending a suitable amount of folic acid, providing them with a comprehensive overview of your health is a great first step to getting the folic acid you need.

Health apps like Halza are great for easily logging your health conditions, tracking your medication intake, uploading medical reports and diagnoses, and more. You can then share all this information with your doctor whenever you need to, at your discretion. Find out more here.

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What Are the Optimal Blood Test Values For Folate?

Since optimal blood levels of folate depend on several factors, your doctor would be able to tell you if yours are within the optimal range.

However, doctors don’t routinely test folate levels, even in women who might become pregnant. It is more practical to recommend supplementation of 400 mcg per day than to frequently test every woman’s folate level.

Is It Dangerous to Have Too Much Folate?

The body eliminates extra folate in urine, so it is unlikely to be dangerous for most people. However, it is always good to check with your doctor before starting any supplement. There are some risks to taking folic acid, including:

  • Folic acid can reduce the effectiveness of some medications.
  • Supplemental folic acid can hide symptoms of a deficiency in vitamin B12.
  • High doses of folic acid may be associated with an increase in certain cancers, but so far studies are inconclusive.

Make sure your medical practitioner knows what other medication you are currently taking to prevent the folic acid from dulling their effectiveness. Having an overview of this information and sharing it with your doctor is just one way the Halza app helps you better manage your health. Learn about the other ways here.

If You Remember Only One Thing from Reading This…

Taking a 400mcg tablet or capsule of folic acid per day for at least a few weeks before you become pregnant is proven to greatly reduce the risk of giving birth to a child with anencephaly or spina bifida.

Please share this information with anyone you think might become pregnant, or who knows someone who might become pregnant. Remember to include boyfriends, husbands, parents, and grandparents!

Jill Garner
Jill GarnerRegistered Nurse and Diabetes Educator

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