Folic acid also known as B9 vitamin or pteroyl glutamic acid, is involved in DNA and RNA synthesis which is the genetic material of the cell. Protein synthesis and RBC production are the shared functions of folic acid with B12. B9 is a water soluble, heat resistant vitamin but is destroyed when heated above 100oC. Folate is essential for the development of nervous system of human embryo. It is absorbed as folic acid and converted to folate in the body. Folate is needed for the efficient functioning of a human being. When blood falls short of the amount required, fatigue and anemia are the very fist symptoms to develop.
Most natural foods contain enough vitamin that supplementation is not required. However diets low in fresh fruits and vegetables can spring up deficiency symptoms in just a few weeks. Also in case of increased demand such as pregnancy, deficit symptoms may appear if supplements are not given. Women on oral contraceptives also rely on supplementation as folate is necessary for the efficacy of contraceptives.
SYMPTOMS OF FOLIC ACID DEFIECIENCY:
1. Megaloblastic Anemia:
Pale appearance, dyspnea (shortness of breath) and headache are the first signs to appear as a result of anemia particularly megaloblastic anemia. This is a type of macrocytic anemia due to hypovitaminosis pertaining to both the folate and cobalamin inadequacy. Anemia may also occur due to inherited insufficiency of folic acid reductase. It is the enzyme required for the formation of tetrahydrofolate, the active coenzyme form of B9 generated in the intestinal mucosal cells during absorption.
2. Neurological Symptoms:
Folate, by the synthesis of neurotransmitters such as epinephrine and acetylcholine provides the muscle control of the body. Thus, body functions such as attention, focus, metabolism, memory and learning are all dependent upon folate availability. Lack of B9 leads to symptoms like confusion, cognitive impairment, psychosis, depression and peripheral sensory deficits. Paresthesia – the burning and tingling sensation in hands and feet is also a manifestation.
3. Oral Symptoms:
Folic acid shortfall has been linked to chromosome breakage which brings about certain cancers. Mouth ulcers is one of these along with glossitis. The tongue become inflamed, red and beefy. Besides, the papillae on tongue surface are lost and it becomes unusually smooth. This smoothness reduces the sense of taste. Supplementation relieves the symptoms and enhances mouth’s ability to fight off infections.
4. Fatigue and Lethargy
Anemia is the very first sign to appear in case of folic acid shortfall. The consequences following anemia are dizziness, low energy, lethargy, tachycardia etc. Muscles become weak as indirect muscle control by folic acid through neurotransmitters is defective due to deficiency.
5. Gastrointestinal Symptoms
As DNA synthesis become defective subject to lack of folate, the cell division is arrested. in this case, the cells of intestinal mucosa are severely affected. The outcome of affected G.I tract is diarrhea, vomiting, abdominal pain and weight loss.
Diagnostic Test Of Folic Acid Deficiency:
- SERUM MEASUREMENT: Normally 20ng/ml to 200µg/ml measured by radio-immuno assay.
- FIGLU TEST: Formimino grp is normally removed from formimino glutamic acid (FIGLU) by tetrahydrofolate. FIGLU is excreted in urine in case of folate shortage. Measurement of the amount excreted is indicative of diagnosis.
- PERIPHERAL BLOOD PICTURE: The most valuable clue of deficiency is by blood picture indicating macrocytes (larger than normal RBCs) in blood.
Vulnerable groups to deficiency:
People with
- digestive disorders such as celiac disease
- alcoholics with faulty liver due to prolonged ingestion of alcohol. The liver becomes unable to store adequate amounts of folate due to its improper function.
- blood disorders such as hemolytic anemia.
- consumption of anti seizure drugs.
- conception as this condition requires excess of the vitamin for the brain development of fetus. Hence supplementation is a must in this case.
Dietary Sources Of Folic Acid:
- Plant sources: citrus fruits, leafy green vegetable, beans, legumes, wheat, nuts.
- Animal sources: meat, liver, fish, eggs, dairy products, seafood.
Recommended Daily Allowance:
Adults =400 – 500 micrograms/day
Infants = 50 micrograms/day
Children = 100–300 micrograms/day
Requirement increases in pregnancy
and lactation.
Pregnant women = 800 micrograms/day
Lactating women = 600 micrograms/day
Folic acid in the prevention of diseases:
- Beneficial in the prevention of cancer – the incidence of cervical dysplasia in women exposed to HPV (human papilloma virus) is reduced to 1/5th by supplementation of B9.
- Neural tube defects such as spina bifida may develop in fetuses due to shortage of folate which is curbed by oral supplements during pregnancy.
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