Folic acid also called vitamin AT9 and is a water-soluble vitamin, necessary for the normal flow of blood in the bone marrow and protein synthesis. With a folic acid deficiency, a person develops macrocytic anemia, in its characteristics and developmental mechanism similar to megaloblastic or pernicious anemia due to vitamin B deficiency.12.
Folic acid enters the human body with food or is produced by microflora in the intestine. Vitamin is absorbed into the blood after pre-conversion into free form and is delivered to the liver, bone marrow and other organs and tissues.
Folic acid – general characteristics and biological role
Folic acid gets its name from the Latin word "folium"what means "sheet", since the largest amounts of this vitamin are found in the green leaves of various vegetables, such as spinach salad, etc. By vitamin B9 In addition to folic acid, there are a number of compounds that are its derivatives and are united by the common name folacin or folates. But since all compounds united by the common name "folacin", have vitamin activity and are absorbed by the body, in the further text of the article we will use the concepts "vitamin b9" and "folic acid" as synonyms, meaning all folacins.
Folic acid can enter the human body not only with food and dietary supplements, but also be produced in the upper third of the small intestine by microorganisms of normal microflora. In many cases, folic acid is produced by microorganisms of the intestinal microflora in quantities that fully satisfy daily needs of the person. Therefore, even if folic acid is supplied with food in insufficient quantities, the symptoms of its deficiency may not develop, since the missing amount of this vitamin is synthesized by the microflora in the intestine.
Vitamin B9 necessary for the formation of red blood cells in the bone marrow. The fact is that folic acid activates enzymes that enable biochemical reactions, during which mature red blood cells are formed. Therefore, anemia develops with folic acid deficiency.
In addition, vitamin B9 necessary for the synthesis of proteins and DNA, and, respectively, and for the division of cells of all organs and tissues. During division, new cells are formed instead of dead or damaged. That is, folic acid provides the process of repair and replacement of dead cellular elements with new ones and, thus, supports the normal structure of all organs and tissues. In addition, folic acid ensures the normal development of the fetus, especially in the first 12 weeks of pregnancy, because it is during this period that very intensive cell division occurs, during which organs and tissues are laid.
Since the formation of new cells occurs at different rates in different tissues, the need for folic acid varies from one organ to another. Thus, the greatest need for folic acid is experienced in tissues in which frequent renewal of cellular composition occurs, namely, skin, mucous membranes, hair, blood, testicles in men and ovaries in women, the fetus in the early stages of pregnancy, etc. That is why folic acid deficiency acids primarily affect organs in which intense cell division occurs.
Thus, when folic acid deficiency, defective spermatozoa and eggs are formed, the fetus develops malformations, the skin becomes dry, flaky and flabby, and various diseases develop in the organs of the gastrointestinal tract. This is because the cells of these organs are intensively divided and they need folic acid for the normal course of this process.
In addition, vitamin B9 participates in the production of serotonin – the hormone of joy, which provides a normal mood and well-being. Therefore, with a lack of folic acid, a person may develop dementia (dementia), depression, neurosis, and some other disorders of brain function.
Folic acid is also involved in the transmission of nerve impulses. Therefore, when folic acid deficiency can develop neuritis and polyneuritis.
Folic acid – application
Folic acid when planning pregnancy
Folic acid is the only vitamin that must be taken by all pregnant women for at least 12 weeks, because it is during this period that the nervous system develops and other organs and tissues of the fetus develop, which requires folacin. However, folic acid is recommended to be taken at the planning stage, not waiting for the onset of pregnancy, in order to create a normal concentration of this vitamin in the tissues. In this case, at the time of pregnancy, the woman will be guaranteed no deficiency of folic acid, which can be critical for the growth and development of the fetus, as well as during pregnancy.
When planning a pregnancy It is recommended to start taking folic acid 3-4 months before the intended conception. , so that at the time of attachment of the ovum to the wall of the uterus in a woman’s body there was no deficiency of this vitamin. When the test results reveal conception, folic acid supplementation should continue until at least the 12th week of pregnancy . After this period of gestation, folic acid intake can be canceled or continued at the request of the woman, if she does not have a deficiency of this vitamin. If there are signs of folic acid deficiency, then it must be taken before delivery in the individual dosage prescribed by the doctor. In addition, if a woman who does not suffer from folate deficiency wants and has the financial ability to take folic acid after 12 weeks of gestation, then she can also do it right up to the birth. Moreover, doctors and scientists consider it desirable to take folic acid at the planning stage and after the 12th week of gestation before delivery. Doctors consider taking folic acid from the beginning to the 12th week of pregnancy as mandatory.
The importance of using folic acid at the planning stage and during pregnancy is due to the fact that this vitamin is critically necessary for the rapid reproduction of cells, which occurs with the growth of the embryo. With a deficiency of this vitamin, malformations of the nervous system are formed, and an increased risk of miscarriages, placental detachment, fetal death, etc. appears. So, it was found that folic acid in the first 12 weeks of pregnancy prevents malformations of the nervous system of the fetus by 70%.
In addition, folacin prophylactises miscarriages, spontaneous abortions, miscarriage, placental abruption and other complications of pregnancy, which are especially dangerous in its early stages, since the fetal death almost inevitably entails.
At the planning stage of pregnancy in most countries, including in the CIS, doctors recommend taking 400 micrograms of folic acid per day for women who have not previously had any births or miscarriages with neural tube defects. If a woman had cases of miscarriage or birth of a fetus with malformations of the neural tube, or she takes antiepileptic drugs or cytostatics, then the folic acid dosage during the pregnancy planning stage should be increased to 800-4000 mcg per day. The exact dosage is determined by the doctor individually. After pregnancy, women should take folic acid in the same dosage as at the planning stage, up to the 12th gestation week.
Read more about pregnancy planning.
Folic acid during pregnancy
Iron and folic acid are the only substances that are proven to improve the outcome and the course of pregnancy in all women. That is why the World Health Organization (WHO) recommends that all pregnant women take folic acid and iron without fail.
Vitamins with folic acid must be taken from the beginning of pregnancy and up to the 12th week of gestation, inclusive. This means that as soon as a woman finds out that she is pregnant, she should start taking folic acid on the same day. If vitamin b9 was taken before pregnancy at the planning stage, then after conception it is necessary to continue taking it at the same dosage until the 12th week of gestation, inclusive.
Beginning from the 13th week of gestation, pregnant women who must be deficient in this vitamin or take medications that reduce its absorption, such as antiepileptic and antimalarial drugs, as well as cytostatics, must take folic acid. All other women, from the 13th week of gestation, it is recommended to continue taking folic acid until delivery, but this is optional, but desirable.
If a woman starts taking multivitamin complexes for pregnant women from the second trimester, then you do not need to drink folic acid, because this vitamin is part of all modern multivitamins. If these vitamin complexes are not taken during the entire pregnancy, then at times when the woman does not use them, it is advisable to drink folic acid separately.
In pregnancy, folic acid is recommended to be taken in a dosage of 400 micrograms per day for women who have not previously had births or miscarriages of children with neural tube defects. If a woman in the past had cases of childbirth or spontaneous abortions by a fetus with neural tube developmental defects, then she should take folic acid at a dosage of 1000-4000 mcg (1-4 mg) per day. In addition, pregnant women who take anti-epileptic, anti-malarial drugs or cytotoxic drugs should increase the dosage of folic acid to 800-4000 mcg. In these cases, the dosage of the vitamin is determined by the doctor individually.
Acceptance of folic acid in pregnant women is mandatory, as this vitamin is very important for the normal course of pregnancy, as well as the growth and development of the fetus. Thus, folic acid deficiency is one of the main triggering factors that provoke miscarriage, spontaneous miscarriage, placental abruption, fetal fetal death, as well as the formation of neural tube malformations in a child. If malformations of the neural tube formed at an early stage of pregnancy (up to 8 – 9 weeks), then in almost all cases they are incompatible with life, that is, fetal death and miscarriage occur. If malformations of the neural tube have formed after 8–9 weeks of gestation, this may lead to the birth of a child with hydrocephalus, cerebral hernia, etc. In addition, even if the child does not develop malformations of the neural tube against the background of folic acid deficiency in the body of a pregnant woman, then after birth he may suffer from mental retardation, psychosis, neurosis, etc.
In addition, the lack of folic acid adversely affects the course of pregnancy and the general well-being of the woman herself. So, with a deficiency of this vitamin in a pregnant woman, the risk of developing toxicosis, depression, pain in the legs and anemia significantly increases. A lack of folic acid in the body of a pregnant woman can manifest itself with the following symptoms:
- Chronic fatigue and irritability
- Anxiety, anxiety
- Lack of appetite
- Feeling of heaviness in the stomach
- Memory impairment
- Dry skin and hair loss.
If a pregnant woman has four or more of the symptoms listed above, this indicates that she is deficient in folic acid. In such a situation, blood should be donated to determine the concentration of vitamin B in it.9, Based on the results, the doctor will select the necessary therapeutic dose of folic acid, which must be taken daily until delivery. The normal concentration of folic acid in the blood is 3 – 17 ng / ml. The lower the vitamin content in the blood of a pregnant woman, the higher the dosage of the vitamin she needs.
Folic Acid Dosage for Planning and Pregnancy
At the planning stage of pregnancy, folic acid should be taken in a dosage of 400 μg for women who have not previously had any miscarriages or births of children with neural tube defects. After pregnancy, these women should continue to take folic acid in the same dosage (400 mcg per day) without fail until the 12th gestation week, inclusive.
If in the past a woman had cases of miscarriage or birth of children with neural tube developmental defects (for example, back bifida, hydrocephalus, etc.), then at the planning stage she should take folic acid 1000 to 4000 mcg (1-4 mg) per day. After the onset of pregnancy in this category of women should take folic acid in the same dosage, that is, 1000 – 4000 mcg per day. In such situations, the dosage is determined by the doctor individually.
If a woman takes any medications that reduce folic acid absorption (for example, antiepileptic, antimalarial, sulfanilamide, antihyperlipidemic, tuberculosis, cytostatics, nitrofurans, drugs with alcohol, glucocorticoids, high doses of aspirin), then at the planning stage of pregnancy she should drink folic acid at 800 – 4000 mcg per day. When pregnancy occurs, this category of women should take folic acid in the same dosage as at the planning stage, that is, 800-4000 mcg per day.
In addition, these women need to take folic acid without compulsory until the 12th week of gestation, but during the whole pregnancy or during the period during which medicines are taken that worsen the absorption of the vitamin. That is, if medications are taken throughout pregnancy, then folic acid is taken at the indicated dosages before delivery. If, at some stage of pregnancy, a woman stops taking medicines that worsen folic acid absorption, then she should do the following:
- If this happened before the 12th week of gestation, then it is imperative to continue receiving folic acid in a dosage of 400 micrograms per day until the beginning of the 13th week.
- If this happened after the 12th week, then you should either stop taking folic acid, or continue, but reduce its dosage to 400 micrograms per day.
Folic acid for men
Men, like women, folic acid is necessary for normal blood formation and functioning of the intestine and stomach, as well as for the transmission of impulses through the nerve fibers. However, this is the general biological role of folic acid in the human body.
In addition, folic acid is very important for the conception of a child, both for men and women. So, it is vitamin B9 takes part in the process of maturation and the formation of normal, not defective, full-fledged sperm in men. And therefore, folic acid intake by men increases the likelihood of conceiving a healthy child.
In recent studies, it was proved that taking folic acid at a dosage of 600-1000 mcg reduces the number of defective spermatozoa with the wrong number of chromosomes by 20-30%, which, accordingly, prevents the birth of children with developmental defects and genetic diseases such as Down syndrome , Shershevsky-Turner syndrome, Marfan syndrome, Kreuzfeldt-Jakob syndrome, etc.
In addition, a decrease in the number of defective sperm cells with folic acid intake increases the likelihood of conception. Thus, a man taking folic acid will be able to fertilize a woman faster and, moreover, from him more healthy offspring will be born.
That is why men are encouraged to include in their diet foods that are rich in folic acid, such as liver, beef, pork, tuna, salmon, cheese, beans, bran, nuts, leafy vegetables, etc. In addition, to obtain a sufficient amount of folic acid, men can take vitamins or dietary supplements.
Separately, it should be noted the recommendation of doctors to be sure to take folic acid at a dosage of 800 mg per day during the week after drinking large amounts of alcohol. This recommendation is aimed at replenishing the folic acid deficiency in the body of a man, which inevitably occurs after heavy drinking of alcohol, since ethyl alcohol disrupts absorption and washes away this vitamin from organs and tissues.
Folic acid for children
Since folic acid deficiency most often develops in full-term or premature newborns or young children, it is necessary to very carefully ensure that these categories of babies receive adequate amounts of vitamin with food or dietary supplements.
Deficiency of folic acid in children leads to the following negative consequences:
- Development of macrocytic anemia
- Weight gap
- Hematopoietic oppression
- Violation of the normal process of maturation of the mucous membrane of the gastrointestinal tract and skin
- Increased risk of developing enteritis, diaper rash and psychomotor retardation.
In the fetus, newborns and infants of the first year of life, folic acid deficiency develops due to the lack of this vitamin in the mother’s body during pregnancy or its low content in infant formula for artificial feeding. Breastfeeding (breastfeeding) contributes to the rapid elimination of folic acid deficiency in infants, since human milk contains enough of it for the needs of a growing baby, even if the woman herself suffers from vitamin B deficiency.9.
Artificial feeding does not contribute to the elimination of the infant’s folic acid deficiency, since this vitamin is destroyed when the feed mixtures are warmed up. In addition, bottle-feeding can lead to a deficiency of folic acid in an infant who is born without one, for the same reason – the destruction of the vitamin in the process of warming up the mixtures.
Therefore, full-term babies under artificial feeding should be given vitamin B9 at a dosage of 100 mcg per day. Premature babies, regardless of the type of feeding, must necessarily give folic acid 100 micrograms per day, because 2–3 weeks after birth, they develop vitamin deficiency and the risk of infectious complications increases.
Folic acid (vitamin B9) when planning pregnancy: instructions for use and dosage, recommended food, advice of a doctor-genetics – video
Instructions for use of folic acid
Prophylactic folic acid is taken in a dosage of 200-400 mg per day. It is allowed to increase the prophylactic dosage of folic acid to 800 μg per day, especially for nursing mothers and young children.
To eliminate the folic acid deficiency, vitamin preparations and dietary supplements are taken in higher dosages compared to prophylactic. In such cases, the dosage is determined by the doctor individually and can reach up to 75 – 80 mg per day. That is, the therapeutic dose of folic acid can be 200 times higher than the prophylactic.
Taking folic acid preparations to eliminate its deficiency in the body is necessary if the following symptoms are present:
- Megaloblastic anemia combined with thrombocytopenia and leukopenia
- Dry red "varnished" tongue
- Atrophic or erosive gastritis
- Enteritis with diarrhea
- Growth retardation in children
- Prolonged wound healing
- Exacerbation of chronic infectious diseases
- Low-grade body temperature, fixed for at least three weeks
- Memory impairment
- Hostility to others
All of the above conditions and diseases are due to folic acid deficiency, so taking this vitamin helps to eliminate them, that is, to recover, to improve the general condition, to normalize well-being and life processes.
Besides, Folic acid in therapeutic dosages is used in the complex treatment of the following diseases:
- Diseases of the blood-forming organs (bone marrow, spleen, liver)
- Radiation sickness
- Chronic hepatitis
- Cirrhosis of the liver
- Increased anxiety
- Cervical dysplasia.
Folic acid dosage
The dosage of folic acid depends on whether it is taken for prophylactic or therapeutic purposes. For the prevention of folic acid deficiency against the background of a qualitatively and quantitatively balanced diet, it should be taken 200 μg per day. If nutrition is inadequate, then folic acid is recommended to take 400 mg per day.
In order to eliminate the folic acid deficiency revealed by the results of tests (the concentration in the blood is below 3 ng / ml), it should be taken in a dosage of 800-5000 µg per day. In this case, the dosage is determined by the doctor individually and adjusted based on the concentration of folic acid in the blood according to the analyzes. To eliminate the deficiency, folic acid in the indicated dosages must be taken within 20 to 30 days. After that, it is recommended to switch to folic acid intake in a prophylactic dosage (200 – 400 mcg per day), which can be continued for several months up to full normalization of health and the disappearance of all symptoms of deficiency.
For the treatment of folic acid deficiency anemia, vitamin B supplements9 should be taken at 1000 mg per day until the normalization of the blood picture and hemoglobin level.
However, for the treatment of folic acid deficiency anemia and elimination of vitamin B deficiency9 In the body, people suffering from alcohol dependence, malabsorption syndrome, liver failure, cirrhosis of the liver, as well as undergoing removal of the stomach or under stress, increase the dosage of folic acid to 5,000 mg per day.
In the complex therapy of various diseases (atherosclerosis, cervical dysplasia, psoriasis, etc.), folic acid should be taken in very high dosages – from 15 to 80 mg per day (15,000 – 80,000 mcg), which are determined by the doctor individually.
How much to drink folic acid?
In prophylactic dosages , Do not exceed 400 micrograms per day, folic acid can be taken indefinitely.
In the treatment of folic acid deficiency Vitamin in therapeutic dosages must be taken within 20 to 30 days. After that, you should switch to folic acid in prophylactic dosages (200-400 mcg per day).
In the treatment of folic acid deficiency anemia vitamin should be taken until the normalization of the blood picture (the disappearance of giant red blood cells from it) and hemoglobin level.
When using folic acid in the treatment of various diseases the duration of its reception is determined by the doctor individually in each case. However, usually in such cases, folic acid in high dosages is taken for a long time.
How to take vitamin b9?
How much folic acid does a person need per day?
Folic acid deficiency
Folic acid deficiency is now common in the CIS countries – according to international organizations, 66–77% of the population suffers from a lack of this vitamin. Most often, folic acid deficiency is observed in pregnant and lactating women, in the elderly and young children.
Lack of vitamin b9 may develop for the following reasons:
one. Inadequate intake of vitamin with food (qualitatively or quantitatively defective diet).
2 Increased need for vitamin (pregnancy, breastfeeding, a period of intensive growth in children and adolescents, skin diseases, hemolytic anemia, etc.).
3 Poor digestibility of folic acid in the intestines with various chronic diseases (for example, enteritis, chronic diarrhea, sprue, malabsorption syndrome, etc.).
four. Binding of folic acid and the deterioration of its digestibility while taking certain medications, such as:
- Medications containing alcohol
- Antiepileptic drugs
- Anti-tuberculosis drugs
- Antihyperlipidemic drugs
- Preparations containing nitrofurans
- Aspirin in high dosages.
Folic acid deficiency is manifested by the following symptoms:
- Megaloblastic anemia
- Thrombocytopenia (low platelet count in the blood)
- Leukopenia (low white blood cell count)
- Elevated blood bilirubin
- Heilosis (blanching, maceration, transverse cracks and bright red border in the junction of the lower and upper lips)
- Gunter Glossite (dry, red, "varnished" tongue)
- Atrophic or erosive gastritis
- Enteritis with diarrhea
With severe folic acid deficiency, growth is delayed in children, prolonged wound healing, immunodeficiency, exacerbation of chronic infections and constant subfebrile temperature.
Besides, folic acid hypovitaminosis can provoke the following non-specific symptoms:
- General weakness
- Pale skin and mucous membranes
- Weight loss
- Memory impairment
- Neuritis and polyneuritis.
Excess Vitamin B9
Since folic acid is a water-soluble vitamin, when it enters the body in an excess of only the required amount is absorbed, and the excess is removed. Therefore, there is no data on the development of symptoms of an overdose of folic acid, even when it is used in doses hundreds of times higher than the daily requirement.
However, according to the observations of doctors, about half of people receiving folic acid in dosages of 15 mg per day or more suffer from bloating, flatulence, vomiting, anorexia, vivid dreams, indisposition and irritability. Similar symptoms appear after a month of taking folic acid in high doses.
In isolated cases, high dosages of folic acid (more than 15 mg per day) cause indigestion, irritability, and also hypertrophy of the kidney cells.
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Author: Nasedkina A.K. Specialist in conducting research on biomedical problems.