The deficiency can be caused by inadequate intake, defective absorption, abnormal metabolism or increased requirements. You can detect this directly, measuring red cell folate concentration, or indirectly, if the blood concentration of homocysteine is increased (remember homocysteine, the one blood test critical for early detection of Alzheimer?). Early symptoms are non-specific, and they can include loss of appetite, irritability and tiredness. Severe symptoms include megaloblastic anaemia (giant, immature, inefficient red blood cells), which is characterized by fatigue, irritability, weakness, headache, breathing difficulties and irregular heartbeat.
Pregnancy folates deficiency can result in premature death, low birth weight and retardation. This can be easily prevented with supplementation during early pregnancy.
Folate deficiency can also affect people on special diets (vegans), poor diet, malabsorption cases (stomach and small intestine disorders). If you have certain anaemia, cancer, renal failure or you are pregnant, you need to increase the folate intake. Oral folic acid is not toxic, but high doses can prevent B12 deficiency detection, with dire consequences.
So, the main benefit of the folic acid is when supplemented during pregnancy, to prevent a particular birth defect called spina bifida (the most common form of neural defect, when the spine does not close properly). As a randomized controlled trial prove it, a daily dose of 4-800 mcg folic acid reduce the risk almost 100%. In 1998, US made folic acid fortification mandatory, quickly followed by Australia, Canada, South Africa. The problem with this is that people who are not pregnant can have folic acid in excess, and this can cover vitamin B12 deficiency (resulting in nerve damage, even if the folic acid can prevent the B12 related anaemia). Also, the extra folate can increase the risk of chronic diseases, via epigenetic mechanisms (genes turned on/off). The epigenetic modifications can last for long, even the entire life, and may promote uncontrolled cell growth (cancer). The is no research proving or disproving this hypothesis, but there are researches pointing into this direction. Because of this, some countries choose to target the right audience (pregnant and future moms) and educate them about the importance of folate supplementation during conception. The other issue is that the epigenetic changes not only last a lifetime, but they are inherited from mother to children, so this can have unintended consequences for the future generations. I will let you to think about it.
Next post will be about vitamin B12.
Yours truly,
George
P.S. If you are Romanian, you can also publish your post link in the Publish0x Romanian Community Facebook group for others to read it.
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