Why does the body need folic acid?
Folates are involved in DNA synthesis, so they are needed primarily by tissues with rapid renewal: bone marrow, intestinal mucosa, and in the fetus, the developing neural tube. Folic acid reserves in the liver are small and are depleted within a few months of poor nutrition, while vitamin B12 reserves last for years. This is why folate deficiency develops relatively quickly. The vitamin is destroyed by prolonged cooking, so even if there are vegetables in the diet, the method of preparation matters.
- DNA synthesis and cell division
- Maturation of red blood cells in the bone marrow
- Formation of the fetal neural tube
- Renewal of the intestinal mucosa
- Homocysteine metabolism
Causes of deficiency
Most often, the deficiency consists of several reasons at once: a monotonous diet without fresh herbs and vegetables, increased consumption and impaired absorption. Alcohol interferes with the absorption and speeds up the elimination of folate, so deficiency is common in people with chronic abuse. A number of medications block folic acid metabolism, and with long-term use, the doctor prescribes preventive replenishment. Increased need is typical for pregnancy, lactation, teenage growth and chronic hemolysis.
- Poor diet without greens, legumes and vegetables
- Long-term cooking of products
- Alcohol abuse
- Celiac disease, Crohn's disease, intestinal surgery
- Pregnancy and breastfeeding
- Taking methotrexate, anticonvulsants and some other drugs
- Chronic hemolytic anemia
Symptoms
Anemia develops gradually, and the body has time to adapt, so complaints are often attributed to fatigue and lack of sleep. Increasing weakness, drowsiness, dizziness, pale skin and mucous membranes, shortness of breath and palpitations when climbing stairs are typical. Digestive problems include loss of appetite, weight loss, inflammation of the tongue with a burning sensation, and cracks in the corners of the mouth. An important difference from B12 deficiency: with a lack of folate alone, there is usually no numbness, tingling, or gait disturbance.
- Weakness and fatigue
- Pale skin and mucous membranes
- Shortness of breath and palpitations on exertion
- Smooth painful bright red tongue
- Cracks in the corners of the mouth
- Irritability, decreased concentration
- Decreased appetite and weight loss
Diagnostics
The starting point is a general blood test: with folate deficiency, hemoglobin decreases, and the average volume of erythrocytes increases, that is, macrocytic anemia. Next, the level of folic acid and definitely vitamin B12 are determined, since their blood picture is almost the same, and the consequences of an error are serious. It is useful to check ferritin: often deficiencies are combined, and then the size of red blood cells may remain normal. If malabsorption is suspected, the intestines are examined.
- General clinical blood test with erythrocyte indices
- Serum folic acid
- Vitamin B12 is a must
- Ferritin and iron metabolism
- Blood biochemistry, bilirubin and LDH
- Intestinal examination if malabsorption is suspected
Treatment and prevention
Folic acid is prescribed in tablets, and health usually improves within a few days, and blood counts return to normal within 1–2 months. At the same time, they eliminate the cause: change the diet, treat intestinal disease, discuss giving up alcohol. The categorical rule is not to start treatment until B12 deficiency has been ruled out: folates will correct the blood test, but will not stop the damage to the nervous system, and the disease will progress silently. For women planning a pregnancy, folic acid is prescribed in advance on the recommendation of a doctor.
- Folic acid preparations in a course as prescribed by a doctor
- Mandatory check and correction of B12 level
- Fresh greens, legumes, cabbage, liver, citrus fruits in the diet
- Gentle cooking of vegetables
- Quitting alcohol
- Preventive treatment when planning pregnancy
- Control blood test after the course
