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Folate and folic acid are forms of vitamin B9 used for deficiency and to prevent pregnancy complications. Many foods contain folate or have folic acid added.

Since 1998, folic acid has been added to cold cereals, flour, breads, pasta, bakery items, cookies, and crackers, as required by federal law. Foods that are naturally high in folate include leafy vegetables, okra, asparagus, certain fruits, beans, yeast, mushrooms, animal liver and kidney, orange juice, and tomato juice. Folic acid is also available as a supplement, and is often used in combination with other B vitamins.

Folic acid is used for preventing and treating low blood levels of folate (folate deficiency) and high blood levels of homocysteine (hyperhomocysteinemia). People who are pregnant or might become pregnant take folic acid to prevent serious birth defects such as spina bifida. Folic acid is also used for many other conditions including depression, stroke, decline in memory and thinking skills, and many others.

NatMed Pro rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
  • Cognitive impairment.  Taking folic acid alone, with other B vitamins or with docosahexaenoic acid (DHA), might improve thinking and memory skills in older patients with cognitive impairment.
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  • Depression.  Oral folic acid seems to modestly reduce depression severity when added to conventional antidepressant therapy. It is unclear if folic acid can reduce the prevalence of depression or the risk for suicide.
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  • Hypertension.  Oral folic acid seems to modestly reduce hypertension.
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  • Phenytoin-induced gingival hyperplasia.  Topical folic acid seems to reduce gingival hyperplasia due to phenytoin. The effect of oral folic acid is unclear.
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  • Stroke.  Although some clinical research has shown that oral folate reduces stroke risk by a small amount, more research is needed to determine who is most likely to benefit. Most individual clinical trials show that folic acid seems to reduce stroke risk only in regions without food-fortification policies.
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  • Vitiligo.  Oral folic acid seems to improve vitiligo symptoms.
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When taken by mouth: It is likely safe for most people to take folic acid in doses of no more than 1 mg daily. Doses higher than 1 mg daily may be unsafe. These doses might cause stomach upset, nausea, diarrhea, irritability, confusion, behavior changes, skin reactions, seizures, and other side effects.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe for most people in doses up to about 400 mcg daily.

There is some concern that taking too much folic acid for a long time might cause serious side effects. Some research suggests that taking folic acid in doses of 0.8-1.2 mg daily might increase the risk for cancer or increase the risk of heart attack in people who have heart problems.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Folic acid 300-400 mcg daily is recommended during pregnancy to prevent certain birth defects. The maximum recommended amount of folic acid during pregnancy or breastfeeding is 800 mcg daily for those under 18 years of age and 1000 mcg daily for those over 18 years of age. Do not use more unless directed by a healthcare professional.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe to take at a dose of up to 400 mcg daily when pregnant or breastfeeding.

Children: It is likely safe for children to take folic acid by mouth in the recommended amounts for their age. But children should avoid taking folic acid in doses that are higher than the daily upper limits. These limits are 300 mcg for 1-3 years of age, 400 mcg for 4-8 years of age, 600 mcg for 9-13 years of age, and 800 mcg for 14-18 years of age.

Another form of folic acid, L-5-methyltetrahydrofolate (L-5-MTHF), can also be found in supplements. This type of folic acid is possibly safe in children.

Procedures to widen narrowed arteries (angioplasty): Using folic acid, vitamin B6, and vitamin B12 might worsen narrowed arteries. Folic acid should not be used by people recovering from this procedure.

Cancer: Early research suggests that taking 0.8-1 mg of folic acid daily might increase the risk of cancer. Until more is known, people with a history of cancer should avoid high doses of folic acid.

Seizure disorder: Taking folic acid supplements, especially in high doses, might make seizures worse in people with seizure disorders.

Vitamin B12 deficiency: Taking folic acid supplements might improve certain lab tests in people with low vitamin B12 levels. This may make it seem like vitamin B12 deficiency is improved when it isn't. If left untreated, this could cause permanent nerve damage.

5-Fluorouracil

Interaction Rating=Moderate Be cautious with this combination.

There is some concern that taking large amounts of folic acid with 5-fluorouracil might increase some side effects of 5-fluorouracil, especially stomach problems. Talk with your healthcare provider before taking folic acid.

Capecitabine (Xeloda)

Interaction Rating=Moderate Be cautious with this combination.

There is some concern that taking large amounts of folic acid might increase the side effects of capecitabine, especially stomach problems like diarrhea and vomiting. Talk with your healthcare provider before taking folic acid.

Fosphenytoin (Cerebyx)

Interaction Rating=Moderate Be cautious with this combination.

Fosphenytoin is used for seizures. The body breaks down fosphenytoin to get rid of it. Folic acid can increase how quickly the body breaks down fosphenytoin. Taking folic acid along with fosphenytoin might decrease the effects of fosphenytoin for preventing seizures.

Phenobarbital (Luminal)

Interaction Rating=Moderate Be cautious with this combination.

Phenobarbital is used for seizures. Taking folic acid can decrease how well phenobarbital works for preventing seizures.

Phenytoin (Dilantin)

Interaction Rating=Moderate Be cautious with this combination.

The body breaks down phenytoin to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin. Taking folic acid and taking phenytoin might decrease the effectiveness of phenytoin and increase the possibility of seizures.

Primidone (Mysoline)

Interaction Rating=Moderate Be cautious with this combination.

Primidone is used for seizures. Folic acid might cause seizures in some people. Taking folic acid along with primidone might decrease how well primidone works for preventing seizures.

Pyrimethamine (Daraprim)

Interaction Rating=Moderate Be cautious with this combination.

Pyrimethamine is used to treat parasite infections. Folic acid might decrease the effects of pyrimethamine for treating parasite infections.

Green tea: There is some concern that green tea extract might keep folic acid from working the way it should in the body. This might lead to a condition that is similar to folic acid deficiency.
Zinc: Folic acid might interfere with zinc absorption. But people who get enough zinc in their diet do not need to worry about this effect.

Folic acid can be taken with food or without food.

But drinking green tea might lower folic acid levels in the body. If you have low folic acid levels, avoid drinking green tea.

Folic acid is an important nutrient. The amount that should be consumed on a daily basis is called the recommended dietary allowance (RDA). The RDA for folic acid is provided as Dietary Folate Equivalents, or DFE. This is because the body absorbs the folic acid in supplements better than the folate found in food. 1 mcg DFE is the same as 1 mcg of folate found in food. But 1 mcg DFE is the same as 0.6 mcg of folic acid supplements.

The RDA in adults is 400 mcg DFE daily. In pregnancy, the RDA is 600 mcg DFE daily. When breastfeeding, the RDA is 500 mcg DFE daily. In children, the RDA depends on age. Speak with a healthcare provider to find out what dose might be best for a specific condition.

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