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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.
- Folate deficiency.  Oral or intravenous folic acid is effective for the prevention or treatment of folate deficiency.
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- Kidney failure.  Taking folic acid orally reduces homocysteine levels in people with kidney failure who are on hemodialysis.
Login for details - Hyperhomocysteinemia.  Oral folic acid, taken alone or in combination with other B vitamins, lowers homocysteine levels in most patients. However, it is unclear if this has cardiovascular benefits.
Login for details - Methotrexate toxicity.  Oral folic acid reduces the severity of methotrexate toxicity.
Login for details - Neural tube birth defects.  Oral folic acid helps to prevent neural tube birth defects in newborns.
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- 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.
Login for details - Depression.  Oral folic acid seems to modestly reduce depression.
Login for details - Hypertension.  Oral folic acid seems to modestly reduce hypertension.
Login for details - Phenytoin-induced gingival hyperplasia.  Topical folic acid seems to reduce gingival hyperplasia due to phenytoin. The effect of oral folic acid is unclear.
Login for details - Stroke.  Folic acid seems to reduce stroke risk in regions without food-fortification policies. In regions that fortify food with folate, folate does not seem to add benefit in most populations.
Login for details - Vitiligo.  Oral folic acid seems to improve vitiligo symptoms.
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- Anemia.  Oral folic acid does not seem to reverse anemia.
Login for details - Age-related cognitive decline.  Oral folic acid does not seem to prevent cognitive decline in healthy elderly adults.
Login for details - Cataracts.  Oral folic acid does not seem to reduce cataract development.
Login for details - Diarrhea.  Oral folic acid does not seem to reduce the risk of diarrhea, and might even increase the incidence of diarrhea in children.
Login for details - Fall prevention.  Oral folic acid does not seem to reduce the risk of falls.
Login for details - Fetal and premature infant mortality.  Oral vitamin B12 does not seem prevent mortality in premature infants.
Login for details - Leukemia.  Oral vitamin B12 does not seem to reduce the risk for pediatric acute lymphoblastic leukemia.
Login for details - Male infertility.  Oral folic acid does not seem to improve sperm parameters or pregnancy rates in males with infertility.
Login for details - Osteoporosis.  Oral folic acid does not seem to reduce the risk of osteoporotic fractures.
Login for details - Physical performance.  Oral folic acid does not seem to improve physical performance in older adults.
Login for details - Pre-eclampsia.  Oral folic acid does not seem to prevent pre-eclampsia in pregnant patients.
Login for details - Respiratory tract infections.  Oral folic acid does not seem to prevent respiratory tract infections.
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- Colorectal adenoma.  Oral folic acid does not prevent colorectal adenomas.
Login for details - Fragile X syndrome.  Oral folic acid does not improve symptoms in children with fragile X syndrome.
Login for details - Preterm labor.  Oral folic acid does not seem to reduce the risk of preterm birth.
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- Acne.  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Age-related macular degeneration (AMD).  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Alzheimer disease.  It is unclear if oral folic acid reduces the risk of developing this condition.
Login for details - Angioplasty.  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Atopic dermatitis (eczema).  It is unclear if oral folic acid during pregnancy reduces the risk of eczema in the child.
Login for details - Autism spectrum disorder.  It is unclear if oral folic acid during pregnancy reduces the risk of autism spectrum disorder in the child.
Login for details - Beta-thalassemia.  There is limited evidence on the oral use of folic acid for beta-thalassemia minor.
Login for details - Bipolar disorder.  It is unclear if adding oral folic acid to conventional bipolar therapy further improves symptoms.
Login for details - Breast cancer.  It is unclear if oral folic acid reduces breast cancer risk.
Login for details - Cardiovascular disease (CVD).  Although oral folic acid does not seem to prevent most CVD events, it might lower the risk of stroke and reduce CVD events in patients with kidney disease.
Login for details - Cervical cancer.  It is unclear if oral folic acid prevents cervical cancer.
Login for details - Child development.  It is unclear if oral folic acid during pregnancy improves child development.
Login for details - Chronic fatigue syndrome (CFS). Login for details
- Chronic kidney disease (CKD).  While adding oral folic acid to enalapril might slow CKD progression, adding folic acid to high-dose vitamin B12 does not seem to be beneficial.
Login for details - Colorectal cancer.  It is unclear if oral folic acid prevents colorectal cancer.
Login for details - Congenital heart disease.  It is unclear if oral folic acid prevents congenital heart disease.
Login for details - Dementia.  It is unclear if oral folic acid is beneficial for the prevention or treatment of dementia.
Login for details - Diabetes.  Small clinical studies suggest that oral folic acid may not improve glycemic control.
Login for details - Diabetic neuropathy.  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Epilepsy.  It is unclear if oral folic acid reduces seizure frequency.
Login for details - Esophageal cancer.  Higher dietary folate intake is associated with a lower risk of esophageal cancer.
Login for details - Fenofibrate (Tricor)-induced hyperhomocysteinemia.  Folic acid seems to attenuate increases in homocysteine in people taking fenofibrate.
Login for details - Gastric cancer.  It is unclear if oral folic acid reduces gastric cancer risk.
Login for details - Gout.  It is unclear if oral folic acid reduces the risk for gout.
Login for details - Head and neck cancer.  It is unclear if oral folic acid is beneficial for head and neck cancer prevention.
Login for details - Hearing loss.  It is unclear if oral folic acid prevents hearing loss.
Login for details - Lometrexol toxicity.  While oral folic acid might reduce lometrexol toxicity, intravenous folic acid does not seem to help.
Login for details - Low birth weight.  It is unclear if oral folic acid supplementation during pregnancy reduces the risk of a low birth weight.
Login for details - Lung cancer.  It is unclear if oral folic acid reduces lung cancer risk.
Login for details - Melanoma.  It is unclear if oral folic acid reduces melanoma risk.
Login for details - Metabolic syndrome. Login for details
- Nitrate tolerance.  It is unclear if oral folic acid helps to prevent the development of tolerance to treatment with nitroglycerin.
Login for details - Oral clefts.  It is unclear if oral folic acid reduces the risk of oral clefts in infants.
Login for details - Pancreatic cancer.  It is unclear if oral folic acid reduces pancreatic cancer risk.
Login for details - Peripheral neuropathy.  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Pharyngeal cancer.  It is unclear if oral folic acid reduces pharyngeal cancer risk.
Login for details - Pregnancy-induced hypertension.  It is unclear if oral folic acid reduces the risk of hypertension during pregnancy.
Login for details - Restless legs syndrome (RLS). Login for details
- Schizophrenia.  Oral folic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear.
Login for details - Sickle cell disease.  Oral folic acid has only been evaluated in combination with other B vitamins; its effect when used alone is unclear.
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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 mg 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.
Fosphenytoin (Cerebyx)
Interaction Rating=Moderate Be cautious with this combination.
Fosphenytoin (Cerebyx) is used for seizures. The body breaks down fosphenytoin (Cerebyx) to get rid of it. Folic acid can increase how quickly the body breaks down fosphenytoin (Cerebyx). Taking folic acid along with fosphenytoin (Cerebyx) might decrease the effectiveness of fosphenytoin (Cerebyx) for preventing seizures.
Methotrexate (MTX, Rheumatrex)
Interaction Rating=Moderate Be cautious with this combination.
Methotrexate (MTX, Rheumatrex) works by decreasing the effects of folic acid in the body's cells. Taking folic acid pills along with methotrexate might decrease the effectiveness of methotrexate (MTX, Rheumatrex).
Phenobarbital (Luminal)
Interaction Rating=Moderate Be cautious with this combination.
Phenobarbital (Luminal) is used for seizures. Taking folic acid can decrease how well phenobarbital (Luminal) works for preventing seizures.
Phenytoin (Dilantin)
Interaction Rating=Moderate Be cautious with this combination.
The body breaks down phenytoin (Dilantin) to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin (Dilantin). Taking folic acid and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.
Primidone (Mysoline)
Interaction Rating=Moderate Be cautious with this combination.
Primidone (Mysoline) is used for seizures. Folic acid might cause seizure in some people. Taking folic acid can along with primidone (Mysoline) might decrease how well primidone works for preventing seizures.
Pyrimethamine (Daraprim)
Interaction Rating=Moderate Be cautious with this combination.
Pyrimethamine (Daraprim) is used to treat parasite infections. Folic acid might decrease the effectiveness of pyrimethamine (Daraprim) 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.
There are no known interactions with foods.
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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