II. Indications: Supplementation

  1. Pregnancy
  2. Elevated Homocysteine levels
  3. Coronary Artery Disease prevention (disproven)

III. Physiology

  1. Folate needed to convert Homocysteine to methionine
  2. Lowers Homocysteine levels (but does not appear to lower CAD risk)

IV. Preparations: Sources

  1. Meat
  2. Dark green leafy vegetables
    1. Spinach
    2. Romaine lettuce
  3. Dry beans
  4. Peanuts
  5. Wheat germ
  6. Yeast
  7. Enriched whole cereal grains (140 ug/100 grams grain)

V. Dosing

  1. General
    1. Typical U.S. intake: 50-500 ug/day
    2. Recommended Daily Allowance (RDA): 400 ug/day
  2. Coronary Artery Disease prevention (not recommended)
    1. Folate 400 ug to 5 mg (depending on Homocysteine)
    2. Not recommended due to low efficacy (lowers Homocysteine but not CAD risk)

VI. Dosing: Pregnancy

  1. General population
    1. Folate 400 mcg daily (as found in Prenatal Vitamins)
    2. Start at least 1 month before conception
    3. Continue for at least first 3 months of pregnancy (12 weeks postconceptions)
      1. Typically continued throughout pregnancy and Lactation
  2. Moderate risk
    1. Folic Acid 1000 mcg daily
      1. Start at least 3 months before conception and continue at least until 12 weeks post-conception
      2. Some guidelines recommend the 4000 to 5000 mcg dose as given to high risk patients (see below)
    2. Indications
      1. Insulin Dependent Diabetes Mellitus
      2. Seizure disorder or anticonvulsant use
      3. Obesity (BMI>35 kg/m2)
      4. Neural Tube DefectFamily History
  3. High risk
    1. Folic Acid 4000-5000 mcg daily
      1. Start at least 3 months before conception and continue at least until 12 weeks post-conception
    2. Indications
      1. Prior Neural Tube Defect
      2. Folic Acid antagonist use (e.g. Methotrexate)
      3. Prior delivery complicated by Folic Acid Deficiency associated birth defect
        1. Cleft Palate
        2. Congenital Heart Disease
        3. Limb defect
        4. Urinary tract anomaly
        5. Hydrocephalus

VII. Signs: Deficiency

VIII. Pharmacokinetics

  1. Folate in supplements twice as bioavailable as food

X. Efficacy: Coronary Artery Disease

  1. Possible Protective against cardiovascular disease
    1. Low intake associated with higher Homocysteine levels
    2. Higher Homocysteine levels associated with CAD, CVA
  2. References
    1. Boushey (1995) JAMA 274:1049 [PubMed]
    2. Malinow (1998) N Engl J Med 338:1009 [PubMed]

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Cost: Medications

Folic Acid (on 6/18/2017 at Walmart.com)
Folic Acid 1mg #30 tablets for $4.00 $0.13 each
Folic Acid 1mg #90 tablets for $10.00 $0.11 each
folic acid (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FOLIC ACID 1 MG TABLET Generic $0.02 each

Ontology: Folic Acid (C0016410)

Definition (MEDLINEPLUS)

Folic acid is a B vitamin. It helps the body make healthy new cells. Everyone needs folic acid. For women who may get pregnant, it is really important. When a woman has enough folic acid in her body before and during pregnancy, it can prevent major birth defects of her baby's brain or spine.

Foods with folic acid in them include leafy green vegetables, fruits, dried beans, peas and nuts. Enriched breads, cereals and other grain products also contain folic acid. If you don't get enough folic acid from the foods you eat, you can also take it as a dietary supplement.

NIH: National Institutes of Health Office of Dietary Supplements

Definition (NCI_NCI-GLOSS) A nutrient in the vitamin B complex that the body needs in small amounts to function and stay healthy. Folate helps to make red blood cells. It is found in whole-grain breads and cereals, liver, green vegetables, orange juice, lentils, beans, and yeast. Folate is water-soluble (can dissolve in water) and must be taken in every day. Not enough folate can cause anemia (a condition in which the number of red blood cells is below normal), diseases of the heart and blood vessels, and defects in the brain and spinal cord in a fetus. Folate is being studied with vitamin B12 in the prevention and treatment of cancer.
Definition (NCI_CRCH) Synthetic folate in fortified foods and supplements containing a single glutamate molecule.
Definition (NCI) A collective term for pteroylglutamic acids and their oligoglutamic acid conjugates. As a natural water-soluble substance, folic acid is involved in carbon transfer reactions of amino acid metabolism, in addition to purine and pyrimidine synthesis, and is essential for hematopoiesis and red blood cell production. (NCI05)
Definition (MSH) A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses (POACEAE). Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia.
Definition (PDQ) A collective term for pteroylglutamic acids and their oligoglutamic acid conjugates. As a natural water-soluble substance, folic acid is involved in carbon transfer reactions of amino acid metabolism, in addition to and purine and pyrimidine synthesis, and is essential for hematopoiesis and red blood cell production. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39641&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39641&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C510" NCI Thesaurus)
Concepts Organic Chemical (T109) , Vitamin (T127) , Pharmacologic Substance (T121)
MSH D005492
SnomedCT 63718003, 6247001
English Pteroylglutamic Acid, Vitamin M, L-Glutamic acid, N-(4-(((2-amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-, Vitamin Bc, FA, N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-L-glutamic acid, N-[4-[[(2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl]amino]benzoyl]-L-glutamic Acid, Vitamin B c, Vitamin B<sub>c</sub>, folic acid, vitamin Bc, vitamin M, folic acid (medication), hematinics folic acid, 2-[4-[(2-amino-4-oxo-1H-pteridin-6-yl)methylamino]benzoyl]aminopentanedioic acid, FOLIC ACID, Folic Acid [Chemical/Ingredient], b c vitamin, vitamin m, pteroylglutamic acid, m vitamins, Vitamin B9, B9, Vitamin, vitamin B complex, Pteroylglutamic acid, Pteroylmonoglutamic Acid, Pteroylmonoglutamic acid, Lactobacillus casei factor, Folic acid, Folic acid preparation, Folic acid product, Pteroylglutamic acid preparation, FA - Folic acid, Vitamin B>c<, Folic acid (substance), Folic acid preparation (product), Folic Acid, Folic acid preparation (substance)
Swedish Folsyra
Czech kyselina listová, pteroylglutamová kyselina, vitamin M, kyselina folová, listová kyselina, kyselina pteroylglutámová, vitamin B9
Finnish Foolihappo
Italian Vitamina M, Acido pteroilglutamico, Acido folico
Russian FOLIEVAIA KISLOTA, VITAMIN M, PTEROILGLUTAMINOVAIA KISLOTA, FOLATSIN, VITAMIN VS, ВИТАМИН M, ВИТАМИН ВС, ПТЕРОИЛГЛУТАМИНОВАЯ КИСЛОТА, ФОЛАЦИН, ФОЛИЕВАЯ КИСЛОТА
Spanish vitamina B c, vitamina B<sub>c</sub>, preparado con ácido pteroilglutámico, preparado con folacina, preparado con ácido fólico (producto), ácido fólico (producto), producto con folato, producto con ácido fólico, preparado con ácido fólico, factor Lactobacillus casei, preparado de ácido fólico (sustancia), vitamina B>c<, ácido fólico (sustancia), ácido fólico, ácido pteroilmonoglutámico, Vitamina M, Ácido Fólico, Ácido Pteroilglutámico
Japanese ビタミンM, プテロイルグルタミン酸, プテロイルモノグルタミン酸, 葉酸
Croatian FOLNA KISELINA
Polish Kwas foliowy, Witamina M, Kwas pteroiloglutaminowy
Norwegian Not Translated[Folic Acid]
French Acide folique, Acide ptéroylglutamique, Folique, acide, Vitamine M
German Vitamin M, Folsäure, Pteroylglutaminsäure
Portuguese Ácido Fólico, Ácido Pteroilglutâmico, Vitamina M

Ontology: Folacin (C0699376)

Definition (CSP) folate and its derivatives.
Concepts Organic Chemical (T109) , Vitamin (T127) , Pharmacologic Substance (T121)
MSH D005492
SnomedCT 6247001
Italian Folacina
English folacin, Folacin preparation, Folacin
Czech folacin