Folic acid belongs to the B vitamin family and is sometimes referred to as vitamin B9. Folic acid is the term for synthetic folic acid that is taken in the form of food supplements or added to some foods. The natural folic acid in food is called folate. For the sake of simplicity and because this has become common practice, we will use the term folic acid or vitamin B9 below.
A latent lack of folic acid or vitamin B9 is widespread – not least because the loss of folic acid through industrial processing of food can be up to 100 percent and through cooking up to 75 percent. “Latent” means that there are no clear deficiency symptoms, at least not clearly for the person concerned.
After all, who can associate mood swings, paleness, loss of appetite and forgetfulness with a certain vitamin – especially since all of these symptoms could have just as many other causes.
However, while the symptoms mentioned still sound quite harmless, the same cannot be said of a stroke. However, this can also be the result of a folic acid deficiency.
Stroke is the second leading cause of death worldwide. A stroke is often followed by other cerebral infarctions – as the stroke is also called. Since a stroke poses an enormous risk of death – around a quarter of stroke patients die during the stroke or shortly thereafter – effective prevention is extremely useful.
Unfortunately, we often do not know how to prevent this or that disease. Sometimes there are effective preventive measures, but they are so complicated and time-consuming that hardly anyone likes to carry them out. When it comes to stroke, however, effective prevention seems to be very simple – according to a new study – so that everyone can implement it immediately.
A study published in the Journal of the American Medical Association involved 20,000 adults. They all suffered from high blood pressure – a major risk factor for stroke. However, they had never experienced a stroke or a heart attack.
High blood pressure is therefore considered a risk factor for strokes, since it can often lead to arteriosclerosis, which in turn can lead to so-called ischemic strokes (reduced blood flow in the brain). However, high blood pressure can also lead directly to a stroke, namely when there is a cerebral hemorrhage. This type of stroke is called a hemorrhagic stroke. It is less common than ischemic stroke.
Half of the study participants now received a drug for high blood pressure, the other half also took the drug, but this together with 0.8 mg (= 800 micrograms) of folic acid or vitamin B9. The candidates were medically monitored for a period of 5 years (from 2008 to 2013).
The additionally administered folic acid was able to reduce the risk of stroke so significantly that 21% less people suffered a stroke in the folic acid group in the period mentioned, compared to the folic acid-free group.
The study authors explained that those participants who had previously only had low to moderate folic acid levels benefited from the additional folic acid supplements.
“We believe that targeted folic acid therapy may be useful and reduce the incidence of stroke even in countries where folic acid-fortified convenience foods and daily consumption of dietary supplements are already commonplace.”
Because if someone is clearly deficient in folic acid, then occasional consumption of fortified foods or the small amounts of folic acid in multivitamin supplements will not produce noticeable improvements in folic acid status.
The researchers also assume that the additional folic acid can prevent strokes not only in patients with high blood pressure but in a similar way in all other groups of people. But how does folic acid protect against stroke? How does it work? And what does it change in the body?
Folic acid (vitamin B9) is mainly active inside the cells. For example, it is involved in the formation of genetic material (DNA) and thus in cell division and all growth and healing processes.
In the case of a massive folic acid deficiency, there are also very different symptoms, such as hair loss, skin problems, depressive moods, anemia (anemia) and regression of the mucous membranes with subsequent mucosal inflammation in the gastrointestinal tract (stomach problems, diarrhea, stomatitis, etc.) or in the urogenital tract.
In pregnant women, a folic acid deficiency is said to increase the rate of premature birth and miscarriage and lead to neural tube defects in the infant.
However, what is believed to be responsible for preventing stroke (and possibly heart attack) is vitamin B9’s ability, along with vitamins B6 and B12, to break down the toxic amino acid homocysteine.
Homocysteine is not ingested with food, but is produced in the body itself as part of the protein metabolism. Due to its toxicity, homocysteine must be broken down immediately, but this is not possible without folic acid.
Homocysteine has been dubbed the “new cholesterol”. It is believed that high homocysteine levels are far more dangerous than high cholesterol, and the diseases that result from high homocysteine levels are also far more serious.
Homocysteine is considered a cell toxin that can attack the blood vessel walls, where it leads to accelerated accumulation of oxidized LDL cholesterol and thus to narrowing of the blood vessels and arteriosclerosis in the long term – the prerequisites for heart attacks and strokes.
In the case of a folic acid deficiency (and also in the case of a vitamin B6 or vitamin B12 deficiency), the homocysteine level in the blood increases because the homocysteine can no longer be broken down into harmless components.
However, a folic acid deficiency does not only arise because you take in too little folic acid with food. Other factors can also lead to a folic acid deficiency.
If you suspect a folic acid deficiency and are taking medication for a chronic medical condition, then be sure to check your medications, as many of these can lead to or worsen a folic acid deficiency.
Drugs that inhibit the absorption of folic acid or nullify its effect (folic acid antagonists) are the following:
Diseases often only develop when there is a lack of vital substances. However, instead of checking the patient’s vitamin and mineral status first, they are given medications that lower their vitamin and mineral levels even further. This not only excludes a cure. Other diseases and more serious side effects also occur.
Therefore, if you are taking one of the medications mentioned, your folic acid requirement (and usually also the requirement for other vital substances) is much higher than for people who are not taking any medication. At the same time, you should definitely discuss folic acid supplements with your therapist, since folic acid can reduce the effectiveness of some medications (e.g. epileptics or MTX).
Even the birth control pill leads to low folic acid levels in the long term (in 30 percent of all women who take the pill).
If a woman wants to get pregnant quickly after stopping the pill, she should first have her folic acid level checked, raise it if necessary and only get pregnant now!
Because the folic acid should be able to minimize the possible risk of the above-mentioned possible neural tube defects in the embryo (spina bifida). For this reason, women with an acute desire to have children usually take a dietary supplement with folic acid. Very few women know that a good supply of folic acid can also reduce the baby’s risk of autism.
Various studies now indicate that a mother who is well supplied with vitamin B9 has a lower risk of having an autistic child than mothers who consume little folic acid. The following was particularly interesting:
It is known that maternal exposure to pesticides during pregnancy can increase the child’s risk of autism. However, in a September 2017 study, folic acid actually offset the negative effects of pesticides on autism risk.
Folic acid is not only important during pregnancy, but also during breastfeeding. The need for folic acid also increases in older people.
Smokers and people who like to consume alcoholic beverages as well as all people who generally eat a low-folic acid diet, i.e. who do not like to eat green leafy vegetables, herbs, legumes and cabbage, usually also suffer from a folic acid deficiency.
In addition, an iron deficiency, a vitamin C deficiency, a vitamin B12 deficiency and a zinc deficiency can accelerate the development of a folic acid deficiency. If you have a folic acid deficiency, you should not only think about folic acid, but also about the vital substances and minerals mentioned.
A dietary supplement with vitamin B9 requires little effort and is inexpensive, so one should not forget this possibility of health prevention under any circumstances – especially not if one belongs to a stroke risk group, e.g. suffers from high blood pressure or diabetes, is overweight, possibly already showing the first signs of arteriosclerosis or has high blood lipid levels.
Of course, the folic acid level can not only be raised with a dietary supplement but also with a folic acid-rich diet.
Although it is not very easy – if you have eaten “completely normally” up to now – to consume high amounts of folic acid with food, it is not impossible. In any case, it is worlds healthier than just swallowing a folic acid tablet. The best sources of folic acid include:
The requirement of vitamin B9 for healthy and non-pregnant women is given as 300 to 400 micrograms. However, the therapeutic dose in the above stroke study was 800 micrograms, as was the case in the autism prevention study mentioned. And sometimes – in the case of a proven folic acid deficiency and greatly increased homocysteine levels – daily doses of 1 to 5 milligrams (= 5,000 micrograms) of folic acid are even recommended.
Since the foods mentioned above are only consumed in very small amounts by many people and folic acid is also very sensitive, i.e. high folic acid losses (up to 75 or even 100 percent) must be expected when cooking and frying as well as during longer storage times. It is not easy for most people to cover the minimum folic acid requirement. A folic acid deficiency is therefore inevitable with a normal diet.
How then is the therapeutic dose of 800 micrograms to be achieved with diet alone? It is possible, but not with a “normal” diet – as you can see in our example of a folic acid-rich diet plan below.
For most people, however, it is much easier if the diet provides, for example, 400 micrograms of folic acid and a high-quality vitamin B complex supplement supplemented with another 400 to 600 micrograms of folic acid (together with the other B vitamins).
How you actually want to handle it is of course up to you. You can also make your further procedure dependent on your personal folic acid status. So let this be determined first and then decide how much vitamin B9 you need and how you want to supply it.
The folic acid level is measured in whole blood, not in serum or plasma. However, determining the homocysteine level is much more sensitive.
In healthy people, the homocysteine level should not be above 15 µmol/l. However, the optimal value is below 10 µmol/l. If the homocysteine level is too high, you know that folic acid and vitamins B6 and B12 are missing (or one of the three substances).
To be on the safe side, all three vitamins are then optimized – either through nutrition or an appropriate dietary supplement. If you choose the latter, you generally take 50 to 100 micrograms per day of vitamin B12 to lower homocysteine levels, and 250 mg of vitamin B6 per day, and you already know the dose of folic acid.
Below is an example meal plan for a day with a diet that provides plenty of folic acid and is also purely plant-based (approximate folic acid content in micrograms in brackets).
Morning: Oatmeal made from 50 g oat flakes (50) with 1 apple (5), ½ banana (6) and 10 g walnut kernels (9) – total folic acid: 70 micrograms
Mid- morning: Green smoothie made from 1 banana (12), 200ml OJ (freshly squeezed, 80) and 80g spinach (120) – Total folic acid: 212 micrograms
Lunch: Salad made from 100 grams of lamb’s lettuce (145), 100 grams of carrots (25), 50 grams of peppers (30), 1 avocado (20), 10 grams of parsley (15) and 10 grams of hazelnuts (7) – Total folic acid: 242 microgram
In the evening: 200 grams of vegetables, e.g. cauliflower, broccoli or similar (200) with any side dish – total folic acid: 100 micrograms – whereby the losses (about 50 percent) through steaming are already taken into account.
With these foods alone you get a good 600 micrograms of folic acid – although the side dishes and snacks are not even listed and included, e.g. pasta, potatoes, pseudo cereals, almond milk, legumes, tofu, dried fruit, fruit, trail mix, etc., all of which provide additional amounts of folic acid, so that you can ultimately consume far more than 600 micrograms of folic acid with a healthy diet.
In addition, just like with iron, vitamin C can increase the utilization of folic acid. However, as you can see in the nutrition plan, all meals not only provide folic acid, but also automatically a lot of vitamin C, since the best sources of vitamin C are known to be fruits, herbs and vegetables.