Folic acid and folic acid deficiency

Folic acid is a vitamin from the B family and is also known as vitamin B9 or vitamin B11. This vitamin is necessary for the processes of cell division and thus for cell regeneration. Our body is constantly making new cells. That is why folic acid plays a crucial role right from the start, which is why the need for it increases when you want to have children or during pregnancy. But the vitamin is also important for our health outside of pregnancy and a deficiency can have serious health consequences. Folic acid is particularly found in green, fresh, uncooked vegetables. You can find out here which foods also contain folic acid, how you can cover your daily requirement for the vitamin, what the folic acid value in the  blood count  means and how a folic acid deficiency affects you.

What is folic acid and what is folate?

Strictly speaking, when we talk about folic acid, we often mean folate. Folate  is a B-group vitamin that occurs naturally in various foods and cannot be produced by the body itself.

In contrast,  folic acid  is the synthetic form of this vitamin used in vitamin preparations and dietary supplements. It is more stable and better utilized by the body (bioavailable), which is why smaller amounts are sufficient to cover the daily need for folate.

Accordingly, it is actually the folate level that plays a role in our health. Colloquially, however, folic acid is usually spoken of, which is why this term is also used in the following article.

Effect: What do we need folic acid for?

Folic acid – folate to be precise – is involved in the division, formation and regeneration of cells.  The vitamin also plays an important role in blood formation, especially in red (erythrocytes) and white blood cells (leukocytes), and in the  metabolism of  certain  amino acids : together with vitamins B2, B6 and B12, it is important in the breakdown of homocysteine.

The subject of current research is how folic acid affects the development of  colon cancer  . While some observational studies have suggested that too much folic acid may promote colorectal cancer, others seem to suggest that folic acid may prevent the development of colorectal cancer. Further research on the subject is pending.

Properties of folic acid

The water-soluble vitamin folic acid is very sensitive to heat, light and air. Changes in food processing, unfavorable storage and incorrect preparation result in high losses of folic acid in food.

For example, ready meals contain significantly less folic acid than freshly prepared meals. But the vitamin is also quickly lost when cooking and washing food. Vegetables should therefore be washed uncut and prepared gently, for example by steaming.

For this reason, an additional intake of folic acid can be recommended in certain situations after consulting a doctor.

Vitamin B12 also activates folic acid in the body. Vitamin B12 is therefore also important for the necessary folic acid content – a vitamin B12 deficiency can therefore also promote a folic acid deficiency.

Food: where is folic acid in it?

Folic acid, or its natural form folate, is found in many foods, especially vegetables. The following foods contain folic acid:

  • cabbage varieties
  • fennel
  • nuts  (e.g. almonds)
  • Green leafy vegetables, such as  spinach  or lettuce (e.g. lamb’s  lettuce )
  • asparagus
  • cucumbers
  • tomatoes
  • bananas
  • Citrus fruits like  lemons  and oranges
  • whole grain products
  • legumes
  • Yeast
  • wheat germ
  • potatoes
  • liver (beef liver)
  • milk  and milk products
  • Eggs (especially yolks)

Daily requirement of folic acid

Today, the daily requirement for folic acid is often not covered by food, which, however, does not automatically equate to a deficiency.

The daily requirement of folate equivalents for adults and adolescents aged 13 and over is  300 micrograms.  For children, the daily requirement depends on their age and is correspondingly lower.

a notice

Since there are various folate-effective compounds in food, the daily requirement is given in  folate equivalents. One microgram of this is equivalent to 1 microgram of dietary folate (from food) or 0.5 microgram of synthetic folic acid (on an empty stomach). This means: If the requirement is to be met through food, twice as much dietary folate must be ingested as when taking folic acid preparations.


However, if synthetic folic acid is ingested with food, its bioavailability is somewhat poorer, then 1 microgram of folate equivalent corresponds to only 0.6 micrograms of folic acid. When dosing folic acid, it should therefore not only be considered how much folic acid is consumed, but also whether this is done in combination with food or not.

Alcohol and certain medications inhibit the utilization of folic acid. Therefore, an adequate intake should also be considered in these cases.

Pregnancy and desire to have children: increased need

Pregnant women in particular have an increased need. Pregnant women  have a daily requirement of 550 micrograms of folate equivalent. This ensures the child’s need for this vitamin for cell formation and cell division. Folic acid also plays a crucial role in protecting newborns from damage to the nervous system and neural tube defects.

Women who are breastfeeding  have a daily requirement of 450 micrograms of folate equivalent.

However, even  before pregnancy  , an additional supply of folic acid can be advisable. If  you want to have children  , it is recommended to take 400 micrograms of folic acid daily in the form of appropriate preparations in addition to a folate-rich diet. Ideally, the increased intake should be started at least four weeks before the start of pregnancy and the folic acid supplement should continue to be taken during the first trimester of pregnancy. It should be noted that the requirement increases over the course of the entire pregnancy.

Folic acid as a blood value

If anemia is suspected  ,  the folic acid level (FOLS) in the blood can be determined – often in connection with the vitamin B12 value. A lack of both vitamins can have serious health consequences.  The folic acid level is also usually checked in the case of multiple pregnancies,  psoriasis and alcoholism.

In addition, the blood value is recorded for certain therapies, such as taking medication for  epilepsy or cancer (folic acid antagonists) or for dialysis.

How high should the folic acid level be?

The normal blood level should be  at least 2.5 ng/ml  (nanograms per milliliter), regardless of age or gender. This corresponds to a value of  5.67 nmol/l  (nanomoles per liter).

The following table shows how the blood value is to be classified:

folic acid level meaning
less than 2 ng/ml folic acid deficiency
2 bis 2,5 ng/ml borderline finding
more than 2.5 ng/ml normal value

Depending on the laboratory, these reference values ​​can also be set differently, which is why they are sometimes lower. Blood should always be taken to measure folic acid levels on an empty stomach,  at least twelve hours  after the last meal.

Folic acid deficiency: blood level too low

A lack of folic acid can occur particularly in young women. This is often caused by pregnancy or increased blood loss during menstruation. Certain medications, psoriasis, cancer or congenital metabolic diseases as well as chronic inflammatory bowel diseases,  sprue  or celiac disease can also cause a folic acid deficiency. In addition, a vitamin B12 deficiency or an unbalanced diet or alcoholism are among the possible causes.

A folic acid deficiency is manifested by changes in the blood count and digestive disorders. It can lead to life-threatening anemia, since the formation of red blood cells is particularly impaired. The blood count shows red blood cells of above-average size, one speaks of folic acid deficiency anemia or megaloblastic anemia (also: megoblastic-hyperchromic anemia). Disturbances in growth and reproduction can also occur in other cells, examples are the white blood cells (leukocytes) or the intestinal cells.

Another possible consequence of a folic acid deficiency is an increased homocysteine ​​level, which in turn can promote venous thrombosis and cardiovascular diseases.

Consequences of a folic acid deficiency during pregnancy

An undersupply of folic acid during pregnancy can have particularly serious consequences for the growing fetus. Premature births or miscarriages, developmental disorders and deformities can be the result. A too low birth weight of the baby is also one of the possible consequences.

The probability of the occurrence of a neural tube defect, also known as an open spine, is significantly increased in the case of a folic acid deficiency. This is a developmental disorder of the central nervous system. Therefore, an additional intake of folic acid during pregnancy is usually recommended.

Deficiency symptoms: How does a folic acid deficiency manifest itself?

A folic acid deficiency in adults can manifest itself through the following symptoms:

  • Tongue burning  and tingling, red  tongue
  • Inflammation of the mucous membranes, especially in the intestinal mucosa
  • paleness
  • Tiredness, exhaustion and difficulty breathing
  • depressed  mood and irritability
  • increased tendency to bleed
  • Loss of appetite, weight loss and  diarrhea
  • cardiovascular problems

Preparations with folic acid

A folic acid deficiency can usually be compensated by appropriate nutrition or by taking folic acid tablets. In some situations, the preventive intake of folic acid is also recommended. This can be particularly important for women who want to have children and who are pregnant.

A large number of different preparations have been developed for this purpose. Femibion® and Folio® as well as Orthomol Natal® are examples of dietary supplements that contain folic acid. The preparations can usually be bought in combination with  iodine  and vitamin B12 in tablet form in the pharmacy or drugstore.

There are also foods that are enriched with folic acid, such as  salt  or cereals.

Overdose and too much folic acid in the blood

In the case of a diet-related overdose of this vitamin, there are hardly any side effects or undesirable symptoms; excessive amounts of folic acid are usually excreted through the kidneys. However, overdose can occur when taking supplements.

It should be noted that a permanent overdose of synthetic folic acid can lead to depression, irritability,  sleep disorders  or epileptic seizures. In addition, there is a risk that a vitamin B12 deficiency will not be recognized. Therefore, the Federal Institute for Risk Assessment (BfR) recommends a dose of 200 micrograms per day as the maximum amount for an additional intake of folic acid through food supplements. Overall, the intake should not exceed a total of 1,000 micrograms daily. For women who want to have children and in the first trimester of pregnancy, there is a recommendation for an additional intake of 400 micrograms daily.

In addition to an overdose of folic acid preparations, hemolysis, i.e. increased breakdown of red blood cells, can also be behind increased folic acid levels. In addition, blood values ​​can also be incorrectly measured as too high if the blood is taken shortly after eating.

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