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Health

How much folate should women take each day?

Dr Shamim Ahmed

Folate -- also called folic acid also known as vitamin B9 is extremely important and has a profound effect on health and well being. It is needed for cell replication and growth. Folic acid helps form building blocks of DNA, the body's genetic information, and building blocks of RNA, needed for protein synthesis in all cells. Therefore, rapidly growing tissues, such as those of a foetus, and rapidly regenerating cells, like red blood cells and immune cells, have a high need for folate/folic acid. Folic acid deficiency results in a form of anemia that responds quickly.

It is also an important factor in heart health and may play a role in the prevention of colon, cervical and possibly even breast cancer. Adequate folic acid intake in adults has been associated with a reduction in cardiovascular disease. A diet low in folic acid has been associated with a high incidence of pre-cancerous polyps in the colon, suggesting that folic acid may prevent the development of colon cancer.

Low folate levels are also heavily implicated in the development of cervical cancer. Cervical dysplasia is the precursor of cervical cancer and is usually first detected through a routine Pap smear. Fortunately, folate supplementation is very effective in reversing cervical dysplasia and preventing the cancer.

A low or deficient blood level of folate/folic acid has been detected in adults suffering from depression. There is now increasing evidence that supplementation with therapeutic amounts of folate can significantly improve the condition of depressed patients

Folate is needed before and during the first weeks of pregnancy to help prevent neural tube defects NTDs. These defects include spina bifida and anencephaly (failure of the spine and brain to form normally), which can be disabling or fatal for the infant. Children who survive are often left paralysed for life. These defects occur in the first days or weeks of pregnancy, before a woman can know she is pregnant. So women should start building folate stores at least several weeks before becoming pregnant. Adequate folate levels may also reduce the risk of early miscarriages, low birth weight and poor growth in the womb.

Folate/Folic acid can reduce the incidence of NTDs by as much as 70%, according to the CDC. Research has also found that, when taken before and during pregnancy, folic acid may also protect against other birth defects, including cleft lip and palate.

Most women need 400 micrograms (mcg) of folate each day, even if they are not planning to get pregnant. The requirement for folic acid increases considerably during pregnancy. Some women need more folate each day. A pregnant women would require 600mcg and a breastfeed mother would need 500 mcg of folate each day.

Women who took folate/folic acid supplements during the second trimester had a reduced risk of pregnancy-induced high blood pressure -- a serious condition known as pre-eclampsia. A study found that women who took folic acid for at least a year before getting pregnant reduces their chances of delivering early (pre mature birth) by 50 percent or more.

The best way to ensures adequate dietary intake of folate is to eat foods that are rich in folate such as fruits such as oranges, pineapple and papaya and vegetables such as green leafy vegetables, spinach, lettuce, mustard, cabbage, beans, lentils, peas, broccoli, okra, cauliflower, peanuts are all rich in folic acid. Of the animal sources, liver is a good source of folate.

Too much folate usually doesn't cause harm, because the vitamin is regularly removed from the body through urine. The folate from supplements and fortified foods is better absorbed than the folate that occurs naturally in foods.

The National Guidelines on Prevention and Treatment of Iron Deficiency Anaemia (IPHN/2001) recommends supplementation of 400 mcg folic acid daily for pregnant and lactating women. Usually, folate/folic acid is marketed together with iron as iron tablet formulations and not usually as a single ingredient. Most of the currently available iron tablet formulations in the market contain 500mcg of folic acid. Iron deficiency anaemia is a serious public health problem in the country, particularly among the pregnant women and lactating mothers. The country still does not have a well-laid national programme to address iron deficiency anaemia. Considering the immense importance of iron and folate, it would be expected that the Directorate of Drug Administration and Directorate of Health Services take immediate steps to implement a countrywide programme to address iron deficiency anaemia and ensure that the required amount of folic acid are available in the iron tablet formulations.