What is folic acid
Folic acid is synthetic form of folate.It is also sometimes known as B vitamin. Folic acid is water soluble vitamin and chemically it is 5′-methlytetrahydrofolate. International Union of Pure and Applied Chemistry state that folic acid and folate are preferred synonyms for pteroylgliutamate and pteroylglutamic acid. Folate is important for the body as it helpe in synthesizing and repair of DNA. It is also required to synthesize methylated DNA which is involved as a cofactor in many biological reactions. Folic acid is synthetically produced and have an fortified theory that it is converted into folate. Folic acid is oxidized form not significatly found in natural fruits and vegetables. Folic acid is available as supplement in solid dosage form i.e tablets in both the typs OTC and prescription based. The Folic acid is available in varied doses from 400mcg, 800mcg and 1mg( need prescription). Folic acid is also available in combination with other vitamins and minerals over the counter.
Where can folic acid be found
Folic acid can be obtained from a lot of sources like green leafy vegetables, fruits, meat and also in deficient world it is now added to foods such as breads, bagels, etc to meet the daily requirements in this challenging world.
Vegetables: Brocolli, spinach, lettuce are rich in folic acid. Other vegetables that also contains good amount of folic acid are Brussels Sprouts, asparagus, okra,etc.
Fruits and fruit juices: Orange and orange juices are rich in this vitamin.
Meat: Beef liver and kidney have high amount of folate.
Grains: whole grains, fortified cereals and beans are other folate rich foods.
Yeast and mushrooms also have an considerable amount of folae in them.
What is the normal folate levels for an healthy individual
The folate levels are generally categorized at two different levels . First is plasma(or serum) folate concentration and secondly RBC folate concentration. This concentrations are dependent on intakes, the serum folate concentrations shows the short term folate intake whereas the RBC folate concentration reflects the long term folate concentration.
The deficiency of folate in an adult can be defined as <3.0 ng/dl for serum folate concentration and <140ng/dl in regards with RBC folate concentration. However, hogh levels of serum folate levels and RBC folate levels are thought to be fine when vitamin B12 is in normal range. Body cells require Vitamin B12 to use folic acid in the body, but when theirs low levels of vitamin B12, cells cannot use folic acid and its level builds up in the body which is a concern and require medical attention.
Folic acid deficiency
What happens if our body does not get considerable amount of folate?
Deficiency of folate is not so common in United States of America due the availability of the folate contained food in diet. However, the underlying causes of deficiency may be low folate in diet , some genetic impariment or underlying diseases.
Meganoblastic anaemia: This is a kind of aneamia that results from the inhibition of DNA synthesis during RBC production. The function of folic acid is to mediate the production of RBC and repair and synthesis of DNA . Meganoblastic anemia is due to hypovitaminosis, specifically a deficiency of vitamon b12 and/or folic acid.
The common symptoms of megnoblastic anemia are: Weakness, fatigue, irritability, concentration problem, headache, shortness of breath and heart palpitation. Red blood cells are responsible for transport of oxygen and less oxygen may lead to above problems.
Other folic acid deficiency causes: Sore in mouth and inside the tongue and change in the colour of hair, finger nails and skin.
The population that mostly affected by the deficiency of folic acid is the pregnant ladies. Deficiency of folic acid in pregnant women may cause spina bifida, which is a neural tube defecr(spine does not close during the first month of pregnancy). Premature birth and low birth weight are also complications that can occur during low level of folic acid.
Folic acid as supplement
Folic acid is a synthetic form of naturally occuring folate and hence is used when there is deficiency of folate in blood. Folic acid is also used in conditions associated with folate deficiencies like ulcerative colitis, liver diseases, and kidney dialysis.
Folic acid is also used in the prevention of heart diseases and strokee. Folic acid decreases the levels of homocysteine which is an amino acid. Folic acid is alone cannot lower the risk of heart diseases, but combination of other vitamins can help.
IT can also be used in conditions like memory loss, alzheimer’s disease, age related hearing loss, osteoporosis, sleep problems, depression, nerve pain, muscle pain and inherited disease Fragile X-syndrome.
Can patients take levothyroxine and folic acid together
Yes you can take levothyroxine and folic acid together at the same time their is no interaction between this medication but follow as per prescribed and finish all. If is women is planing to get pregnant and she is suffering from hypothyroidism she will be prescribed with an prenatal tablets or prenatal supplement which contains vitamins and folic acid even. So their is no prominent adverse event reported till date with combination therapy.
Changes in homocysteine level with the combination therapy
Homocyteine is a homologue of amino acid cysteine, differing by an additional methylene bridge. The normal range of homocysteine in western population is 10-12 micro mol/L and levels of 20micro mol/L in populations with low intakes of vitamin B or in older age group. Homocysteine levels are usually higher in men than women as per the studies conducted, and generally the levels increases with the increase of age.
An study was conducted volunterally where the effects of folic acid plus lebvothyroxine on serum homocysteine level in hypothyroidism were studied. Levels of homocysteine are higher in untreated hypothyroidim. Therefore proper treatment of hypothyroidism may decrease the risk of arttherosclerosis and heart diseases by reducing the homocysteine levels. Folate and vitamin B12, which are involved actively in the metabolism of homocysteine and convert it to cysteine and in turn causing reduction in serum homocysteine levels.
Therefore, it was concluded that the combination of levpthyroxine and folic acid had an better control on controlling and reducing the homocysteine levels and causing further reduction generating heart diseases.