II. Indications: Supplementation
- Pregnancy
- Elevated Homocysteine levels
- Coronary Artery Disease prevention (disproven)
III. Physiology
- Folate is a precursor to Tetrahydrofolate (THF)
-
Tetrahydrofolate (THF) is a single carbon (or methyl group) donor important to many reactions
- THF donates a methyl group in the formation of Purines (including thymine in DNA)
- THF is needed to convert Glycine to Serine
- THF is needed to convert Homocysteine to Methionine (with Vitamin B12 as a Cofactor)
- Lowers Homocysteine levels (but does not appear to lower CAD risk)
IV. Pharmacokinetics
- Folate in supplements is twice as Bioavailable as food
V. Preparations: Sources
- Meat
- Dark green leafy vegetables
- Spinach
- Romaine lettuce
- Dry beans
- Peanuts
- Wheat germ
- Yeast
- Enriched whole cereal grains (140 ug/100 grams grain)
VI. Dosing
-
General
- Typical U.S. intake: 50-500 mcg/day
- Recommended Daily Allowance (RDA): 400 mcg/day
-
Coronary Artery Disease prevention (not recommended)
- Folate 400 mcg to 5 mg (depending on Homocysteine)
- Not recommended due to low efficacy (lowers Homocysteine but not CAD risk)
VII. Dosing: Pregnancy
-
General population
- Folate 400 mcg (600 Dietary Folate Equivalents or DFE) daily (as found in Prenatal Vitamins)
- Start at least 1 month before conception
- Continue for at least first 3 months of pregnancy (12 weeks postconceptions)
- Typically continued throughout pregnancy and Lactation
- Moderate risk
- Folic Acid 1000 mcg (1500 Dietary Folate Equivalents or DFE) daily
- Start at least 3 months before conception and continue at least until 12 weeks post-conception
- Some guidelines recommend the 4000 to 5000 mcg dose as given to high risk patients (see below)
- Indications
- Insulin Dependent Diabetes Mellitus
- Seizure Disorder or anticonvulsant use
- Obesity (BMI>35 kg/m2)
- Neural Tube DefectFamily History
- Folic Acid 1000 mcg (1500 Dietary Folate Equivalents or DFE) daily
- High risk
- Folic Acid 4000-5000 mcg daily
- Start at least 3 months before conception and continue at least until 12 weeks post-conception
- Indications
- Prior Neural Tube Defect
- Folic Acid Antagonist use (e.g. Methotrexate)
- Prior delivery complicated by Folic Acid Deficiency associated birth defect
- Cleft Palate
- Congenital Heart Disease
- Limb defect
- Urinary tract anomaly
- Hydrocephalus
- Folic Acid 4000-5000 mcg daily
VIII. Signs: Deficiency
IX. Efficacy: Pregnancy
- At conception, reduces Neural Tube Defects by 50%
- Reduced fetal risk of Cleft Lip and Palate by 25-50%
- Reduces Conotruncal heart defects by 43%
X. Efficacy: Coronary Artery Disease
- Possible Protective against cardiovascular disease
- Low intake associated with higher Homocysteine levels
- Higher Homocysteine levels associated with CAD, CVA
- References
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Related Studies
| folic acid (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FOLIC ACID 1 MG TABLET | Generic | $0.03 each |