Wednesday, November 12, 2008

Folic Acid (Folate)

The importance of folic acid is becoming fairly well known because of an advertising campaign sponsored by the CDC (Center for Disease Control), the March of Dimes, and the National Council on Folic Acid. I think many women are aware of the link between adequate folic acid and reduced risk of neural tube defects, like spina bifda.

Folic acid is critical very early in pregnancy. By the time many women realize they are pregnant, their baby's spinal column and brain are already fully formed (around week four). Many women plan pregnancies, but just about as many are surprised by an unplanned pregnancy. For these reasons, all the books I read recommend that women of childbearing age take a daily multivitamin that contains at least 400 mcg of folic acid, whether they are planning a pregnancy or not.

During pregnancy, most of the books recommend 600-800mcg of folic acid, daily. All the prenatal vitamins I reviewed contained 800mcg of folic acid. While getting some folic acid through diet is certainly do-able, this particular vitamin is another one, like calcium and iron, where supplementing with a vitamin can make a lot of sense.


What does Folic Acid do?
Folic acid is best known for what it prevents: say folic acid and many of us think "prevent spinal bifida", even if we're not sure what spina bifida is. Inadequate folic acid has been linked to neural tube disorders, which are malformations of the central nervous system. Spina bifida is the most common of these neural tube disorders. Many studies have shown that adequate folic acid during the first weeks of pregnancy dramatically reduce these very serious disorders.

In Nutrition for a Healthy Pregnancy, Elizabeth Somer explains just how important folic acid is: "Neural tube defects are the second leading cause of death among infants who die from birth defects in this country (Downs syndrome is the leading cause). One nutrient known to prevent NTDs is folic acid. Numersous studies since they early 1990s have consistently found that folic acid supplementation in women around the time of conception and during pregnancy reuces the risk of NTD, especially spina bifida and anencephaly. Women who supplement with folic acid also deliver babies at low risk for urinary tract, cardiovascular, and limb defects. You also tend to improve your fertility, are less likely to miscarry, and should suffer less from nausea" (6).

It is important to continue to get adequate folic acid because low levels may increase the risk of complications during pregnancy. Some studies show that a deficiency of folic acid during pregnancy can also increase the chance of preterm birth.

Having a Baby, Naturally also mentions folate's importance in DNA synthesis and the formation of red blood cells.


What are good food sources for Folic Acid?
Because folic acid is so important, many foods are now fortified with it, including cereal, pasta and rice.

Good natural food sources of folic acid include: beans and peas, leafy green vegetables, asparagus, sunflower seeds, whole grains, papaya, oranges, blueberries and strawberries.

According to Peggy O'Mara in Having a Baby Naturally, "you can get 400mcg of folate in your daily diet if you eat:
  • 1 glass of orange juice or 1/4C of wheat germ or a small handful of dried soybeans and
  • 1 egg or 2 slices of bread or 1/4 of a cantaloupe and
  • 1 cup of pinto, black or navy beans or two cups of cooked turnip greens, spinach or asparagus or 1 tablespoon brewer's yeast" (25).
  • Other excellent food sources include:
    1 cup of most breakfast cereals = 100mcg
    1/2 cup boiled lentils = 180mcg
    1/2 cup pinto beans = 147mcg
    1/2 cup boiled asparagus = 130mcg
    1/2 cup boiled spinach = 130mcg
    1/2 cup wheat germ = 100mcg
    1/2 cup orange juice, from concentrate = 109mcg
    1/2 cup chickpeas, canned = 80mcg
    1 cup spinach, fresh = 109mcg
    1 cup split peas, cooked = 123mcg

    How is Folic Acid absorbed?
    Folic acid is not stored in the body, according to The Pregnancy Book, by Dr. Sears, which is why it is so important for women of childbearing age to have a consistently adequate intake of folic acid. Dr. Sears also explains that the kidneys excrete more folic acid during pregnancy, which is one of the reasons why pregnant women need more folic acid than when they're not pregnant.


    Folic Acid supplements
    Nutrition for a Healthy Pregnancy explains that, unlike many other vitamins, folic acid supplements actually work better than food sources. "Supplements are better than food when it comes to raising blood levels of this B vitamin and reducing birth defects . . . Folic acid levels in the blood increased only in the women who supplemented or consumed fortified foods, while dietary intake of folic acid-rich foods produced no change in folate status . . . Your best bet is to include two or more servings of folic acid-rich foods in your daily diet AND take a supplement that includes at least 400mcg of folic acid" (8).

    Below are the books I used to write this post:
    The Pregnancy Book, by William Sears, MD and Martha Sears, RN
    The Harvard Medical School Guide to Healthy Eating During Pregnancy, by W. Allan Walker, MD
    Nutrition for a Healthy Pregnancy, by Elizabeth Somer, MA, RD
    Having a Baby Naturally, by Peggy O'Mara

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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