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100 Vegetarian Tablets

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Description
Supports healthy fetal development*
Required for proper red blood cell formation*
Adequate folate in healthful diets may reduce a woman's risk or having a child with a brain or spinal cord defect.

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Supplement Facts

As a dietary supplement, take 1 or 2 tablets daily. Daily folic acid intake should not exceed 1000 mcg.

Serving Size 1 Tablet
Servings Per Container 100
Amount Per Serving % DV
Folic Acid 400.00 mcg 100%
** Daily Value (DV) not established

Other Ingredients: Dextrose, Whole Brown Rice Powder

No Preservatives, Sodium Free, No Soy, No Artificial Colors, No Wheat, No Dairy, No Artificial Flavors, No Gluten, Yeast Free

Storage Instructions: Keep out of reach of children, store in a cool dry place.

Health Notes

Folic Acid

Folic Acid
This nutrient has been used in connection with the following health goals
  • Reliable and relatively consistent scientific data showing a substantial health benefit.
  • Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
  • For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary "Star-Rating" system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

This supplement has been used in connection with the following health conditions:

High Homocysteine
Dose: 400 to 1,000 mcg of folic acid daily, 10 to 50 mg of vitamin B6 daily, and 50 to 300 mcg of vitamin B12 daily
Vitamin B6, folic acid, and vitamin B12 all play a role in converting homocysteine to other substances within the body and have consistently lowered homocysteine levels in trials.(more)
Atherosclerosis
Dose: Consult a qualified healthcare practitioner
Blood levels of an amino acid called homocysteine have been linked to atherosclerosis and heart disease in most research. Taking folic acid may help lower homocysteine levels.(more)
Heart Attack
Dose: 500 to 800 mcg daily
Taking folic acid may reduce blood levels of homocysteine. High homocysteine levels have been linked to an increased heart attack risk.(more)
Intermittent Claudication
Dose: 200 mg of EPA and 130 mg of DHA daily, plus small amounts of vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid
In one study, men with intermittent claudication who drank a milk product fortified with fish oil, vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid could walk further without pain than those who drank regular milk.(more)
Peripheral Vascular Disease
Dose: Refer to label instructions
As with other vascular diseases, people with thromboangiitis obliterans are more likely to have low levels of folic acid. Supplementing with folic acid may help correct a deficiency.(more)
Stroke and High Homocysteine
Dose: Refer to label instructions
Elevated blood levels of homocysteine have been linked to stroke risk in most studies. Supplementing with folic acid may lower homocysteine levels and reduce stroke risk.(more)
Birth Defects
Dose: At least 400 mcg daily
Supplementing with folic acid before and during the early weeks of pregnancy dramatically reduces the risk of neural tube defects.(more)
Pregnancy and Postpartum Support
Dose: 800 mcg daily, beginning before pregnancy
Supplementing with folic acid protects against the formation of birth defects, such as spina bifida. It also may lead to few infections for mothers and higher birth weight for babies.(more)
Preeclampsia
Dose: 5 mg daily
Supplementing with folic acid and vitamin B6 may lower homocysteine levels. Elevated homocysteine damages the lining of blood vessels and can lead to the preeclamptic symptoms.(more)
Seborrheic Dermatitis
Dose: Refer to label instructions
Supplementing with folic acid has been shown to improve adult seborrheic dermatitis.(more)
Macular Degeneration
Dose: 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12
In a double-blind study of female health professionals who had cardiovascular disease or risk factors, daily supplementation with folic acid, vitamin B6, and vitamin B12 significantly decreased age-related macular degeneration. (more)
Age-Related Cognitive Decline
Dose: 800 mcg per day
Folic acid has been shown to slow the rate of cognitive decline in people with high homocysteine levels and in elderly people. (more)
Age-Related Cognitive Decline
Dose: Refer to label instructions
In women with cardiovascular disease or related risk factors and low dietary intake of folic acid, vitamin B6, and vitamin B12, supplementing with a combination of these nutrients may protect against age-related cognitive decline. (more)
Age-Related Cognitive Decline
Dose: 100 mcg per day of vitamin B12 and 400 mcg per day of folic acid
In a double-blind trial, supplementing with vitamin B12 and folic acid for 2 years slowed the rate of cognitive decline, compared with placebo, in elderly volunteers.(more)
Alzheimer's Disease
Dose: Refer to label instructions
Some researchers feel Alzheimer's disease may be related to folic acid deficiency.(more)
Ulcerative Colitis
Dose: Consult a qualified healthcare practitioner
People with ulcerative colitis may be at a higher risk of colon cancer, supplementing with folic acid may reduce the risk.(more)
Celiac Disease
Dose: Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with folic acid may correct a deficiency.(more)
Celiac Disease
Dose: 3 mg vitamin B6, 0.8 mg folic acid, and 0.5 mg vitamin B12
Daily supplementation with a combination of vitamin B6 (3 mg), folic acid (0.8 mg), and vitamin B12 (0.5 mg) have been shown to help relieve depression in people with celiac disease.(more)
Crohn's Disease
Dose: Refer to label instructions
Folic acid is needed to repair intestinal cells damaged by Crohn's disease. Supplementation may offset some of the deficiency caused by Crohn's-related malabsorption.(more)
Diarrhea
Dose: Refer to label instructions
Folic acid can help repair intestinal lining damage caused by acute diarrhea.(more)
Pregnancy and Postpartum Support
Dose: 800 mcg daily, beginning before pregnancy
Supplementing with folic acid protects against the formation of birth defects, such as spina bifida. It also may lead to few infections for mothers and higher birth weight for babies.(more)
Abnormal Pap Smear
Dose: 10 mg daily under medical supervision
Large amounts of folic acid have been shown to improve the abnormal Pap smears of some women who are taking birth control pills.(more)
Breast Cancer
Dose: 400 mcg daily
For women who drink alcohol, folic acid may reduce breast cancer risk by reversing the damaging effect alcohol has on DNA.(more)
Age-Related Cognitive Decline
Dose: 800 mcg per day
Folic acid has been shown to slow the rate of cognitive decline in people with high homocysteine levels and in elderly people. (more)
Age-Related Cognitive Decline
Dose: Refer to label instructions
In women with cardiovascular disease or related risk factors and low dietary intake of folic acid, vitamin B6, and vitamin B12, supplementing with a combination of these nutrients may protect against age-related cognitive decline. (more)
Age-Related Cognitive Decline
Dose: 100 mcg per day of vitamin B12 and 400 mcg per day of folic acid
In a double-blind trial, supplementing with vitamin B12 and folic acid for 2 years slowed the rate of cognitive decline, compared with placebo, in elderly volunteers.(more)
Bipolar Disorder
Dose: Refer to label instructions
Folic acid deficiency is associated with both mania and depression. Getting enough folic acid helps the body manufacture serotonin and other neurotransmitters.(more)
Schizophrenia
Dose: Refer to label instructions
(more)
Gingivitis
Dose: 5 ml of a 0.1% solution used as a mouth rinse twice per day
Rinsing with a folic acid solution may help reduce inflammation and bleeding.(more)
Halitosis and Gum Disease
Dose: Use 5 ml twice per day of a 0.1% solution
Folic acid is often recommended by doctors to help prevent and treat periodontitis and has been shown to reduce the severity of gingivitis when taken as a mouthwash.(more)
Gingivitis
Dose: Refer to label instructions
In pill form, folic acid may improve gingivitis symptoms, although one study found the mouth rinse form to be more effective.(more)
Gingivitis
Dose: Refer to label instructions
(more)
Migraine Headache
Dose: 5 mg per day
Taking folic acid may improve migraines in people with high homocysteine levels and a certain genetic characteristic. (more)
Osteoporosis and High Homocysteine
Dose: 5 mg with 1,500 mcg of vitamin B12 daily
Homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. By lowering homocysteine levels, folic acid may help prevent osteoporosis.(more)
Macular Degeneration
Dose: 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12
In a double-blind study of female health professionals who had cardiovascular disease or risk factors, daily supplementation with folic acid, vitamin B6, and vitamin B12 significantly decreased age-related macular degeneration. (more)
Skin Ulcers
Dose: Consult a qualified healthcare practitioner
Large amounts of folic acid given both orally and by injection could promote healing of chronic skin ulcers due to poor circulation.(more)
Vitiligo
Dose: Refer to label instructions
Studies have shown folic acid to be effective at skin repigmentation in people with vitiligo.(more)
Psoriasis
Dose: Only for people who are not taking prescription drugs such as methotrexate that interfere with folic acid metabolism
High amounts of folic acid have been shown to improve psoriasis.(more)
Seborrheic Dermatitis
Dose: Refer to label instructions
Supplementing with folic acid has been shown to improve adult seborrheic dermatitis.(more)
Dermatitis Herpetiformis
Dose: Refer to label instructions
Supplementing with folic acid can counteract the nutrient deficiency that often occurs as a result of malabsorption.(more)
Restless Legs Syndrome
Dose: Refer to label instructions
People with familial restless leg syndrome appear to have an unusually high requirement for folic acid. Supplementing with folic acid may help relieve uncomfortable sensations.(more)
HIV and AIDS Support
Dose: Refer to label instructions
Low folic acid levels are also common in HIV-positive people, supplementing may help correct a deficiency.(more)
High Homocysteine
Dose: 400 to 1,000 mcg of folic acid daily, 10 to 50 mg of vitamin B6 daily, and 50 to 300 mcg of vitamin B12 daily

Vitamin B6, folic acid, and vitamin B12 all play a role in converting homocysteine to other substances within the body. By so doing, they consistently lower homocysteine levels in research trials,1, 2, 3 a finding that is now well accepted. Several studies have used (and some doctors recommend) 400-1,000 mcg of folic acid per day, 10-50 mg of vitamin B6 per day, and 50-300 mcg of vitamin B12 per day.

Of these three vitamins, folic acid supplementation lowers homocysteine levels the most for the average person.4, 5 It also effectively lowers homocysteine in people on kidney dialysis.6 In 1996, the FDA required that all enriched flour, rice, pasta, cornmeal, and other grain products contain 140 mcg of folic acid per 3 0.5 ounces.7 This level of fortification has led to a measurable decrease in homocysteine levels.8 However, even higher levels of food fortification with folic acid have been reported to be more effective in lowering homocysteine,9 suggesting that the FDA-mandated supplementation is inadequate to optimally protect people against high homocysteine levels. Therefore, people wishing to lower their homocysteine levels should continue to take folic acid supplements despite the FDA-mandated fortification program.

References

1. Glueck CJ, Shaw P, Land JE, et al. Evidence that homocysteine is an independent risk factor for atherosclerosis in hyperlipidemic patients. Am J Cardiol 1995;75:132-6.

2. Ubbink JB, Vermaak WJH, van der Merwe A, Becker PJ. Vitamin B12, vitamin B6, and folate nutritional status in men with hyperhomocysteinemia. Am J Clin Nutr 1993;57:47-53.

3. Ubbink JB, Vermaak WJH, ven der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

4. Dierkes J, Kroesen M, Pietrzik K. Folic acid and vitamin B6 supplementation and plasma homocysteine concentrations in healthy young women. Int J Vitam Nutr Res 1998;68:98-103.

5. Stein JH, McBride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. Arch Intern Med 1998;158:1301-6.

6. McGregor D, Shand B, Lynn K. A controlled trial of the effect of folate supplements on homocysteine, lipids and hemorheology in end-stage renal disease. Nephron 2000;85:215-20.

7. Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Fed Regist 1996;61:8781-97.

8. Jacques PF, Selhub J, Bostom AG, et al. The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med 1999;340:1449-54.

9. Malinow MR, Duell PB, Hess DL, et al. Reduction of plasma homocyst(e)ine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. N Engl J Med 1998;338:1009-15.

Atherosclerosis
Dose: Consult a qualified healthcare practitioner

Blood levels of an amino acid called homocysteine have been linked to atherosclerosis and heart disease in most research,1, 2 though uncertainty remains about whether elevated homocysteine actually causes heart disease.3, 4 Although some reports have found associations between homocysteine levels and dietary factors, such as coffee and protein intakes,5 evidence linking specific foods to homocysteine remains preliminary. Higher blood levels of vitamin B6, vitamin B12, and folic acid are associated with low levels of homocysteine6 and supplementing with these vitamins lowers homocysteine levels.7, 8

While several trials have consistently shown that B6, B12, and folic acid lower homocysteine, the amounts used vary from study to study. Many doctors recommend 50 mg of vitamin B6, 100-300 mcg of vitamin B12, and 500-800 mcg of folic acid. Even researchers finding only inconsistent links between homocysteine and heart disease have acknowledged that a B vitamin might offer protection against heart disease independent of the homocysteine-lowering effect.9 In one trial, people with normal homocysteine levels had demonstrable reversal of atherosclerosis when supplementing B vitamins (2.5 mg folic acid, 25 mg vitamin B6, and 250 mcg of vitamin B12 per day).10 Similar results were seen in another study.11 In another study, supplementing with 5 mg per day of folic acid for 18 months reversed atherosclerosis in the carotid artery (an artery that supplies the brain) in people who had one or more risk factors for cardiovascular disease.12

For the few cases in which vitamin B6, vitamin B12, and folic acid fail to normalize homocysteine, adding 6 grams per day of betaine (trimethylglycine) may be effective.13 Of these four supplements, folic acid appears to be the most important.14 Attempts to lower homocysteine by simply changing the diet rather than by using vitamin supplements have not been successful.15

References

1. Stampfer MJ, Malinow R, Willett WC, et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992;268:877-81.

2. Bostom AG, Silbershatz H, Rosenberg IH, et al. Nonfasting plasma total homocysteine levels and all-cause and cardiobascular disease mortality in elderly Framingham men and women. Arch Intern Med 1999;159:1077-80.

3. Folsom AR, Nieto FJ, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation 1998;98:204-10.

4. Kuller LH, Evans RW. Homocysteine, vitamins, and cardiovascular disease. Circulation 1998;98:196-9 [editorial/review].

5. Stolzen berg-Solomon RZ, Miller ER III, Maguire MG, et al. Association of dietary protein intake and coffee consumption with serum homocysteine concentrations in an older population. Am J Clin Nutr 1999;69:467-75.

6. Selhub J, Jacques PF, Wilson PW, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693-8.

7. Ubbink JB, Vermaak WJH, ven der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

8. Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197-204 [review].

9. Folsom AR, Nieto FJ, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation 1998;98:204-10.

10. Hackam DG, Peterson JC, Spence JD. What level of plasma homocyst(e)ine should be treated? Am J Hypertens 2000;13:105-10.

11. Till U, Rohl P, Jentsch A, et al. Decrease of carotid intima-media thickness in patients at risk to cerebral ischemia after supplementation with folic acid, vitamins B6 and B12. Atherosclerosis2005;181:131-5.

12. Ntaios G, Savopoulos C, Karamitsos D, et al. The effect of folic acid supplementation on carotid intima-media thickness in patients with cardiovascular risk: a randomized, placebo-controlled trial. Int J Cardiol 2010;143:16-9

13. Franken DG, Boers GHJ, Blom HJ, et al. Treatment of mild hyperhomocysteinemia in vascular disease patients. Arterioscler Thromb 1994;14:465-70.

14. Ubbink JB, Vermaak WJH, ven der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

15. Ubbink JB, van der Merwe A, Vermaak WJH, Delport R. Hyperhomocysteinemia and the response to vitamin supplementation. Clin Investig 1993;71:993-8.

Heart Attack
Dose: 500 to 800 mcg daily

High blood levels of the amino acid homocysteine have been linked to an increased risk of heart attack in most,1, 2, 3, 4 though not all,5, 6 studies. A blood test screening for levels of homocysteine, followed by supplementation with 400 mcg of folic acid and 500 mcg of vitamin B12 per day could prevent a significant number of heart attacks, according to one analysis.7Folic acid8, 9 and vitamins B6 and B12 are known to lower homocysteine.10

There is a clear association between low blood levels of folate and increased risk of heart attacks in men.11 Based on the available research, some doctors recommend 50 mg of vitamin B6, 100-300 mcg of vitamin B12, and 500-800 mcg of folic acid per day for people at high risk of heart attack.

References

1. Israelsson B, Brattstrom LE, Hultberg BL. Homocysteine and myocardial infarction. Atherosclerosis 1988;71:227-33.

2. Ridker PM, Manson JE, Buring JE, et al. Homocysteine and risk of cardiovascular disease among postmenopausal women. JAMA 1999;281:1817-21.

3. Bots ML, Launer LJ, Lindemans J, et al. Homocysteine and short-term risk of myocardial infarction and stroke in the elderly: the Rotterdam Study. Arch Intern Med 1999;159:38-44.

4. Stampfer MJ, Malinow R, Willett WC, et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992;268:877-81.

5. Folsom AR, Nieto FJ, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation 1998;98:204-10.

6. Kuller LH, Evans RW. Homocysteine, vitamins, and cardiovascular disease. Circulation 1998;98:196-9 [editorial/review].

7. Nallamothu BK, Fendrick AM, Rubenfire M, et al. Potential clinical and economic effects of homocyst(e)ine lowering. Arch Intern Med 2000;160:3406-12.

8. Landgren F, Israelsson B, Lindgren A, et al. Plasma homocysteine in acute myocardial infarction: homocysteine-lowering effect of folic acid. J Intern Med 1995;237:381-8.

9. Ward M, McNulty H, McPartlin J, et al. Plasma homocysteine, a risk factor for cardiovascular disease, is lowered by physiological doses of folic acid. QJM 1997;90:519-24.

10. Lobo A, Naso A, Arheart K, et al. Reduction of homocysteine levels in coronary artery disease by low-dose folic acid combined with vitamins B6 and B12. Am J Cardiol 1999;83:821-5.

11. Voutilainen S, Lakka TA, Porkkala-Sarataho E, et al. Low serum folate concentrations are associated with an excess incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study. Eur J Clin Nutr 2000;54:424-8.

Intermittent Claudication
Dose: 200 mg of EPA and 130 mg of DHA daily, plus small amounts of vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid

Men with intermittent claudication consumed a fortified milk product or regular milk daily for one year. The fortified product provided daily 130 mg of eicosapentaenoic acid and 200 mg of docosahexaenoic acid (EPA and DHA, two fatty acids in fish oil), small amounts of supplemental vitamin E, folic acid, and vitamin B6, and additional amounts of oleic acid and alpha-linolenic acid. Compared with regular milk, the fortified milk product significantly increased the distance the participants could walk before the onset of pain.1

References

1. Carrero JJ, Lopez-Huertas E, Salmeron LM, et al. Daily supplementation with (n-3) PUFAs, oleic acid, folic acid, and vitamins B-6 and E increases pain-free walking distance and improves risk factors in men with peripheral vascular disease. J Nutr2005;135:1393-9.

Peripheral Vascular Disease
Dose: Refer to label instructions

As with other vascular diseases, people with TAO are more likely to have high levels of homocysteine and low levels of folic acid.1 However, no research has tested folic acid as prevention or treatment for this disease.

References

1. Stammler F, Diehm C, Hsu E, et al. The prevalence of hyperhomocysteinemia in thromboangiitis obliterans. Does homocysteine play a role pathogenetically? Dtsch Med Wochenschr 1996;121:1417-23 [in German].

Stroke and High Homocysteine
Dose: Refer to label instructions

Elevated blood levels of homocysteine, a toxic amino acid byproduct, have been linked to risk of stroke in most studies.1, 2, 3 Supplementation with folic acid, vitamin B6, and vitamin B12 generally lowers homocysteine levels in humans.4, 5, 6 In a pooled analysis (meta-analysis) of eight randomized trials, folic acid supplementation in varying amounts (usually 0.5 mg to 5 mg per day) reduced stroke risk by 18%.7

References

1. Lalouschek W, Aull S, Serles W, et al. Genetic and nongenetic factors influencing plasma homocysteine levels in patients with ischemic cerebrovascular disease and in healthy control subjects. J Lab Clin Med 1999;133:575-82.

2. Ridker PM, Manson JE, Buring JE, et al. Homocysteine and risk of cardiovascular disease among postmenopausal women. JAMA 1999;281:1817-21.

3. Perry IJ. Homocysteine, hypertension and stroke. J Hum Hypertens 1999;13:289-93 [review].

4. Genest J Jr. Hyperhomocyst(e)inemia-determining factors and treatment. Can J Cardiol 1999;15:35B-38B [review].

5. Ubbink JB, Vermaak WJH, ven der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

6. Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197-204 [review].

7. Wang X, Qin X, Demirtas H, et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. Lancet 2007;369:1876-82.

Birth Defects
Dose: At least 400 mcg daily

Several studies and clinical trials have shown that 50% or more of NTDs can be prevented if women consume a folic acid-containing supplement before and during the early weeks of pregnancy.1, 2 The United States Department of Public Health, the Centers for Disease Control and Prevention (CDC), and the March of Dimes recommend that all women who are capable of becoming pregnant supplement with 400 mcg folic acid daily. Daily supplementation prior to pregnancy is necessary because most pregnancies in the United States are unplanned3 and the protective effect of folic acid occurs in the first four weeks of fetal development,4 before most women know they are pregnant.

For women who have had a previous NTD-affected pregnancy, the CDC recommends daily supplementation with 4,000 mcg per day of folic acid. In a preliminary study, this amount of supplemental folic acid before and during early pregnancy resulted in a 71% reduction in the recurrence rate of NTDs.5

References

1. MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131-7.

2. Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-5.

3. Forrest JD. Epidemiology of unintended pregnancy and contraceptive use. Am J Obstet Gynecol. 1994;170:1485-9.

4. Moore KL. Formulation of the trilaminar embryo. In: The Developing Human. Philadelphia, PA: WB Saunders Co., 1988:55-64.

5. Centers for Disease Control and Prevention. Use of folic acid for prevention of spina bifida and other neural tube defects: 1983-1991. MMWR 1991;40:513-6.

Pregnancy and Postpartum Support
Dose: 800 mcg daily, beginning before pregnancy

Most doctors, many other healthcare professionals, and the March of Dimes recommend that all women of childbearing age supplement with 400 mcg per day of folic acid. Such supplementation could protect against the formation of neural tube defects (such as spina bifida) during the time between conception and when pregnancy is discovered.

The requirement for the B vitamin folic acid doubles during pregnancy, to 800 mcg per day from all sources.1 Deficiencies of folic acid during pregnancy have been linked to low birth weight2 and to an increased incidence of neural tube defects (e.g., spina bifida) in infants. In one study, women who were at high risk of giving birth to babies with neural tube defects were able to lower their risk by 72% by taking folic acid supplements prior to and during pregnancy.3 Several preliminary studies have shown that a deficiency of folate in the blood may increase the risk of stunted growth of the fetus.4, 5, 6, 7, 8, 9, 10, 11 This does not prove, however, that folic acid supplementation results in higher birth weights. Although some trials have found that folic acid and iron, when taken together, have improved birth weights,12, 13, 14, 15 other trials have found supplementation with these nutrients to be ineffective.16, 17, 18

The relationship between folate status and the risk of miscarriage is also somewhat unclear. In some studies, women who have had habitual miscarriages were found to have elevated levels of homocysteine (a marker of folate deficiency).19, 20, 21, 22 In a preliminary study, 22 women with recurrent miscarriages who had elevated levels of homocysteine were treated with 15 mg per day of folic acid and 750 mg per day of vitamin B6, prior to and throughout their next pregnancy. This treatment reduced homocysteine levels to normal and was associated with 20 successful pregnancies.23 It is not known whether supplementing with these vitamins would help prevent miscarriages in women with normal homocysteine levels. As the amounts of folic acid and vitamin B6 used in this study were extremely large and potentially toxic, this treatment should be used only with the supervision of a doctor.

In other studies, however, folate levels did not correlate with the incidence of habitual miscarriages.24, 25, 26

Preliminary27 and double-blind28 evidence has shown that women who use a multivitamin-mineral formula containing folic acid beginning three months before becoming pregnant and continuing through the first three months of pregnancy have a significantly lower risk of having babies with neural tube defects (e.g., spina bifida) and other congenital defects.

In addition to achieving significant protection against birth defects, women who take folic acid supplements during pregnancy have been reported to have fewer infections, and to give birth to babies with higher birth weights and better Apgar scores. 29 (An Apgar score is an evaluation of the well-being of a newborn, based on his or her color, crying, muscle tone, and other signs.) However, if a woman waits until after discovering her pregnancy to begin taking folic acid supplements, it will probably be too late to prevent a neural tube defect.

References

1. Truswell AS. ABC of nutrition. Nutrition for pregnancy. Br Med J 1985;291:263-6.

2. Scholl TO, Hediger ML, Schall JI, et al. Dietary and serum folate: their influence on the outcome of pregnancy. Am J Clin Nutr 1996;63:520-5.

3. MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131-7.

4. Tamura T, Goldenberg RL, Johnston KE, et al. Serum concentrations of zinc, folate, vitamins A and E, and proteins, and their relationships to pregnancy outcome. Acta Obstet Gynecol Scand Suppl 1997;165:63-70.

5. Tamura T, Goldenberg RL, Freeberg LE, et al. Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome. Am J Clin Nutr 1992;56:365-70.

6. Goldenberg RL, Tamura T, Cliver SP, et al. Serum folate and fetal growth retardation: a matter of compliance? Obstet Gynecol 1992;795 (Pt 1):719-22.

7. Neggers YH, Goldenberg RL, Tamura T, et al. The relationship between maternal dietary intake and infant birthweight. Acta Obstet Gynecol Scand Suppl 1997;165:71-5.

8. Frelut ML, de Courcy GP, Christides JP, et al. Relationship between maternal folate status and foetal hypotrophy in a population with a good socio-economical level. Int J Vitam Nutr Res 1995;65:267-71.

9. Ek J. Plasma and red cell folate in mothers and infants in normal pregnancies. Relation to birth weight. Acta Obstet Gynecol Scand 1982;61:17-20.

10. Malinow MR, Rajkovic A, Duell PB, et al. The relationship between maternal and neonatal umbilical cord plasma homocyst(e)ine suggests a potential role for maternal homocyst(e)ine in fetal metabolism. Am J Obstet Gynecol 1998;178:228-33.

11. Burke G, Robinson K, Refsum H, et al. Intrauterine growth retardation, perinatal death, and maternal homocysteine levels. N Engl J Med 1992;326:69-70 [letter].

12. Iyengar L, Rajalakshmi K. Effect of folic acid supplement on birth weights of infants. Am J Obstet Gynecol 1975;122:332-6.

13. Rolschau J, Date J, Kristoffersen K. Folic acid supplement and intrauterine growth. Acta Obstet Gynecol Scand 1979;58:343-6.

14. Blot I, Papiernik E, Kaltwasser JP, et al. Influence of routine administration of folic acid and iron during pregnancy. Gynecol Obstet Invest 1981;12:294-304.

15. Baumslag N, Edelstein T, Metz J. Reduction of incidence of prematurity by folic acid supplementation in pregnancy. Br Med J 1970;1:16-7.

16. Fleming AF, Martin JD, Hahnel R, Westlake AJ. Effects of iron and folic acid antenatal supplements on maternal haematology and fetal wellbeing. Med J Aust 1974;2:429-36.

17. Fletcher J, Gurr A, Fellingham FR, et al. The value of folic acid supplements in pregnancy. J Obstet Gynaecol Br Commonw 1971;78:781-5.

18. Giles PF, Harcourt AG, Whiteside MG. The effect of prescribing folic acid during pregnancy on birth-weight and duration of pregnancy. A double-blind trial. Med J Aust 1971;2:17-21.

19. Sutterlin M, Bussen S, Ruppert D, Steck T. Serum levels of folate and cobalamin in women with recurrent spontaneous abortion. Hum Reprod 1997;12:2292-6.

20. Wouters MG, Boers GH, Blom HJ, et al. Hyperhomocysteinemia: a risk factor in women with unexplained recurrent early pregnancy loss. Fertil Steril 1993;60:820-5.

21. Steegers-Theunissen RP, Boers GH, Blom HJ, et al. Hyperhomocysteinaemia and recurrent spontaneous abortion or abruptio placentae. Lancet 1992;339:1122-3 [letter].

22. Quere I, Bellet H, Hoffet M, et al. A woman with five consecutive fetal deaths: case report and retrospective analysis of hyperhomocysteinemia prevalence in 100 consecutive women with recurrent miscarriages. Fertil Steril 1998;69:152-4.

23. Quere I, Mercier E, Bellet H, et al. Vitamin supplementation and pregnancy outcome in women with recurrent early pregnancy loss and hyperhomocysteinemia. Fertil Steril 2001;75:823-5.

24. Pietrzik K, Prinz R, Reusch K, et al. Folate status and pregnancy outcome. Ann N Y Acad Sci 1992;669:371-3.

25. Neiger R, Wise C, Contag SA, et al. First trimester bleeding and pregnancy outcome in gravidas with normal and low folate levels. Am J Perinatol 1993;10:460-2.

26. Neela J, Raman L. The relationship between maternal nutritional status and spontaneous abortion. Natl Med J India 1997;10:15-6.

27. Botto LD, Mulinare J, Erickson JD. Occurrence of congenital heart defects in relation to maternal mulitivitamin use. Am J Epidemiol 2000;151:878-84.

28. Czeizel AE. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet 1996;62:179-83.

29. Tamura T, Goldenberg RL, Freeberg LE, et al. Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome. Am J Clin Nutr 1992;56:365-70.

Preeclampsia
Dose: 5 mg daily

Women with preeclampsia have been shown to have elevated blood levels of homocysteine.1, 2, 3, 4 Research indicates elevated homocysteine occurs prior to the onset of preeclampsia.5 Elevated homocysteine damages the lining of blood vessels,6, 7, 8, 9, 10, 11, 12 which can lead to the preeclamptic signs of elevated blood pressure, swelling, and protein in the urine.13

In one preliminary trial, women with a previous pregnancy complicated by preeclampsia and high homocysteine supplemented with 5 mg of folic acid and 250 mg of vitamin B6 per day, successfully lowering homocysteine levels.14 In another trial studying the effect of vitamin B6 on preeclampsia incidence, supplementation with 5 mg of vitamin B6 twice per day significantly reduced the incidence of preeclampsia. Women in that study were not, however, evaluated for homocysteine levels.15 In fact, no studies have yet determined whether lowering elevated homocysteine reduces the incidence or severity of preeclampsia. Nevertheless, despite a lack of proof that elevated homocysteine levels cause preeclampsia, many doctors believe that pregnant women with elevated homocysteine should attempt to reduce those levels to normal.

References

1. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

2. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

3. Rajkovic A, Catalano PM, Malinow MR. Elevated homocyst(e)ine levels with preeclampsia. Obstet Gynecol 1997;90:168-71.

4. Laivuori H, Kaaja R, Turpeinen U, et al. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet Gynecol 1999;93:489-93.

5. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

6. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

7. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999;20:519-29 [review].

8. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

9. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:5-15.

10. Hayman R, Brockelsby J, Kenny L, Baker P. Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor. J Soc Gynecol Investig 1999;6:3-10.

11. Lyall F, Greer IA. The vascular endothelium in normal pregnancy and pre-eclampsia. Rev Reprod 1996;1:107-16.

12. Roberts JM, Redman CWG. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1994;341:1447-54.

13. Taylor RN, de Groot CJ, Cho YK, Lim KH. Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:17-31.

14. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

15. Wachstein M, Graffeo LW. Influence of Vitamin B6 on the incidence of preeclampsia. Obstet Gynecol 1956;8:177-80.

Seborrheic Dermatitis
Dose: Refer to label instructions

One physician reported that injections of B-complex vitamins were useful in the treatment of seborrheic dermatitis in infants.1 A preliminary trial found that 10 mg per day of folic acid was helpful in 17 of 20 cases of adult seborrheic dermatitis.2 However, this study also found that oral folic acid did not benefit infants with cradle cap. A preliminary study found that topical application of vitamin B6 ointment (containing 10 mg B6 per gram of ointment) to affected areas improved adult seborrheic dermatitis.3 However, oral vitamin B6 (up to 300 mg per day) was ineffective. Injections of vitamin B12 were reported to improve in 86% of adults with seborrheic dermatitis in a preliminary trial.4 Oral administration of vitamin B12 for seborrheic dermatitis has not been studied.

References

1. Nisenson A. Treatment of seborrheic dermatitis with biotin and vitamin B complex. J Pediatr 1972;81:630-1 [letter].

2. Callaghan TJ. The effect of folic acid on seborrheic dermatitis. Cutis 1967;3:583-8.

3. Schreiner AW, Rockwell E, Vilter RW. A local defect in the metabolism of pyridoxine in the skin of persons with seborrheic dermatitis of the "sicca" type. J Invest Derm 1952;19:95-6.

4. Andrews GC, Post CF, Domnkos AN. Seborrheic dermatitis: supplemental treatment with vitamin B12. NY State Med J 1950;50:1921-5.

Macular Degeneration
Dose: 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12

In a double-blind study of female health professionals who had cardiovascular disease or cardiovascular disease risk factors, daily supplementation with folic acid (2.5 mg), vitamin B6 (50 mg), and vitamin B12 (1 mg) for 7.3 years significantly decreased the incidence of age-related macular degeneration.1

References

1. Christen WG, Glynn RJ, Chew EY, et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med 2009;169:335-41.

Age-Related Cognitive Decline
Dose: 800 mcg per day

In a double-blind trial, elderly people with high homocysteine levels received 800 mcg of folic acid per day or a placebo for three years. Compared with placebo, folic acid supplementation significantly slowed the rate of decline of memory and of other measures of cognitive function.1

References

1. Durga J, van Boxtel MPJ, Schouten EG, et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial. Lancet 2007;369:208-16.

Age-Related Cognitive Decline
Dose: Refer to label instructions

In a study of female health professionals who had cardiovascular disease or cardiovascular disease risk factors, daily supplementation with folic acid (2.5 mg), vitamin B6 (50 mg), and vitamin B12 (1 mg) for 5.4 years had no effect on cognitive function. However, supplementation appeared to prevent age-related cognitive decline in the 30% of women who had low dietary intake of B vitamins.1

Supplementation with homocysteine-lowering B vitamins (folic acid, vitamin B12, and vitamin B6) also slowed the rate of brain atrophy in elderly people who had mild cognitive impairment and high homocysteine levels.2

References

1. Kang JH, Cook N, Manson J, Buring JE, Albert CM, Grodstein F. A trial of B vitamins and cognitive function among women at high risk of cardiovascular disease. Am J Clin Nutr 2008;88:1602-10.)

2. Smith AD, Smith SM, de Jager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One 2010;5(9):e12244.

Age-Related Cognitive Decline
Dose: 100 mcg per day of vitamin B12 and 400 mcg per day of folic acidIn a double-blind trial, supplementation with 100 mcg per day of vitamin B12 and 400 mcg per day of folic acid for 2 years slowed the rate of cognitive decline, compared with placebo, in elderly volunteers.1
References

1. Walker JG, Batterham PJ, Mackinnon AJ, et al. Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms - the Beyond Ageing Project: a randomized controlled trial. Am J Clin Nutr 2012;95:194-203.

Alzheimer's Disease
Dose: Refer to label instructions

Some researchers have found an association between Alzheimer's disease and deficiencies of vitamin B12 and folic acid;1, 2 however, other researchers consider such deficiencies to be of only minor importance.3 In a study of elderly Canadians, those with low blood levels of folate were more likely to have dementia of all types, including Alzheimer's disease, than those with higher levels of folate.4 Little is known about whether supplementation with either vitamin would significantly help people with this disease. Nonetheless, it makes sense for people with Alzheimer's disease to be medically tested for vitamin B12 and folate deficiencies and to be treated if they are deficient.

References

1. Clarke R, Smith D, Jobst KA, et al. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol 1998;55:1449-55.

2. Snowdon DA, Tully CL, Smith CD, et al. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun study. Am J Clin Nutr 2000;71:993-8.

3. Joosten E, Lesaffre E, Riezler R, et al. Is metabolic evidence for vitamin B-12 and folate deficiency more frequent in elderly patients with Alzheimer's disease? J Gastroenterol 1997;52A:M76-M79.

4. Ebly EM, Schaefer JP, Campbell NR, Hogan DB. Folate status, vascular disease and cognition in elderly Canadians. Age Ageing 1998;27:485-91.

Ulcerative Colitis
Dose: Consult a qualified healthcare practitioner

UC is linked to an increased risk of colon cancer. Studies have found that people with UC who take folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with people who have UC and do not take folic acid supplements.1, 2, 3 Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals.4 Moreover, low blood folic acid levels have been found in more than half of all people with UC.5 People with UC who are taking the drug sulfasalazine, which inhibits the absorption of folic acid,6 are at a particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with UC. Since taking folic acid may mask a vitamin B12 deficiency, however, people with UC who wish to take folic acid over the long term should have their vitamin B12 status assessed by a physician.

Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer.7 People with UC should, therefore, keep alcohol intake to a minimum.

References

1. Lashner BA, Heidenreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterology 1989;97:255-9.

2. Lashner BA. Red blood cell folate is associated with the development of dysplasia and cancer in ulcerative colitis. J Cancer Res Clin Oncol 1993;119:549-54.

3. Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterology 1997;112:29-32.

4. Kim YI, Salomon RN, Graeme-Cooke F, et al. Dietary folate protects against the development of macroscopic colonic neoplasia in a dose responsive manner in rats. Gut 1996;39:732-40.

5. Elsbord L, Larsen L. Folate deficiency in chronic inflammatory bowel disease. Scand J Gastroenterol 1979;14:1019-24.

6. Halsted CH, Gandhi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. N Engl J Med 1981;317:1513-7.

7. Kaltsky AL, Armstrong MA, Friedman GD, Hiatt RA. The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988;128:1007-15.

Celiac Disease
Dose: Consult a qualified healthcare practitioner

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron, vitamin D, vitamin K, calcium, magnesium, and folic acid.1Zinc malabsorption also occurs frequently in celiac disease2 and may result in zinc deficiency, even in people who are otherwise in remission.3 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral. Some patients may require even higher amounts of some of these vitamins and minerals-an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.4

References

1. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

2. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706-12.

3. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371-5.

4. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453-61.

Celiac Disease
Dose: 3 mg vitamin B6, 0.8 mg folic acid, and 0.5 mg vitamin B12In one trial, 11 people with celiac disease suffered from persistent depression despite being on a gluten-free diet for more than two years. However, after supplementation with vitamin B6 (80 mg per day) for six months, the depression disappeared.1 Daily supplementation with a combination of vitamin B6 (3 mg), folic acid (0.8 mg), and vitamin B12 (0.5 mg) for 6 months also improved psychological well-being in people with long-standing celiac disease who had poor psychological well-being despite being on a strict gluten-free diet.2
References

1. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult celiac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol 1983;18:299-304.

2. Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther 2009;29:811-6.

Crohn's Disease
Dose: Refer to label instructions

Crohn's disease often leads to malabsorption. As a result, deficiencies of many nutrients are common. For this reason, it makes sense for people with Crohn's disease to take a high potency multivitamin-mineral supplement. In particular, deficiencies in zinc, folic acid, vitamin B12, vitamin D, and iron have been reported.1, 2, 3 Zinc, folic acid, and vitamin B12 are all needed to repair intestinal cells damaged by Crohn's disease. Some doctors recommend 25 to 50 mg of zinc (balanced with 2 to 4 mg of copper), 800 mcg of folic acid, and 800 mcg of vitamin B12. Iron status should be evaluated by a doctor before considering supplementation.

References

1. Imes S, Plinchbeck BR, Dinwoodie A, et al. Iron, folate, vitamin B-12, zinc, and copper status in out-patients with Crohn's disease: effect of diet counseling. J Am Dietet Assoc 1987;87:928-30.

2. Sandstead HH. Zinc deficiency in Crohn's disease. Nutr Rev 1982;40:109-12.

3. Driscoll RH Jr, Meredith SC, Sitrin M, et al. Vitamin D deficiency and bone disease in patients with Crohn's disease. Gastroenterology 1982;83:1252-8.

Diarrhea
Dose: Refer to label instructions

Acute diarrhea can damage the lining of the intestine. Folic acid can help repair this damage. In one preliminary trial, supplementing with very large amounts of folic acid (5 mg three times per day for several days) shortened the duration of acute infectious diarrhea by 42%.1 However, a double-blind trial failed to show any positive effect with the same level of folic acid.2 Therefore, evidence that high levels of folic acid supplementation will help people with infectious diarrhea remains weak.

References

1. Haffejee IE. Effect of oral folate on duration of acute infantile diarrhoea. Lancet 1988;2:334-5 [letter].

2. Ashraf H, Rahman MM, Fuchs GJ, Mahalanabis D. Folic acid in the treatment of acute watery diarrhoea in children: a double-blind, randomized, controlled trial. Acta Pediatr 1998;87:1113-5.

Pregnancy and Postpartum Support
Dose: 800 mcg daily, beginning before pregnancy

Most doctors, many other healthcare professionals, and the March of Dimes recommend that all women of childbearing age supplement with 400 mcg per day of folic acid. Such supplementation could protect against the formation of neural tube defects (such as spina bifida) during the time between conception and when pregnancy is discovered.

The requirement for the B vitamin folic acid doubles during pregnancy, to 800 mcg per day from all sources.1 Deficiencies of folic acid during pregnancy have been linked to low birth weight2 and to an increased incidence of neural tube defects (e.g., spina bifida) in infants. In one study, women who were at high risk of giving birth to babies with neural tube defects were able to lower their risk by 72% by taking folic acid supplements prior to and during pregnancy.3 Several preliminary studies have shown that a deficiency of folate in the blood may increase the risk of stunted growth of the fetus.4, 5, 6, 7, 8, 9, 10, 11 This does not prove, however, that folic acid supplementation results in higher birth weights. Although some trials have found that folic acid and iron, when taken together, have improved birth weights,12, 13, 14, 15 other trials have found supplementation with these nutrients to be ineffective.16, 17, 18

The relationship between folate status and the risk of miscarriage is also somewhat unclear. In some studies, women who have had habitual miscarriages were found to have elevated levels of homocysteine (a marker of folate deficiency).19, 20, 21, 22 In a preliminary study, 22 women with recurrent miscarriages who had elevated levels of homocysteine were treated with 15 mg per day of folic acid and 750 mg per day of vitamin B6, prior to and throughout their next pregnancy. This treatment reduced homocysteine levels to normal and was associated with 20 successful pregnancies.23 It is not known whether supplementing with these vitamins would help prevent miscarriages in women with normal homocysteine levels. As the amounts of folic acid and vitamin B6 used in this study were extremely large and potentially toxic, this treatment should be used only with the supervision of a doctor.

In other studies, however, folate levels did not correlate with the incidence of habitual miscarriages.24, 25, 26

Preliminary27 and double-blind28 evidence has shown that women who use a multivitamin-mineral formula containing folic acid beginning three months before becoming pregnant and continuing through the first three months of pregnancy have a significantly lower risk of having babies with neural tube defects (e.g., spina bifida) and other congenital defects.

In addition to achieving significant protection against birth defects, women who take folic acid supplements during pregnancy have been reported to have fewer infections, and to give birth to babies with higher birth weights and better Apgar scores. 29 (An Apgar score is an evaluation of the well-being of a newborn, based on his or her color, crying, muscle tone, and other signs.) However, if a woman waits until after discovering her pregnancy to begin taking folic acid supplements, it will probably be too late to prevent a neural tube defect.

References

1. Truswell AS. ABC of nutrition. Nutrition for pregnancy. Br Med J 1985;291:263-6.

2. Scholl TO, Hediger ML, Schall JI, et al. Dietary and serum folate: their influence on the outcome of pregnancy. Am J Clin Nutr 1996;63:520-5.

3. MRC Vitamin Study Research Group. Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131-7.

4. Tamura T, Goldenberg RL, Johnston KE, et al. Serum concentrations of zinc, folate, vitamins A and E, and proteins, and their relationships to pregnancy outcome. Acta Obstet Gynecol Scand Suppl 1997;165:63-70.

5. Tamura T, Goldenberg RL, Freeberg LE, et al. Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome. Am J Clin Nutr 1992;56:365-70.

6. Goldenberg RL, Tamura T, Cliver SP, et al. Serum folate and fetal growth retardation: a matter of compliance? Obstet Gynecol 1992;795 (Pt 1):719-22.

7. Neggers YH, Goldenberg RL, Tamura T, et al. The relationship between maternal dietary intake and infant birthweight. Acta Obstet Gynecol Scand Suppl 1997;165:71-5.

8. Frelut ML, de Courcy GP, Christides JP, et al. Relationship between maternal folate status and foetal hypotrophy in a population with a good socio-economical level. Int J Vitam Nutr Res 1995;65:267-71.

9. Ek J. Plasma and red cell folate in mothers and infants in normal pregnancies. Relation to birth weight. Acta Obstet Gynecol Scand 1982;61:17-20.

10. Malinow MR, Rajkovic A, Duell PB, et al. The relationship between maternal and neonatal umbilical cord plasma homocyst(e)ine suggests a potential role for maternal homocyst(e)ine in fetal metabolism. Am J Obstet Gynecol 1998;178:228-33.

11. Burke G, Robinson K, Refsum H, et al. Intrauterine growth retardation, perinatal death, and maternal homocysteine levels. N Engl J Med 1992;326:69-70 [letter].

12. Iyengar L, Rajalakshmi K. Effect of folic acid supplement on birth weights of infants. Am J Obstet Gynecol 1975;122:332-6.

13. Rolschau J, Date J, Kristoffersen K. Folic acid supplement and intrauterine growth. Acta Obstet Gynecol Scand 1979;58:343-6.

14. Blot I, Papiernik E, Kaltwasser JP, et al. Influence of routine administration of folic acid and iron during pregnancy. Gynecol Obstet Invest 1981;12:294-304.

15. Baumslag N, Edelstein T, Metz J. Reduction of incidence of prematurity by folic acid supplementation in pregnancy. Br Med J 1970;1:16-7.

16. Fleming AF, Martin JD, Hahnel R, Westlake AJ. Effects of iron and folic acid antenatal supplements on maternal haematology and fetal wellbeing. Med J Aust 1974;2:429-36.

17. Fletcher J, Gurr A, Fellingham FR, et al. The value of folic acid supplements in pregnancy. J Obstet Gynaecol Br Commonw 1971;78:781-5.

18. Giles PF, Harcourt AG, Whiteside MG. The effect of prescribing folic acid during pregnancy on birth-weight and duration of pregnancy. A double-blind trial. Med J Aust 1971;2:17-21.

19. Sutterlin M, Bussen S, Ruppert D, Steck T. Serum levels of folate and cobalamin in women with recurrent spontaneous abortion. Hum Reprod 1997;12:2292-6.

20. Wouters MG, Boers GH, Blom HJ, et al. Hyperhomocysteinemia: a risk factor in women with unexplained recurrent early pregnancy loss. Fertil Steril 1993;60:820-5.

21. Steegers-Theunissen RP, Boers GH, Blom HJ, et al. Hyperhomocysteinaemia and recurrent spontaneous abortion or abruptio placentae. Lancet 1992;339:1122-3 [letter].

22. Quere I, Bellet H, Hoffet M, et al. A woman with five consecutive fetal deaths: case report and retrospective analysis of hyperhomocysteinemia prevalence in 100 consecutive women with recurrent miscarriages. Fertil Steril 1998;69:152-4.

23. Quere I, Mercier E, Bellet H, et al. Vitamin supplementation and pregnancy outcome in women with recurrent early pregnancy loss and hyperhomocysteinemia. Fertil Steril 2001;75:823-5.

24. Pietrzik K, Prinz R, Reusch K, et al. Folate status and pregnancy outcome. Ann N Y Acad Sci 1992;669:371-3.

25. Neiger R, Wise C, Contag SA, et al. First trimester bleeding and pregnancy outcome in gravidas with normal and low folate levels. Am J Perinatol 1993;10:460-2.

26. Neela J, Raman L. The relationship between maternal nutritional status and spontaneous abortion. Natl Med J India 1997;10:15-6.

27. Botto LD, Mulinare J, Erickson JD. Occurrence of congenital heart defects in relation to maternal mulitivitamin use. Am J Epidemiol 2000;151:878-84.

28. Czeizel AE. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet 1996;62:179-83.

29. Tamura T, Goldenberg RL, Freeberg LE, et al. Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome. Am J Clin Nutr 1992;56:365-70.

Abnormal Pap Smear
Dose: 10 mg daily under medical supervision

Large amounts of folic acid-10 mg per day-have been shown to improve the abnormal Pap smears of women who are taking birth control pills.1 Folic acid does not improve the Pap smears of women who are not taking oral contraceptives.2, 3 High blood levels of folate (the food form of folic acid) have been linked to protection against the development of cervical dysplasia but these higher levels may only be a marker for eating more fruit and vegetables.4, 5

References

1. Butterworth CE Jr, Hatch KD, Gore H, et al. Improvement in cervical dysplasia associated with folic acid therapy in users of oral contraceptives. Am J Clin Nutr 1982;35:73-82.

2. Zarcone R, Bellini P, Carfora E, et al. Folic acid and cervix dysplasia. Minerva Ginecol 1996;48:397-400.

3. Butterworth CE, Hatch KD, Soong S-J, et al. Oral folic acid supplementation for cervical dysplasia: A clinical intervention trial. Am J Obstet Gynecol 1992;166:803-9.

4. Butterworth CE Jr, Hatch KD, Macaluso M, et al. Folate deficiency and cervical dysplasia. JAMA 1992;267:528-33.

5. Piyathilake CJ, Macaluso M, Brill I, et al. Lower red blood cell folate enhances the HPV-16-associated risk of cervical intraepithelial neoplasia. Nutrition 2007;23:203-10.

Breast Cancer
Dose: 400 mcg daily

Among women who drink alcohol, those who consume relatively high amounts of folate from their diet have been reported to be at reduced risk of breast cancer, compared with women who drink alcohol but consumed less folate, according to a preliminary study.1 In a similar report, consumption of folic acid-containing supplements was associated with a lower risk of breast cancer in women who drank alcohol, compared with women who drank alcohol but did not take such supplements.2

The damaging effect alcohol has on DNA-the material responsible for normal replication of cells-is partially reversed by folic acid. Therefore, a potential association between both dietary folate and folic acid supplements and protection against breast cancer in women who drink alcohol is consistent with our understanding of the biochemical effects of these substances. A combined intake from food and supplements of at least 600 mcg per day was associated with a 43% reduced risk of breast cancer in women who consumed 1.5 drinks per day or more, compared with women who drank the same amount but did not take folic acid-containing supplements.3

References

1. Rohan TE, Jain MG, Howe GR, Miller AB. Dietary folate consumption and breast cancer risk. J Natl Cancer Inst 2000;92:266-9.

2. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632-7.

3. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632-7.

Age-Related Cognitive Decline
Dose: 800 mcg per day

In a double-blind trial, elderly people with high homocysteine levels received 800 mcg of folic acid per day or a placebo for three years. Compared with placebo, folic acid supplementation significantly slowed the rate of decline of memory and of other measures of cognitive function.1

References

1. Durga J, van Boxtel MPJ, Schouten EG, et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial. Lancet 2007;369:208-16.

Age-Related Cognitive Decline
Dose: Refer to label instructions

In a study of female health professionals who had cardiovascular disease or cardiovascular disease risk factors, daily supplementation with folic acid (2.5 mg), vitamin B6 (50 mg), and vitamin B12 (1 mg) for 5.4 years had no effect on cognitive function. However, supplementation appeared to prevent age-related cognitive decline in the 30% of women who had low dietary intake of B vitamins.1

Supplementation with homocysteine-lowering B vitamins (folic acid, vitamin B12, and vitamin B6) also slowed the rate of brain atrophy in elderly people who had mild cognitive impairment and high homocysteine levels.2

References

1. Kang JH, Cook N, Manson J, Buring JE, Albert CM, Grodstein F. A trial of B vitamins and cognitive function among women at high risk of cardiovascular disease. Am J Clin Nutr 2008;88:1602-10.)

2. Smith AD, Smith SM, de Jager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One 2010;5(9):e12244.

Age-Related Cognitive Decline
Dose: 100 mcg per day of vitamin B12 and 400 mcg per day of folic acidIn a double-blind trial, supplementation with 100 mcg per day of vitamin B12 and 400 mcg per day of folic acid for 2 years slowed the rate of cognitive decline, compared with placebo, in elderly volunteers.1
References

1. Walker JG, Batterham PJ, Mackinnon AJ, et al. Oral folic acid and vitamin B-12 supplementation to prevent cognitive decline in community-dwelling older adults with depressive symptoms - the Beyond Ageing Project: a randomized controlled trial. Am J Clin Nutr 2012;95:194-203.

Bipolar Disorder
Dose: Refer to label instructions

Both folic acid and vitamin B12 are used in the body to manufacture serotonin and other neurotransmitters. It is well known that deficiency of either nutrient is associated with depression.1, 2 There is some evidence that patients diagnosed with mania are also more likely to have folate deficiencies than healthy controls.3 Other studies, however, have found that folic acid deficiency was not more common in bipolar patients taking lithium than in healthy people.4, 5, 6 Some studies have found that people who take lithium long term, and who also have high blood levels of folic acid, respond better to lithium.7, 8 Not all studies have confirmed these findings, however.9 A double-blind study of patients receiving lithium therapy showed that the addition of 200 mcg of folic acid per day resulted in clinical improvement, whereas placebo did not.10

References

1. Botiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev 1996;54:382-90 [review].

2. Fine EJ, Soria ED. Myths about vitamin B12 deficiency. Southern Med J 1991;84:1475-81.

3. Hasanah CI, Khan UA, Musalmah M, Razali SM. Reduced red-cell folate in mania. J Affect Disord 1997;46:95-9.

4. McKeon P, Shelley R, O'Regan S, O'Broin J. Serum and red cell folate and affective morbidity in lithium prophylaxis. Acta Psychiatr Scand 1991;83:199-201.

5. Lee S, Chow CC, Shek CC, et al. Folate concentration in Chinese psychiatric outpatients on long-term lithium treatment. J Affect Disord 1992;24:265-70.

6. Stern SL, Brandt JT, Hurley RS, et al. Serum and red cell folate concentrations in outpatients receiving lithium carbonate. Int Clin Psychopharmacol 1988;3:49-52.

7. Coppen A, Abou-Saleh MT. Plasma folate and affective morbidity during long-term lithium therapy. Br J Psychiatry 1982;141:87-9.

8. Lee S, Chow CC, Shek CC, et al. Folate concentration in Chinese psychiatric outpatients on long-term lithium treatment. J Affect Disord 1992;24:265-70.

9. Stern SL, Brandt JT, Hurley RS, et al. Serum and red cell folate concentrations in outpatients receiving lithium carbonate. Int Clin Psychopharmacol 1988;3:49-52.

10. Coppen A, Chaudrhy S, Swade C. Folic acid enhances lithium prophylaxis. J Affect Disord 1986;10:9-13.

Schizophrenia
Dose: Refer to label instructionsWith schizophrenia may have a great tendency to be deficient in folic acid, than the general population1 and they may show improvement when given supplements.2 A preliminary trial found that, among schizophrenic patients with folic acid deficiency, those give folic acid supplements had more improvement and shorter hospital stays than those not on given supplements. In a double-blind trial, a very high amount of folic acid (15 mg daily) was given to schizophrenic patients being treated with psychiatric medications who had low or borderline folic acid levels. The patients receiving the folic acid supplements had significant improvement, which became more significant over the six-month course of the trial.3 The symptoms of folic acid deficiency can be similar to those of schizophrenia, and two cases of wrong "schizophrenia" diagnoses have been reported.4, 5 In one of these cases, an initial supplement of 20 mg daily of folic acid and a maintenance supplemental intake of 10 mg daily, led to resolution of symptoms.
References

1. Herran A, Garcia-Unzueta MT, Amado JA, et al. Folate levels in psychiatric outpatients. Psychiatry Clin Neurosci 1999;53:531-3.

2. Carney MW, Sheffield BF. Associations of subnormal serum folate and vitamin B12 values and effects of replacement therapy. J Nerv Ment Dis 1970;150:404-12.

3. Procter A. Enhancement of recovery from psychiatric illness by methylfolate. Br J Psychiatry 1991;159:271-2.

4. Freeman JM, Finkelstein JD, Mudd SH. Folate-responsive homocystinuria and "schizophrenia." A defect in methylation due to deficient 5,10-methylenetetrahydrofolate reductase activity. N Engl J Med 1975;292:491-6.

5. Folate-responsive homocystinuria and "schizophrenia."Nutr Rev 1982;40:242-5.

Gingivitis
Dose: 5 ml of a 0.1% solution used as a mouth rinse twice per day

A 0.1% solution of folic acid used as a mouth rinse (5 ml taken twice a day for 30 to 60 days) has reduced gum inflammation and bleeding in people with gingivitis in double-blind trials.1, 2 The folic acid solution is rinsed in the mouth for one to five minutes and then spit out. Folic acid was also found to be effective when taken in capsule or tablet form (4 mg per day),3 though in another trial studying pregnant women with gingivitis, only the mouthwash-and not folic acid in pill form-was effective.4 However, this may have been due to the body's increased requirement for folic acid during pregnancy.

Phenytoin (Dilantin) therapy causes gum disease (gingival hyperplasia) in some people. A regular program of dental care has been reported to limit or prevent gum disease in people taking phenytoin.5, 6, 7 Double-blind research has shown that a daily oral rinse with a liquid folic acid preparation inhibited phenytoin-induced gum disease more than either folic acid in pill form or placebo.8

References

1. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619-28.

2. Vogel RI, Fink RA, Frank O, Baker H. The effect of topical application of folic acid on gingival health. J Oral Med 1978;33(1):20-2.

3. Vogel RI, Fink RA, Schneider LC, et al. The effect of folic acid on gingival health. J Periodontol 1976;47:667-8.

4. Pack ARC, Thomson ME. Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy. J Clin Periodontol 1980;7:402-14.

5. Francetti L, Maggiore E, Marchesi A, et al. Oral hygiene in subjects treated with diphenylhydantoin: effects of a professional program. Prev Assist Dent 1991;17(30):40-3 [in Italian].

6. Fitchie JG, Comer RW, Hanes PJ, Reeves GW. The reduction of phenytoin-induced gingival overgrowth in a severely disabled patient: a case report. Compendium 1989;10(6):314.

7. Steinberg SC, Steinberg AD. Phenytoin-induced gingival overgrowth control in severely retarded children. J Periodontol 1982;53(7):429-33.

8. Drew HJ, Vogel RI, Molofsky W, et al. Effect of folate on phenytoin hyperplasia. J Clin Periodontol 1987;14:350-6.

Halitosis and Gum Disease
Dose: Use 5 ml twice per day of a 0.1% solution

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),1vitamin E, selenium, zinc, coenzyme Q10, and folic acid.2 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.3

References

1. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51-9.

2. Murray M, Pizzorno J. Encyclopedia of Natural Medicine, rev2d ed. Rocklin, CA: Prima Publishing, 1998, 722-9.

3. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619-28.

Gingivitis
Dose: Refer to label instructions

A 0.1% solution of folic acid used as a mouth rinse (5 ml taken twice a day for 30 to 60 days) has reduced gum inflammation and bleeding in people with gingivitis in double-blind trials.1, 2 The folic acid solution is rinsed in the mouth for one to five minutes and then spit out. Folic acid was also found to be effective when taken in capsule or tablet form (4 mg per day),3 though in another trial studying pregnant women with gingivitis, only the mouthwash-and not folic acid in pill form-was effective.4 However, this may have been due to the body's increased requirement for folic acid during pregnancy.

Phenytoin (Dilantin) therapy causes gum disease (gingival hyperplasia) in some people. A regular program of dental care has been reported to limit or prevent gum disease in people taking phenytoin.5, 6, 7 Double-blind research has shown that a daily oral rinse with a liquid folic acid preparation inhibited phenytoin-induced gum disease more than either folic acid in pill form or placebo.8

References

1. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619-28.

2. Vogel RI, Fink RA, Frank O, Baker H. The effect of topical application of folic acid on gingival health. J Oral Med 1978;33(1):20-2.

3. Vogel RI, Fink RA, Schneider LC, et al. The effect of folic acid on gingival health. J Periodontol 1976;47:667-8.

4. Pack ARC, Thomson ME. Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy. J Clin Periodontol 1980;7:402-14.

5. Francetti L, Maggiore E, Marchesi A, et al. Oral hygiene in subjects treated with diphenylhydantoin: effects of a professional program. Prev Assist Dent 1991;17(30):40-3 [in Italian].

6. Fitchie JG, Comer RW, Hanes PJ, Reeves GW. The reduction of phenytoin-induced gingival overgrowth in a severely disabled patient: a case report. Compendium 1989;10(6):314.

7. Steinberg SC, Steinberg AD. Phenytoin-induced gingival overgrowth control in severely retarded children. J Periodontol 1982;53(7):429-33.

8. Drew HJ, Vogel RI, Molofsky W, et al. Effect of folate on phenytoin hyperplasia. J Clin Periodontol 1987;14:350-6.

Gingivitis
Dose: Refer to label instructions
Migraine Headache
Dose: 5 mg per day In a preliminary trial, supplementation with 5 mg of folic acid per day for six months completely eliminated recurrent migraine attacks in 10 of 16 children and reduced the number of attacks by 50 to 75% in the other six children. The children selected to be in this study had elevated homocysteine levels (which can be reduced by folic acid supplementation), as well as a certain genetic characteristic known as a polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene.1 Further research is needed to determine whether folic acid supplementation would be beneficial for migraine patients who do not have these specific characteristics.
References

1. Di Rosa G, Attina S, Spano M, et al. Efficacy of folic acid in children with migraine, hyperhomocysteinemia and MTHFR polymorphisms. Headache 2007;47:1342-4.

Osteoporosis and High Homocysteine
Dose: 5 mg with 1,500 mcg of vitamin B12 dailyFolic acid, vitamin B6, and vitamin B12 are known to reduce blood levels of the amino acid homocysteine, and homocystinuria, a condition associated with high homocysteine levels, frequently causes osteoporosis. Therefore, some researchers have suggested that these vitamins might help prevent osteoporosis by lowering homocysteine levels.1 In a double-blind study of people who had suffered a stroke and had high homocysteine levels, daily supplementation with 5 mg of folic acid and 1,500 mcg of vitamin B12 for two years reduced the incidence of fractures by 78%, compared with a placebo.2 The reduction in fracture risk appeared to be due to an improvement in bone quality, rather than to a change in bone mineral density. However, supplementation with these vitamins did not reduce fracture risk in people who had only mildly elevated homocysteine levels and relatively high pretreatment folic acid levels.3 For the purpose of lowering homocysteine, amounts of folic acid and vitamins B6 and B12 found in high-potency B-complex supplements and multivitamins should be adequate.
References

1. Gaby AR. Preventing and Reversing Osteoporosis. Rocklin, CA: Prima Publishing, 1994, 88-9 [review].

2. Sato Y, Honda Y, Iwamoto J, et al. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. JAMA 2005;293:1082-8.

3. Sawka AM, Ray JG, Yi Q, et al. Randomized clinical trial of homocysteine level lowering therapy and fractures. Arch Intern Med 2007;167:2136-9.

Macular Degeneration
Dose: 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12

In a double-blind study of female health professionals who had cardiovascular disease or cardiovascular disease risk factors, daily supplementation with folic acid (2.5 mg), vitamin B6 (50 mg), and vitamin B12 (1 mg) for 7.3 years significantly decreased the incidence of age-related macular degeneration.1

References

1. Christen WG, Glynn RJ, Chew EY, et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med 2009;169:335-41.

Skin Ulcers
Dose: Consult a qualified healthcare practitioner

An older preliminary report suggested that large amounts of folic acid given both orally and by injection could promote healing of chronic skin ulcers due to poor circulation.1 No controlled research has further investigated this claim.

References

1. Kopjas TL. Effect of folic acid on collateral circulation in diffuse chronic arteriosclerosis. J Am Geriatr Soc 1966;14:1187-92.

Vitiligo
Dose: Refer to label instructions

A clinical report describes the use of vitamin supplements in the treatment of vitiligo.1Folic acid and/or vitamin B12 and vitamin C levels were abnormally low in most of the 15 people studied. Supplementation with large amounts of folic acid (1-10 mg per day), along with vitamin C (1 gram per day) and intramuscular vitamin B12 injections (1,000 mcg every two weeks), produced marked repigmentation in eight people. These improvements became apparent after three months, but complete repigmentation required one to two years of continuous supplementation. In another study of people with vitiligo, oral supplementation with folic acid (10 mg per day) and vitamin B12 (2,000 mcg per day), combined with sun exposure, resulted in some repigmentation after three to six months in about half of the participants.2 This combined regimen was more effective than either vitamin supplementation or sun exposure alone.

References

1. Montes LF, Diaz ML, Lajous J, Garcia NJ. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis 1992;50:39-42.

2. Juhlin L, Olsson MJ. Improvement of vitiligo after oral treatment with vitamin B12 and folic acid and the importance of sun exposure. Acta Derm Venereol 1997;77:460-2.

Psoriasis
Dose: Only for people who are not taking prescription drugs such as methotrexate that interfere with folic acid metabolism

Folic acid antagonist drugs have been used to treat psoriasis. In one preliminary report, extremely high amounts of folic acid (20 mg taken four times per day), combined with an unspecified amount of vitamin C, led to significant improvement within three to six months in people with psoriasis who had not been taking folic acid antagonists;those who had previously taken these drugs saw a worsening of their condition.1

References

1. Oster KA. A cardiologist considers psoriasis Cutis 1977;20:39-40,45.

Seborrheic Dermatitis
Dose: Refer to label instructions

One physician reported that injections of B-complex vitamins were useful in the treatment of seborrheic dermatitis in infants.1 A preliminary trial found that 10 mg per day of folic acid was helpful in 17 of 20 cases of adult seborrheic dermatitis.2 However, this study also found that oral folic acid did not benefit infants with cradle cap. A preliminary study found that topical application of vitamin B6 ointment (containing 10 mg B6 per gram of ointment) to affected areas improved adult seborrheic dermatitis.3 However, oral vitamin B6 (up to 300 mg per day) was ineffective. Injections of vitamin B12 were reported to improve in 86% of adults with seborrheic dermatitis in a preliminary trial.4 Oral administration of vitamin B12 for seborrheic dermatitis has not been studied.

References

1. Nisenson A. Treatment of seborrheic dermatitis with biotin and vitamin B complex. J Pediatr 1972;81:630-1 [letter].

2. Callaghan TJ. The effect of folic acid on seborrheic dermatitis. Cutis 1967;3:583-8.

3. Schreiner AW, Rockwell E, Vilter RW. A local defect in the metabolism of pyridoxine in the skin of persons with seborrheic dermatitis of the "sicca" type. J Invest Derm 1952;19:95-6.

4. Andrews GC, Post CF, Domnkos AN. Seborrheic dermatitis: supplemental treatment with vitamin B12. NY State Med J 1950;50:1921-5.

Dermatitis Herpetiformis
Dose: Refer to label instructions

People with DH frequently have mild malabsorption (difficulty absorbing certain nutrients) associated with low stomach acid (hypochlorhydria) and inflammation of the stomach lining (atrophic gastritis).1 Mild malabsorption may result in anemia2 and nutritional deficiencies of iron, folic acid,3, 4vitamin B12,5, 6 and zinc.7, 8, 9 More severe malabsorption may result in loss of bone mass.10 Additional subtle deficiencies of vitamins and minerals are possible, but have not been investigated. Therefore, some doctors recommend people with DH have their nutritional status checked regularly with laboratory studies. These doctors may also recommend multivitamin-mineral supplements and, to correct the low stomach acid, supplemental betaine HCl (a source of hydrochloric acid).

References

1. Yancy KB, Lawley TJ. "Immunologically Mediated Skin Diseases."Harrison's Online. 1999. http://www.harrisonsonline.com/hill-bin/Chapters.cgi (Jan 10, 2000).

2. Kastrup W, Mobacken H, Stockbrugger R, et al. Malabsorption of vitamin B12 in dermatitis herpetiformis and its association with pernicious anaemia. Acta Med Scand 1986;220:261-8.

3. Gawkrodger DJ, Ferguson A, Barnetson RS. Nutritional status in patients with dermatitis herpetiformis. Am J Clin Nutr 1988;48:355-60.

4. Hoffbrand AV, Douglas AP, Fry L, Stewart JS. Malabsorption of dietary folate (Pteroylpolyglutamates) in adult coeliac disease and dermatitis herpetiformis. Br Med J 1970;4:85-9.

5. Davies MG, Marks R, Nuki G. Dermatitis herpetiformis-a skin manifestation of a generalized disturbance in immunity. Q J Med 1978;47:221-48.

6. Kastrup W, Mobacken H, Stockbrugger R, et al. Malabsorption of vitamin B12 in dermatitis herpetiformis and its association with pernicious anaemia. Acta Med Scand 1986;220:261-8.

7. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706-12.

8. Gawkrodger DJ, Ferguson A, Barnetson RS. Nutritional status in patients with dermatitis herpetiformis. Am J Clin Nutr 1988;48:355-60.

9. Hoffbrand AV, Douglas AP, Fry L, Stewart JS. Malabsorption of dietary folate (Pteroylpolyglutamates) in adult coeliac disease and dermatitis herpetiformis. Br Med J 1970;4:85-9.

10. Di Stefano M, Jorizzo RA, Veneto G, et al. Bone mass and metabolism in dermatitis herpetiformis. Dig Dis Sci 1999;44:2139-43.

Restless Legs Syndrome
Dose: Refer to label instructions

In some people with RLS, the condition may be genetic. People with familial RLS appear to have inherited an unusually high requirement for folic acid. Although not all people with RLS suffer from uncomfortable sensations, folate-deficient people with this condition always do.1 In one report, 45 people were identified to be from families with folic acid-responsive RLS. The amount of folic acid required to relieve their symptoms was extremely large, ranging from 5,000 to 30,000 mcg per day.2 Such amounts should only be taken under the supervision of a healthcare professional.

References

1. Botez MI. Neuropsychological correlates of folic acid deficiency: facts and hypotheses. in: Botez MI, Reynolds EH, eds. Folic Acid in Neurology, Psychiatry and Internal Medicine. New York: Raven Press, 1979.

2. Botez MI. Folate deficiency and neurological disorders in adults. Med Hypotheses 1976;2:135-40.

HIV and AIDS Support
Dose: Refer to label instructions

In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS.1 Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS.2 It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group.3 In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival.4 Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.5

References

1. Kanter AS, Spencer DC, Steinberg MH, et al. Supplemental vitamin B and progression to AIDS and death in black South African patients infected with HIV. J Acquir Immune Defic Syndr 1999;21:252-3 [letter].

2. Butterworth RF, Gaudreau C, Vincelette J, et al. Thiamine deficiency in AIDS. Lancet 1991;338:1086.

3. Baum MK, Mantero-Atienza E, Shor-Posner G, et al. Association of vitamin B6 status with parameters of immune function in early HIV-1 infection. J Acquir Immune Defic Syndr 1991;4:1122-32.

4. Tang AM, Graham NMH, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency type 1 infection. Am J Epidemiol 1996;143:1244-56.

5. Boudes P, Zittoun J, Sobel A. Folate, vitamin B12, and HIV infection. Lancet 1990;335:1401-2.

Folic acid is a B vitamin 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 fetus, and rapidly regenerating cells, like red blood cells and immune cells, have a high need for folic acid. Folic acid deficiency results in a form of anemia that responds quickly to folic acid supplementation.

Copyright 2014 Aisle7. All rights reserved. Aisle7.com

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.

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