acid supplement (400 mcg for most women and higher
does for those who have already had a baby with a
neural tube defect). Good natural sources of folate
include beef liver, green leafy vegetables, and dried
beans. Cooking animal products does not reduce the
folate content much, but cooking vegetables can
reduce the amount of folate by up to 40% depending
on the vegetable and the cooking method.
The following list gives the approximate folate/
folic acid content for some common foods:
asparagus, cooked, 1/2 cup: 132 mcg
spinach, cooked, 1/2 cup: 131 mcg
turnip greens, cooked, 1/2 cup: 135 mcg
broccoli, steamed 1/2 cup: 85 mcg
beets, boiled; 1/2 cup: 68 mcg
great northern beans, cooked 1/2 cup: 90 mcg
pinto beans, cooked, 1/2 cup: 147 mcg
navy beans, cooked, 1/2 cup: 127 mcg
tomato juice, canned, 6 ounces: 35 mcg
raspberries 1/2 cup: 16 mcg
corn, yellow, cooked, 1/2 cup: 37 mcg
breakfast cereal, fortified 100%, 3/4 cup: 400 mcg
bread, white or whole wheat 1 slice: 25 mcg
rice, white, enriched long-grain, cooked, 1/2 cup:
65 mcg
bread, whole wheat, 1 slice: .07 mg
bread, white, enriched, 1 slice: .09 mgFolate deficiency
Most healthy people in the United States get
enough folate in their diet because folate is added to
many common foods such as bread; however, this is
not the case elsewhere.In Europe, low intakes are
commonly reported particularly in teenage girls and
older people. Causes of folate deficiency include inad-
equate intake, impaired absorption, (celiac disease,
Crohn’s disease, certain medications), inability of the
body to use folate (enzyme deficiencies), increased
folate needs (pregnancy, cancer), or increased loss or
excretion (kidney dialysis, alcoholism). As a group,
the elderly are the largest group at risk to develop
folate deficiency.
The major symptom of folate deficiency in preg-
nant women is having a baby born with a brain or
spinal cord abnormality. Other symptoms of folate
deficiency include slow growth in infants and children,
megaloblastic anemia, digestive problems such as
diarrhea, sore tongue, irritability, forgetfulness and
changes in mental state. These changes can also haveother causes and should be evaluated by a healthcare
professional.PrecautionsSince many pregnancies are unplanned and unrec-
ognized until after the critical period for brain and
spinal cord formation, any woman who may become
pregnant should be careful to include enough folate in
her diet and folic acid supplements should be taken
before and in the first trimester of pregnancy.
Folic acid may mask vitamin B 12 deficiency. Folic
acid supplements will reverse anemia symptoms, but
they do not stop nerve damage caused by B 12 defi-
ciency. Permanent nerve damage may result. People
with suspected folate deficiency who begin taking folic
acid supplements should also be evaluated for vitamin
B 12 deficiency.InteractionsThe following medications may interfere with the
ability of the body to absorb and use folate. Individu-
als taking these medications should check with their
physician about the effects they may have on folate/
folic acid levels in the body:
seizure medications such as dilantin, phenytoin, and
primidone
metaformin (Fortamet, Glucophage, Glucophage
XR, Riomet) used to treat type 2 diabetes
sulfasalazine used to treat Chron’s disease and inflam-
matory bowel disease
triameterene, a diuretic or ‘‘water pill’’
barbiturate sedatives
methotrexate, used to treat cancer, rheumatoid arthri-
tis, and psoriasis
drugs used to treat gastroesophageal reflux disease
(GERD), such as omeprazole (Prilosec), lansoprazole
(Prevacid), cimetidine (Tagamet), famotidine (Pep-
sid), nizatidine (Axid), or ranitidine (Zantac)ComplicationsNo complications are expected when folate/folic
acid is taken within recommended levels. Complica-
tions related to deficiencies are discussed above. Com-
plications of excess folic acid intake at levels above
1,000 mcg daily over an extended period can include
seizures in individuals taking anticonvulsant medica-
tions and general irritability, and restlessness in other-
wise healthy individuals.Folate