Folic acid is absorbed through food and plays a crucial role in many processes in the human body. Accordingly, a deficiency of folic acid has a strong impact on our health. However, in our latitudes, no one has to suffer from such a deficiency – there are enough foods that can effectively prevent or combat folic acid deficiency and supply folic acid.
What is folic acid deficiency?
Who suffers from folic acid deficiency, whose organism is too little of this vital vitamin available to be able to work optimally. The reason that folic acid is particularly known as the “pregnancy vitamin” is that folic acid is needed to form DNA. This, of course, comes into play particularly during and especially in the early stages of pregnancy. But folic acid is also simply needed for cell division. Cell division is one of the most important processes in life. Blood cells and mucous membrane cells, i.e. cells that divide particularly often, show a folic acid deficiency particularly early on. For example, folic acid deficiency can lead to anemia, anemia of the blood. The human folic acid store is the liver. When this store is depleted, the lack of folic acid becomes noticeable.
Causes
People who take in too little folic acid in their diet and do not take a supplemental vitamin preparation risk folic acid deficiency. The liver can store a lot of folic acid, but if not enough is supplied, then even this depot is once exhausted. However, this does not have to happen at all, because folic acid is contained in many different foods. Of course, deficiency symptoms can also occur if too few of these foods, such as green vegetables, are consumed. However, pregnancy is a particularly frequent reason for a deficiency. Pregnant women have an enormously increased need for folic acid. No wonder, then, that in this country people are advised to take additional folic acid not only if they are already pregnant, but also if they simply want to have children. But not only pregnancy leads to folic acid deficiency, also the excessive consumption of alcohol, smoking or taking various medications can plunder the folic acid stores of the body and lead to a deficiency.
Symptoms, complaints and signs
A folic acid deficiency leads primarily to anemia with pronounced poor performance and fatigue. Since not only the production of red blood cells but also that of leukocytes (white blood cells) and platelets is impaired, there is also an increased susceptibility to infection and increased bleeding. In addition to fatigue, anemia is also manifested by difficulty concentrating, conspicuous pallor, and a reddened and inflamed tongue. In severe cases, even cardiac arrhythmias and breathing difficulties occur, because the body can no longer be properly supplied with oxygen due to the lack of red blood cells. As a result of the increased susceptibility to infection, there is a risk of severe infections. At the same time, the increased bleeding tendency frequently leads to mucosal bleeding, bruising and punctiform hemorrhages in the skin. Other symptoms include loss of appetite and severe weight loss. In pregnancies, there may be increased miscarriage and malformed births with neural tube defects (open back). The nervous system is also affected by folic acid deficiency. Thus, in addition to anemia, adults sometimes experience mental deterioration, lack of concentration and memory lapses, and even dementia. Furthermore, susceptibility to stress is increased and sometimes nerve pain also occurs. In children, folic acid deficiency manifests itself in severe physical and mental developmental disorders due to impaired cell division. In addition to neural tube defects (open back), the formation of the brain and skull may also be disturbed.
Diagnosis and course
If a folic acid deficiency has been diagnosed, then a preparation is usually prescribed that quickly supplies the body with a sufficient amount of the vital vitamin. A quick response is also necessary, because since the symptoms are not very specific, the deficiency is usually only recognized late. A drop in performance, a generally listless feeling, constant fatigue and weakness in concentration could fit in with many clinical pictures.Only when the stores are really empty and the anemia becomes noticeable with weight loss, cardiac arrhythmia and similar symptoms, does the deficiency usually become apparent. In most cases, sufficient folic acid can no longer be supplied quickly enough through food, so concentrated preparations are needed. A daily dose of 5 to 15 milligrams of folic acid is considered a guideline – at least at the beginning of treatment.
Complications
Folic acid deficiency that lasts for several weeks can lead to regression of the mucous membranes, which in turn can result in mucosal inflammation of the mouth, gastrointestinal tract, and also the urogenital tract. Wounds and injuries to the mucous membranes heal more slowly. A lack of blood platelets (thrombocytopenia) and anemia can occur, including a form of anemia that is rare in this country, megaloblastic anemia. Other symptoms caused by folic acid deficiency include diarrhea, nausea, weight loss, and inflammation of the tongue (glossitis). Other possible complications include hair loss, skin problems and depressive moods. Folic acid deficiency also increases homocysteine levels in the blood. Homocysteine can attack blood vessel walls, causing oxidized LDL cholesterol to be deposited there more quickly. In the long term, this results in a narrowing of the blood vessels and arteriosclerosis. This in turn is a significant risk factor for heart attack and stroke. In unborn children, a folic acid deficiency in the pregnant mother can lead to severe malformations of the embryo. These malformations include neural tube defects such as the so-called open back (spina bifida) and anencephaly (missing parts of the skull roof, meninges, scalp and brain). In addition, folic acid deficiency may increase the risk of premature birth or miscarriage.
When should you see a doctor?
If you experience chronic fatigue, difficulty concentrating, and pallor, you may have a folic acid deficiency. A visit to the doctor is recommended if the symptoms do not subside on their own within three to five days or if other complaints are added. If symptoms such as palpitations, shortness of breath or dizziness occur even during light physical exertion, a doctor should be consulted in the next few days. Diarrhea, persistent breathing difficulties and cardiovascular problems that severely impair well-being are best clarified immediately. If a folic acid deficiency is present, it must be treated in any case. Otherwise, the deficiency can take a severe course and possibly lead to memory loss, neurological deficits or even a heart attack. Children, the elderly and the sick are particularly at risk. Allergy sufferers and patients with a congenital immune deficiency or a hormonal imbalance should also talk to their family doctor if they have the symptoms mentioned. Other contacts are internists and specialists for the symptom in question. In a medical emergency, the emergency medical services must be alerted.
Treatment and prevention
Those who eat a balanced diet basically need not fear a folic acid deficiency. Many foods receive enough of the vital vitamin to supply the human organism adequately. Green vegetables in particular are recommended. Green leafy vegetables and lettuce in particular, but also cabbage varieties and asparagus contain plenty of it. The same applies to almonds and legumes, but also to egg yolk and liver. Since folic acid is found in many different food groups, including whole grain products, for example, vegetarians and vegans are just as likely to get enough folic acid from their diet as omnivorous eaters. Those who consume these foods – green vegetables, whole grains, egg, etc. -will automatically get plenty of folic acid. People with increased needs – such as pregnant women – would do well in any case to take an additional supplement. However, it should be borne in mind that an occasional or even daily pill can in no way replace a healthy diet, but always only supplement it – this is no different with folic acid.
Follow-up
In most cases, folic acid deficiency cannot be treated by aftercare measures. The patient is primarily dependent on direct medical treatment of this condition to prevent further complications. In most cases, this even involves lifelong therapy, since folic acid deficiency cannot be treated from scratch.The affected person is usually dependent on the intake of certain foods or on the intake of supplements to counteract this deficiency. Special complications or other measures are usually not necessary. Regular intake of these medications or foods must be ensured in order to limit the folic acid deficiency. Regular examinations by a doctor are also very useful. In pregnant women, special measures are necessary in the case of folic acid deficiency so that the child is not damaged in its development by this deficiency. First and foremost, a doctor should be consulted who can treat the folic acid deficiency properly. Regular examinations are also very useful here. Further measures are usually not necessary to treat this disease. It also does not reduce the life expectancy of the affected person.
Outlook and prognosis
Normally, the prognosis for folic acid deficiency is favorable. The deficiency can be reduced within a few days and weeks by changing and optimizing the diet. In most cases, freedom from symptoms is achieved within the next few months. In the case of a severe deficiency, the organism can be additionally supported by the administration of medication, especially in the initial phase of treatment. If a relapse occurs in the course of life and the folic acid deficiency recurs, the prognosis is also favorable. People who smoke or consume excessive amounts of alcohol should consistently change their lifestyle habits to improve their health. In these patients, the folic acid store steadily decreases over the course of several years until a deficiency symptom develops. As soon as the affected person stops consuming the harmful substances and is prepared to eat a healthy, balanced diet, his or her state of health improves. The prognosis is particularly unfavorable for pregnant women in the early stages of gestation. Severe folic acid deficiency can lead to malformations of the embryo, premature birth or miscarriage. The malformations cannot be corrected in the further course of development. In the expectant mother, the abnormalities or the loss of the child increase the likelihood of a psychological sequelae. This contributes to a substantial deterioration in the general sense of health.
Here’s what you can do yourself
If a folic acid deficiency is suspected, a blood test should be ordered from the attending family physician. If this deficiency is confirmed, dietary supplements help to provide the folic acid in high concentration. Compensating for the deficiency with food would take too much time and could lead to a worsening of the symptoms. However, for the further course of treatment, a conscious diet with foods rich in folic acid is recommended. These include a wide variety of leafy vegetables and cabbage, and asparagus is also rich in folic acid. Other sources of folic acid are whole-grain products and hen’s eggs, as well as almonds, liver and legumes. Eggplants and all herbs also supply the body with the important folic acid. Basically, all green vegetables are very rich in folic acid. Ideally, they should only be steamed before consumption to preserve the high content of vital substances. Between 75 and 100 percent of the important vitamin is lost through boiling and frying. Strong chopping also reduces the folic acid content. It is recommended to consume herbs and vegetables in raw form, spread throughout the day. With a consistently balanced diet, the risk of continued folic acid deficiency is minimal. Vegetarians and vegans can also meet their needs very well through a plant-based diet. Pregnant women have an increased need and should take a folic acid supplement during this time.
