Folic Acid: Important for RA and for Mothers

  • Folic Acid Awareness Week is January 6-12, 2013 sponsored by the National Council on Folic Awareness (NCFA), a partnership of national organizations, associations, and state folic acid councils. The Center for Disease Control and Prevention (CDC) and the National Council on Folic Awareness emphasize that adequate folic acid intake is important for the prevention of birth defects.  

    As a person living with RA, I am aware of the importance of taking folic acid to help prevent some of the negative side-effects of methotrexate.  As a new bride, I am impressed with a simple effort by the county to raise awareness of the importance of folic acid in healthy pregnancies.

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    When Rob and I went to the county courthouse to apply for our marriage license, we received a large folder containing the information and paperwork required in the Commonwealth of Virginia to get married.  One brochure enclosed in our folder provided by Fairfax County focused on the importance of folic acid intake for every woman of childbearing age.  

    What is Folic Acid?

    Folic acid is a synthetic form of the B-vitamin folate that occurs naturally in some foods such as dark green leafy vegetables, dried beans and peas, and citrus fruits and juices.  Folic acid is part of many multi-vitamin supplements and is used to fortify select foods, including enriched breads, cereals, flours, cornmeals, pastas, rice, and other grain products.

    Folic acid is a water-soluble vitamin which is not stored in the body.  Any excess amount of folic acid which is not used by the body is excreted in urine.  You need to consume the recommended daily amount of folic acid by eating fortified foods, taking a daily multi-vitamin supplement, and eating a wide variety of foods as part of a healthy diet.

    Why is Folic Acid Important?

    Folate, or folic acid, is necessary for the production of healthy cells in the body.  Getting adequate amounts of folic acid, the synthetic form of folate, is important for the prevention of certain birth defects affecting a baby’s brain or spinal cord.  Common birth defects caused by folic acid deficiency include the neural tube defects (NTDs) spina bifida and anencephaly caused by incomplete closing of the spine and skull.  

    Getting enough folic acid during the month before becoming pregnant and in the early stages of pregnancy when the baby’s brain and spinal cord are forming can prevent from 50% up to 70% of neural tube defects.

    Whether or not you plan to become pregnant, all women of child-bearing age should consume 400 mcg to 800 mcg of folic acid daily.  Folate helps the body form red blood cells and produce DNA.  It also works with vitamins B12 and C to help the body create and metabolize proteins.

    Signs of folic acid deficiency may include diarrhea, gray hair, mouth ulcers, peptic ulcer, poor growth, swollen tongue (glossitis), and certain types of anemia.

    Recommended Daily Amounts of Folic Acid

    The amount of folic acid which you need to consume daily depends upon your age and gender, and other important factors such as certain illnesses and pregnancy.  Women who are pregnant or planning to become pregnant should take at least 400 mcg of folic acid every single day.  Pregnant women may need even higher levels of folic acid.

  • Here are recommended daily amounts of folic acid for individuals established by the Food and Nutrition Board of the Institute of Medicine:
        •    0 - 6 months: 65 mcg/day
        •    7 - 12 months: 80 mcg/day
        •    1 - 3 years: 150 mcg/day
        •    4 - 8 years: 200 mcg/day
        •    9 - 13 years: 300 mcg/day
    Adolescents and Adults
        •    Males age 14 and older: 400 mcg/day
        •    Females age 14 - 50: 400 mcg/day plus 400 mcg/day from supplements or fortified foods
        •    Females age 50 and over: 400 mcg/day

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    Taking excess amounts of folic acid by persons older than 50 years of age may mask vitamin B12 deficiency.  Ask your doctor what amount of folic acid is best for you or your family members to take daily.  

    Folic Acid and Methotrexate

    Methotrexate is a folate antagonist which is commonly prescribed for the treatment of rheumatoid arthritis and other autoimmune diseases.  Negative side-effects of methotrexate can include hair loss, upset stomach, and mouth ulcers.  Rheumatologists will often recommend or prescribe daily supplements of folic acid to help counterbalance these side-effects.  

    My rheumatologist initially prescribed 1000 mcg of daily folic acid when I began taking methotrexate in 2007.  After a study released in 2009 in the Journal of American Medical Association (JAMA) suggested that treatment  with folic acid plus vitamin B12 was associated with increased cancer risk, my rheumatologist recommended that I stop taking a daily dose of folic acid, which I did.  Only after I started to develop mouth sores did I begin to take 800 mcg of folic acid again which has kept my mouth healthy.

    These recommendations were personal to my own needs and do not necessarily reflect what your own doctor may recommend.  Talk to your doctor(s) about your own needs for vitamin and mineral supplementation.  In the meantime, be aware that approximately 50% of all pregnancies are unplanned and that it is important to be prepared physically for the possibility that you could become pregnant if you are of child-bearing age.


    Folic Acid in Diet - MedlinePlus Medical Encyclopedia


    Folic Acid Awareness Week 2013 - National Council on Folic Awareness


    Folic Acid - Centers for Disease Control and Prevention (CDC)


    Folic Acid: Frequently Asked Questions - Department of Health and Human Services (pdf)


    Folic Acid with Methotrexate: the Debate - RA Warrior, accessed January 6, 2013.  


    Ebbing M, et al.  Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12.  JAMA 2009;302(19):2119-2126. doi:10.1001/jama.2009.1622.


    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.


Published On: January 07, 2013