Folic Acid
Chester J. Zelasko, Ph.D. | May 7, 2002

Almost every week, more information is being reported about the relationship between folic acid and disease. Recently, the American Stroke Association, a division of the American Heart Association, reported a study showing that people who had a folic acid intake greater than 300 mcg had a reduced risk of having a stroke. This adds to the building evidence that folic acid has a role to play in guarding the health of the cardiovascular and neural systems.

Prior research demonstrated that folic acid can help prevent neural tube defects in pregnant woman. The evidence was so overwhelming that processed foods, especially grain products such as bread and pasta, are required to be fortified with folic acid. The effort has paid off--the U.S. Center for Disease Control has reported a 19% decrease in neural tube defects since the folic acid fortification program began (1). Folic acid also seems to play a role in preventing heart disease and Alzheimer's disease.

Folic acid, also known as folate or folacin, is a B vitamin. It primarily functions as a co-enzyme in many biochemical reactions involving protein metabolism. The exact role folic acid has in preventing disease is still not well understood. However, it seems to be related to homocysteine, an intermediate product in the metabolism of the amino acid methionine. High blood levels of homocysteine have been found in people who have heart attacks, strokes, and Alzheimer's Disease (2-3). Folic acid, whether from foods or food supplements, reduces homocysteine levels especially when combined with vitamin B12.

So what should you do? It depends. Every woman of childbearing age should be sure to get 400-800 mcg of folic acid every day. The reason is that the neural tube in the fetus develops before a woman knows she is pregnant. By the time she finds out, it is too late--so it's essential to have an adequate intake during this stage of a woman's life.

If you have a family history of heart disease, stroke, or Alzheimer's disease, the first step is to consult with your healthcare professional to see if you have elevated homocysteine levels. Serum homocysteine levels can be measured with a simple blood test. Your doctor may also test the levels of folic acid, B6, and B12. Once the numbers are in, you and your healthcare professional can develop a strategy for optimal health.

That strategy will probably include increasing your folic acid intake. Eat more foods that contain folic acid such as vegetables, nuts, beans, and fruits. The Dietary Approaches to Stop Hypertension (DASH) trial included a diet rich in fruits, vegetables, and low-fat dairy foods and low in saturated fat, total fat, and cholesterol; the diet also included whole grains, poultry, fish, and nuts. Researchers found that it significantly and quickly lowers blood pressure and also lowers homocysteine levels (4). Interestingly, folic acid is absorbed twice as well from enriched foods or supplements than it is from natural foods (5). Eating grains such as breads or pasta also adds calories, so you must adjust your diet to compensate for the additional calories. It may be simpler to take a multivitamin or stress B-complex that contains at least 400-800 mcg of folic acid.

Here's an interesting side note. With the recent prevalence of high-protein diets, researchers recently examined the effects of a high-protein diet on the risk factors, including homocysteine levels, for the progression of atherosclerosis in patients with disease (6). While other subjects using a more traditional diet improved, those on the high-protein diet continued to experience a progression of the disease. It may have been partially caused by the lack of nutrients, including folic acid, in the diet.

It reiterates what we've always recommended at Better Life Unlimited: eat your fruits and vegetables every day!


  1. Honein MA, et al. Impact of Folic Acid Fortification of the US Food Supply on the Occurrence of Neural Tube Defects. JAMA. 2001. 285:2981-2986.
  2. Clarke R, et al. Folate, Vitamin B12, and Serum Total Homocysteine Levels in Confirmed Alzheimer Disease. Arch Neurol. 1998. 55:1449-1455.
  3. Seshadri S, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med. 2002. 346(7):476-83.
  4. Appel LJ, et al. Effect of dietary patterns on serum homocysteine: results of a randomized, controlled feeding study. Circulation 2000. 102(8):852-7.
  5. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academy of Sciences. 2000.
  6. Fleming RM. The effect of high-protein diets on coronary blood flow. Angiology 2000. 51(10):817-26.
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