Mechanism: Folic acid is important for formation of red blood cells, create new proteins as well as DNA synthesis.

Dietary sources: Folate is found naturally in a wide variety of foods, such dark green leafy vegetables, fruits and fruit juices, nuts, beans, peas, dairy products, poultry and meat, eggs, seafood, and grains. Spinach, liver, yeast, asparagus, and Brussels sprouts are among the foods with the highest levels of folate. By FDA requirement, manufacturers add folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products, since 1998. This accounts for 100-180mcg per day.

Pregnancy: decreased incidence of Spina bifida (opening of the spine) and anencephaly (failure of the brain to develop). Because of its role in the synthesis of DNA and other critical cell components, folate is especially important during phases of rapid cell growth. Supplement 400-800mcg before pregnancy occurs since the neural tube closes between day 21 and 28 after conception. If high risk for spina bifida, may use up to 4mg (4000mcg). All women of childbearing capability should be taking supplemental folic acid of at least 400mcg. Since 1998, when the mandatory folic acid fortification program took effect in the United States, spinal bifida and anencephaly rates have declined by 25% to 30%. Keep in mind that half of pregnancies in the United States are unplanned, adequate folate status is especially important even before conception (planned or unplanned) occurs.

Alcoholism: People with alcohol dependence frequently have poor-quality diets that contain insufficient amounts of folate.

DRUGS that LOWER folic acid

· Seizure medications: CYP450 inducers (phenytoin, phenobarbital, carbamazepine)

· Birth control pills

· Proton pump inhibitors (PPI’s) such as omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium) and others, by blocking acid formation reduce folic acid absorption.

· Histamine-2 Receptor Antagonists (H2RA such as famotidine (Pepcid) and cimetidine (Tagamet) decrease acid release and lower absorption of folic acid.

· Methotrexate (for Rheumatoid Arthritis)

· Sulfasalazine (Azulfidine®) for rheumatoid arthritis and ulcerative colitis- by inhibiting the intestinal absorption of folate.

• Folic Acid is available in multivitamins, prenatal vitamins, single entity over the counter 400mcg and 800mcg, and prescription strength 1mg.

Lots of vitamins are available in our vitamin aisle, probably none is more important than folic acid. That’s the pharmacist and grandfather in me talking!