Vitamin B9, Food Source, Deficiency Symptoms, Health Benefit

Vitamin B9 is one of the B vitamins. Folic acid is a form of vitamin B-9 that can dissolve in water. It is a key ingredient in the making of the nucleic acid that forms part of all genetic material.The recommended daily intake of folate in the US is 400 micrograms from foods or dietary supplements. Folate in the form of folic acid is used to treat anemia caused by folic acid deficiency. Folic acid is also used as a supplement by women during pregnancy to prevent neural tube defects(NTD) in the baby. Low levels in early pregnancy are believed to be the cause of more than half of babies born with neural tube defects. More than 50 countries use fortification of certain foods with folic acid as a measure to decrease the rate of NTDs in the population. Long term supplementation is also associated with small reductions in the risk of stroke and cardiovascular disease.It may be taken by mouth or by injection.

Symptoms of Vitamin B9 Deficiency

Folic acid deficiency occurs when the newborn baby does not receive enough of this vitamin in the womb. A fetus that has received insufficient quantities of folic acid has strong possibilities of being born with spina bifida and may also suffer from serious defects of the nervous system.

Deficiency of folic acid may also lead to the following

occurrence of acne
cracked lips
Loss of appetite
weight loss can occur
weakness,
sore tongue,
headaches,
heart palpitations,
irritability, and
behavioral disorders
anemia(macrocytic, megaloblastic anemia) can be a sign of advanced folate deficiency.
Women with folate deficiency who become pregnant are more likely to give birth to low birth weight premature infants, and infants with neural tube defects.
In infants and children, folate deficiency can lead to failure to thrive or slow growth rate,
diarrhea,
oral ulcers,
megaloblastic anemia,
neurological deterioration.
Microcephaly,
seizures,
blindness and cerebellar ataxia can also be observed.
cracking on the corners of the mouth
sore tongue
feeling of tiredness
nausea
osteoporosis
anemia
chronic fatigue syndrome
high blood pressure
Alzheimer’s disease
cancer of the cervix, rectum and bowel

Folic acid has many roles to play in the development of bones and iron uptake by the cells. Hence its deficiency may lead to malfunctioning of the vital systems.

Recommended Intakes of Vitamin B9

Intake recommendations for folate and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies (formerly National Academy of Sciences) . DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and gender, include:

Recommended Dietary Allowance (RDA) – Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals.
Adequate Intake (AI) – Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA.
Estimated Average Requirement (EAR) – Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals.
Tolerable Upper Intake Level (UL) – Maximum daily intake unlikely to cause adverse health effects.

Table 1 lists the current RDAs for folate as micrograms (mcg) of dietary folate equivalents (DFEs). The FNB developed DFEs to reflect the higher bioavailability of folic acid than that of food folate. At least 85% of folic acid is estimated to be bioavailable when taken with food, whereas only about 50% of folate naturally present in food is bioavailable . Based on these values, the FNB defined DFE as follows:

1 mcg DFE = 1 mcg food folate
1 mcg DFE = 0.6 mcg folic acid from fortified foods or dietary supplements consumed with foods
1 mcg DFE = 0.5 mcg folic acid from dietary supplements taken on an empty stomach

For infants from birth to 12 months, the FNB established an AI for folate that is equivalent to the mean intake of folate in healthy, breastfed infants in the United States.

**Recommended Dietary Allowances (RDAs) for Folate**
Age	Male	Female	Pregnant	Lactating
Birth to 6 months*	65 mcg DFE*	65 mcg DFE*
7–12 months*	80 mcg DFE*	80 mcg DFE*
1–3 years	150 mcg DFE	150 mcg DFE
4–8 years	200 mcg DFE	200 mcg DFE
9–13 years	300 mcg DFE	300 mcg DFE
14–18 years	400 mcg DFE	400 mcg DFE	600 mcg DFE	500 mcg DFE
19+ years	400 mcg DFE	400 mcg DFE	600 mcg DFE	500 mcg DFE

* Adequate Intake (AI)

Food Source of Vitamin B9

**Selected Food Sources of Folate and Folic Acid**
Food	mcg DFE per serving	Percent DV*
Beef liver, braised, 3 ounces	215	54
Spinach, boiled, ½ cup	131	33
Black-eyed peas (cowpeas), boiled, ½ cup	105	26
Breakfast cereals, fortified with 25% of the DV†	100	25
Rice, white, medium-grain, cooked, ½ cup†	90	23
Asparagus, boiled, 4 spears	89	22
Spaghetti, cooked, enriched, ½ cup†	83	21
Brussels sprouts, frozen, boiled, ½ cup	78	20
Lettuce, romaine, shredded, 1 cup	64	16
Avocado, raw, sliced, ½ cup	59	15
Spinach, raw, 1 cup	58	15
Broccoli, chopped, frozen, cooked, ½ cup	52	13
Mustard greens, chopped, frozen, boiled, ½ cup	52	13
Green peas, frozen, boiled, ½ cup	47	12
Kidney beans, canned, ½ cup	46	12
Bread, white, 1 slice†	43	11
Peanuts, dry roasted, 1 ounce	41	10
Wheat germ, 2 tablespoons	40	10
Tomato juice, canned, ¾ cup	36	9
Crab, Dungeness, 3 ounces	36	9
Orange juice, ¾ cup	35	9
Turnip greens, frozen, boiled, ½ cup	32	8
Orange, fresh, 1 small	29	7
Papaya, raw, cubed, ½ cup	27	7
Banana, 1 medium	24	6
Yeast, baker’s, ¼ teaspoon	23	6
Egg, whole, hard-boiled, 1 large	22	6
Vegetarian baked beans, canned, ½ cup	15	4
Cantaloupe, raw, 1 wedge	14	4
Fish, halibut, cooked, 3 ounces	12	3
Milk, 1% fat, 1 cup	12	3
Ground beef, 85% lean, cooked, 3 ounces	7	2
Chicken breast, roasted, ½ breast	3	1

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* DV = Daily Value. The FDA developed DVs to help consumers compare the nutrient contents of products within the context of a total diet. The DV for folate is 400 mcg for adults and children aged 4 and older. However, the FDA does not require food labels to list folate content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

† Fortified with folic acid as part of the folate fortification program.

The U.S. Department of Agriculture’s Nutrient Database Web site lists the nutrient content of many foods and provides a comprehensive list of foods containing folate arranged by nutrient content and by food name.

Health Benefit of Vitamin B9

Folate deficiency. Taking folic acid improves folate deficiency.
Serious kidney disease. About 85% of people with serious kidney disease have high levels of homocysteine. High levels of homocysteine have been linked to heart disease and stroke. Taking folic acid lowers homocysteine levels in people with serious kidney disease. However, folic acid supplementation does not appear to reduce the risk of heart disease-related events.
High amounts of homocysteine in the blood (hyperhomocysteinemia). High levels of homocysteine have been linked to heart disease and stroke. Taking folic acid lowers homocysteine levels by 20% to 30% in people with normal to slightly elevated homocysteine levels. It is recommended that people with homocysteine levels greater than 11 micromoles/L supplement with folic acid and vitamin B12.
Reducing harmful effects of a medicine called methotrexate. Taking folic acid seems to reduce nausea and vomiting, which are possible side effects of methotrexate treatment.
Birth defects (neural tube defects). Folic acid during pregnancy reduces the risk of neural tube birth defects. It is recommended that pregnant women get 600-800 mcg of folic acid per day from their diet or supplements starting 1 month before pregnancy and during pregnancy. Pregnant women with a history of neural tube birth defects are advised to get 4000 mcg of folic acid per day.

Possibly Effective for

Age-related vision loss (age-related macular degeneration). Research shows that taking folic acid with other vitamins including vitamin B6 and vitamin B12 reduces the risk of developing age-related vision loss.
Depression. Limited research shows that taking folic acid along with antidepressants seems to improve symptoms in people with depression.
High blood pressure. Research shows that taking folic acid daily for at least 6 weeks reduces blood pressure in people with high blood pressure. But Taking folic acid with blood pressure medication does not seem to lower blood pressure more than taking only blood pressure medicine
Gum problems due to a drug called phenytoin. Applying folic acid to the gums seems to prevent gum problems caused by phenytoin. However, taking folic acid by mouth does not seem to improve symptoms of this condition.
Gum disease during pregnancy. Applying folic acid to the gums seems to improve gum disease during pregnancy.
Stroke. Taking folic acid can reduce the risk of stroke by 10% to 25% in people who live in countries that don’t fortify grain products with folic acid. But folic acid doesn’t seem to prevent strokes in most people who live in countries that do fortify grain products with folic acid.
A skin discoloration disorder called vitiligo. Taking folic acid by mouth seems to improve symptoms of vitiligo.
Cancer of the white blood cells (acute lymphoblastic leukemia). Taking folate during pregnancy does not reduce the risk of childhood cancer of the white blood cells.
Iron deficiency. Taking folic acid with iron supplements is not more effective than taking the iron supplements without folic acid for treating and preventing iron deficiency and anemia caused by too little iron in the body.
Memory and thinking skills in older people. Most research shows that taking folic acid does not prevent decline in memory and thinking skills in the elderly.
Preventing re-blockage of blood vessels after angioplasty. There is inconsistent evidence on the benefits of taking folic acid after a procedure to widen the blood vessels. But taking folic acid plus vitamin B6 and vitamin B12 might actually interfere with healing in cases where a device (stent) is inserted in the blood vessel to keep it open.
Breast cancer. Consuming folate in the diet might lower the risk of developing breast cancer in women who also eat high amounts of methionine, vitamin B12 (cyanocobalamin), or vitamin B6 (pyridoxine), but research is not consistent. Other research suggests that taking folic acid supplements alone does not lower the risk of breast cancer.
Heart disease. Most research shows that taking folic acid alone or with other B vitamins does not reduce the risk of death or heart disease-related events in people with heart disease.
Cataracts. Research shows that taking folic acid with other vitamins including vitamin B6 and vitamin B12 does not prevent cataracts. In fact, it might increase the chance of needing to have cataracts removed.
Chronic fatigue syndrome. Daily injections of folic acid appear to have no effect on symptoms of chronic fatigue syndrome.
Diarrhea. Taking a specific nutritional supplement with added folic acid and possibly vitamin B12 does not seem to prevent diarrhea in children at risk of malnutrition. Taking this product may increase the risk of having diarrhea last more than a few days.
Preventing falls. Taking folic acid with vitamin B-12 does not seem to prevent falls in older people who are also taking vitamin D.
Fetal and early infant death. Taking folic acid during pregnancy does not seem to reduce the risk of having a baby die just before or after birth.
Toxicity from the drug lometrexol. Daily injections of folic acid appear to have no effect on symptoms of chronic fatigue syndrome.
Lower respiratory tract infections.Taking a specific nutritional supplement with added folic acid and possibly vitamin B12 does not seem to prevent infections in the lungs in children at risk of malnutrition.
Weak bones (osteoporosis). In elderly individuals with osteoporosis, taking folic acid with vitamin B12 and possibly vitamin B6 (pyridoxine) does not seem to prevent broken bones.
Performance in older people. Taking folic acid with vitamin B-12 doesn’t seem to help older people walk better or have stronger hands.
Growths in the large intestine and rectum (colorectal adenoma).Taking folic acid supplements does not seem to prevent growths in the large intestine or rectum.
Inherited disease called Fragile-X syndrome.Taking folic acid by mouth does not improve symptoms of fragile-X-syndrome.
Premature infants. Taking folic acid during pregnancy does not decrease the risk of having a premature baby.

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Insufficient Evidence for

Acne. Limited evidence suggests that taking a specific nutritional supplement, containing vitamin B3 (nicotinamide), a compound isolated from grains (azelaic acid), zinc, vitamin B6 (pyridoxine), copper, and folic acid (NicAzel, Elorac Inc., Vernon Hills, IL) appears to reduce inflammation associated with pimples on the face.
Alzheimer’s disease. Limited evidence suggests that elderly people who consume more folic acid than the recommended dietary allowance (RDA) appear to have a lower risk of developing Alzheimer’s disease than people who consume less folic acid.
Autism. Limited research suggests taking folic acid during pregnancy might reduce the risk of autism in the child.
Beta-thalassemia. Beta-thalassemia is a disorder of the blood that results in the production of less hemoglobin, the protein that carries oxygen in the blood. Patients with beta-thalassemia usually have bone and muscle pain and have less strength. In children with this disorder, limited research suggests taking folic acid by itself, or with L-carnitine a compound similar to an amino acid from protein, might reduce bone pain and help increase strength.
Bipolar disorder. Taking folic acid does not appear to improve the antidepressant effects of lithium in people with bipolar disorder. However, taking folate with the medication valproate improves the effects of valproate.
Cervical cancer. There is some evidence that increasing folic acid and folate intake from dietary and supplement sources, along with thiamine, riboflavin, and vitamin B12, might help to prevent cervical cancer.
Long-term kidney disease (chronic kidney disease, CKD). Taking folic acid might help slow kidney function decline in people with CKD. But it is not beneficial when used along with vitamin B12 (cyanocobalamin). In fact, the combination might make kidney disease worse.
Colon cancer, rectal cancer. Research suggests that taking folic acid or eating folate in the diet can reduce the risk of developing colon or rectal cancer. However, there is some research that does not suggest that taking folic acid or folate in the diet offers the same benefit. It is possible that folic acid may be more helpful for preventing colon cancer than rectal cancer or it may be more helpful for specific kinds of colon cancer.
Diabetes. Taking folic acid supplements does not seem to benefit people with diabetes.
Epilepsy. Taking folic acid does not reduce seizures in people with epilepsy.
Esophageal cancer. Research suggests that consuming more folate in the diet lowers the risk for developing esophageal cancer.
High amounts of homocysteine in the blood caused by the drug fenofibrate.Taking folic acid every other day might lower levels of homocysteine in the blood caused by the drug fenofibrate.
Stomach cancer. Research suggests that taking folic acid reduces the risk of developing some types of stomach cancer.
Gout. Early research suggests that folate might reduce the risk of gout.
Head and neck cancer. Getting more folic acid from the diet has been linked to a lower risk of head and neck cancer.
Hearing loss. Low levels of folate in the blood seem to be related to the risk for sudden hearing loss in adults. Some evidence suggests that taking folic acid daily for 3 years slows the decline of hearing loss in older people who have low folate levels. It is not clear if folic acid supplementation reduces hearing loss in people with normal folate levels.
Male infertility. Some research suggests that taking folic acid plus zinc sulfate daily can increase sperm count in men with low sperm counts.
Low birth weight. Taking folic acid during pregnancy does not prevent some babies from being born at a low birth weight but it does seem to increase the overall average of birth weights. However, some early research suggests that taking folic acid before getting pregnant might reduce the risk of having a baby that is too small even when born full term. Although this risk is not reduced in mothers that start supplementation after the baby is conceived.
Lung cancer. There does not appear to be a relationship between low levels of folic acid and lung cancer in most people.
A type of skin cancer called melanoma. Early research shows that taking folic acid might reduce the risk of melanoma.
Helping medicines used for chest pain work longer. Some evidence suggests that taking folic acid does not help medications for chest pain (nitrates) work longer.
Cleft lip. Some research suggests that taking folic acid during pregnancy lowers the risk of left lip. However, other research shows no effect.
Pancreatic cancer. Eating more than 280 mcg of folate in the diet daily is linked to a lower risk of developing pancreatic cancer. However, other research suggests that folate intake is not linked to pancreatic cancer risk.
Nerve pain (peripheral neuropathy). There is conflicting evidence about the role of folic acid in nerve pain for people with diabetes (diabetic neuropathy). Some research suggests that taking folic acid with vitamin B6 (pyridoxine) and vitamin B12 improves some symptoms of nerve pain so that people feel happier. However, the nerves do not seem to function any better.
Cancer of the throat. Limited research suggests folic acid and folate from dietary and sources and supplements may protect against oropharyngeal cancer, a specific type of throat cancer.
Pre-eclampsia. Pre-eclampsia is marked by high blood pressure and protein in the urine during pregnancy. Limited research suggests taking folic acid supplements during pregnancy does not reduce the risk of pre-eclampsia.
Pregnancy-induced high blood pressure. Limited research suggests that taking folic acid during pregnancy does not reduce the risk of high blood pressure (gestational hypertension).
A disorder that causes a strong urge to move ones legs (restless legs syndrome; RLS). Taking folic acid seems to reduce symptoms of restless legs syndrome. Researchers are studying whether folic acid deficiency causes restless legs syndrome.
Schizophrenia. Taking a combination of folic acid and vitamin B12 may reduce some of the negative symptoms associated with schizophrenia, but only in some patients with a specific genetic make-up. In most people, folic acid does not help with these symptoms.
Sickle-cell disease. Taking folic acid might lower homocysteine levels. However, it is not known if this will benefit people with sickle-cell disease.
Alcoholism.
Liver disease.

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The European Food Safety Authority (EFSA), which provides scientific advice to assist policy makers, has confirmed that clear health benefits have been established for the dietary intake of folate (vitamin B9) in contributing to:

normal blood formation;
normal homocysteine;
normal metabolism of the immune system;
normal cell division;
normal maternal tissue growth during pregnancy;
normal amino acid synthesis;
normal psychological functions;
the reduction of tiredness and fatigue;
maintenance of normal vision;
In addition, the EFSA has confirmed that supplemental folate intake increases maternal folate status, which contributes to the reduction of the risk of neural tube defects (NTD).

Possible Interactions

If you are currently being treated with any of the following medications, you should not use folic acid supplements without first talking to your doctor.

Antibiotics, tetracycline: Folic acid should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Folic acid, either alone or in combination with other B vitamins, should be taken at different times from tetracycline. All vitamin B-complex supplements act in this way and should be taken at different times from tetracycline.

Phenytoin (Dilantin): Phenytoin, an anti-seizure medication, may lower levels of folate in the body. However, folic acid may interfere with the way phenytoin works, raising the risk of seizures. Ask your doctor before taking folic acid supplements.

Pyrimethamine (Daraprim): Pyrimethamine is a medication used to prevent and treat malaria and to treat toxoplasmosis. Folic acid may make this medication less effective.

Chemotherapy medications: Folic acid may raise the amounts of 5-fluorouracil and capecitabine (Xeloda) to dangerous levels in the body. If you are undergoing chemotherapy, ask your oncologist before taking any supplements or herbs.

Medications that lower levels of folic acid: The following medications may interfere with the body’s absorption of folate, meaning you may need to take a folic acid supplement while taking them. Talk to your doctor first.

Antacids.
H2 blockers: Used to reduce stomach acid, including cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac).
Proton pump inhibitors: Used to reduce stomach acid, including someprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and rabeprazole (Aciphex).
Bile acid sequestrants: Used to lower cholesterol, including colestipol (Colestid), cholestyramine (Questran), and colsevelam (Welchol).
Anti-seizure medications: Including phenobarbital, primidone (Mysoline), and carbamazepine (Tegretol).
Nonsteroidal anti-inflammatory drugs (NSAIDs): Including ibuprofen (Advil, Motrin) and naproxen (Aleve).
Sulfasalazine (Azulfidine): Used to treat inflammatory bowel disease (IBD) and rheumatoid arthritis (RA).
Triamterene (Dyrenium): A diuretic (water pill).
Cycloserine: An antibiotic.
Pyrimethamine (Daraprim): Used to prevent and treat malaria and to treat toxoplasmosis.
Trimethoprim: An antibiotic used to treat urinary tract infections.

When taken for long periods of time, these medications, as well as other anti-inflammatory medicines, can increase the body’s need for folic acid.

Methotrexate: Methotrexate, a medication used to treat cancer, rheumatoid arthritis (RA), and psoriasis, reduces the amount of folic acid in the body. If you take methotrexate for RA or psoriasis, your doctor may prescribe a higher dose of folic acid, which helps reduce the side effects of methotrexate. People taking methotrexate for cancer, however, should not take folic acid supplements unless their doctor tells them to. Folic acid may interfere with methotrexate’s effects on cancer.

Precautions

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider.

At the recommended daily allowance, side effects from folic acid are rare. Very high doses can cause:

Stomach problems
Sleep problems
Skin reactions
Confusion
Loss of appetite
Nausea
Seizures

Talk to your doctor before taking more than 800 mcg of folic acid. Folic acid can hide the symptoms of an underlying vitamin B12 deficiency, which can cause permanent damage to the nervous system. Taking any one of the B vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, you may want to take a B-complex vitamin, which includes all the B vitamins.

People who are being treated for seizures or cancer should not take folic acid without talking to their doctors.