Potential Side Effects and Risks of Folic Acid : What You Need to Know

Folic acid safety grade

No side effects have been observed when doses of less than one milligram of folic acid are taken by adults, so folic acid is often safe for most people, but it is likely that taking large doses of it orally and in the long term is unsafe.

Although doses of up to 5 milligrams per day have been used safely in some research, doses of more than one milligram per day may cause some side effects, including abdominal cramps, diarrhea, rashes, sleep disturbances, as well as certain behavioral changes, skin allergies, and more.

There is concern that eating too much folic acid for a long time may cause serious side effects, as some research indicates that consuming it in doses ranging from (800-1200) micrograms per day may increase the risk of heart attack in people with heart problems, and other research indicates that taking these high doses may also increase the risk of some types of cancer, such as lung or prostate cancer.

For both pregnant and breastfeeding women, oral consumption of folic acid in appropriate quantities is often safe, and it should be noted that consuming the equivalent of (300-400) micrograms of folic acid per day is common during pregnancy to prevent birth defects.

Contraindications to the use of folic acid

Those who suffer from some health conditions should be careful when using folic acid, as its use in the form of dietary supplements may cause some harmful side effects, we mention the following cases :

Those who use the narrowed vasodilation technique known as angioplasty : those who use this technique should avoid consuming some B vitamins, as the use of folic acid, vitamin B6, and vitamin B12 orally may aggravate the state of narrowing of their arteries.
Cancer patients : early research suggests that taking about 800-1000 micrograms of folic acid per day may increase the risk of cancer. As a result, those with a history of cancer should avoid excessive intake of folic acid.
Heart patients : early research suggests that taking folic acid along with vitamin B6 may increase the risk of heart attack in people with a history of heart disease.
Malaria patients : early research suggests that taking folic acid along with iron may increase the risk of death, or may increase the need for hospital stays in areas of the world where malaria is common.
Patients with vitamin B12 deficiency anemia : taking folic acid may mask vitamin B12 deficiency anemia, delaying appropriate treatment.
Those with epileptic seizures : taking folic acid supplements may worsen the condition of people with epileptic seizures, especially at high doses of epileptic seizures.
Women in pregnancy : taking too many folic acid supplements during pregnancy may increase insulin resistance and slow the baby’s brain development.

Drug interactions with folic acid

Folic acid may interact with some medications, including the following :

Fluorouracil.
Capecitabine.
Fosphenytoin.
Methotrexate.
Phenobarbital.
Phenytoin.
Primidone.
Pyrimethamine.

Recommended amounts of folic acid

The following table shows the recommended dietary intake (RDAs) of folic acid :

Age Group	Reference dietary intake of folate (μg/day)
Children 1-3 years	150
Children 4-8 years	200
Children 9-13 years	300
Males and females aged 14 years and over	400
Pregnant women 14-18 years of age or older	600
Lactating women 14-18 years of age or older	500

Recommended Categories for Folic Acid Supplement Consumption

Enough folic acid can be obtained when following a balanced diet, so its deficiency is rare, however, official guidelines recommend that all pregnant women and women who may become pregnant take folic acid because it is necessary for the early development of the entire fetal parts, especially the spinal cord; it is one of the parts of the body that forms at the beginning of pregnancy, so folic acid deficiency can lead to spinal cord disorders. We note that there are some groups at risk of folic acid deficiency, which may need to use their supplements, including :

Some conditions that may affect the body’s ability to absorb folic acid from the digestive system, such as :
- Inflammatory bowel disease.
- Wheat allergy disease or other malabsorption disorders.
- Bariatric surgery.
Some groups that need more folic acid than usual, such as :
- Women in the period of breastfeeding.
- Infant.
- Cancer patients.
Other categories :
- Liver patients.
- Patients with chronic hemolytic anemia.
- Patients who wash the kidneys.
- Sufferers with high homocysteine levels in the blood.

Natural sources of folic acid

Here are the most important good sources of folic acid :

Green leafy vegetables, including kale, spinach, romaine lettuce, asparagus, Brussels sprouts, and broccoli.
Peanuts.
Sunflower seeds.
Fresh fruits, fruit juices.
Whole grains.
Liver meat.
Seafood.
Eggs.
Peas, chickpeas, beans.
Folic acid-fortified breakfast cereals.

Folic Acid Overview

Folic acid is one of the types of B vitamins that can be soluble in water, as it is not stored in the fatty tissue in the body, but excess amounts of it are excreted through urine, so its levels in the blood will decrease after a few weeks of a low-folate diet.

Folic acid has a key role in many vital functions in the body, such as building white and red blood cells, and contributing to the processes of energy production from carbohydrates, in addition to its role in the manufacture and production of DNA in the human body.

Folic acid deficiency may occur due to taking certain medications such as metformin, birth control pills, and methotrexate, in addition to some medical conditions, such as severe bleeding, liver disease, or malabsorption disorders, and consuming enough folic acid may help prevent some health conditions, including stroke, neural tube defects, age-related macular degeneration, and even some cancers.