Folic acid is necessary for growth and cellular repair, since it is a critical component of DNA and RNA as well as essential for the formation and maturation of red blood cells. Folic acid deficiency is one of the most common of all vitamin deficiencies. Although it occurs in both males and females, folic acid deficiency anemia most often affects women over age 30. It becomes increasingly common as age impedes the body's ability to absorb folic acid, a water-soluble vitamin that is manufactured by intestinal bacteria and stored for a short time in the liver. Folic acid deficiency has also been implicated as a cause of neural tube defects in the developing fetus. Recent research has shown that adequate amounts of folic acid can prevent up to one-half of these birth defects, if women start taking folic acid supplements shortly before conception. Research from China in 2004 showed that women who were low in B vitamins and folate before conception, though not technically anemic, still had increased risk of lower birth weight babies and adverse pregnancy outcome.

A healthy adult needs at least 400 mcg of folic acid every day. Requirements at least double during pregnancy, and increase by 50% when a woman is breastfeeding. The average American diet, high in fats, sugar, and white flour, provides about 200 mcg of folic acid, approximately the amount needed to maintain tissue stores of the substance for six to nine months before a deficiency develops. Most of the folic acid in foods (with the exception of the folic acid added to enriched flour and breakfast cereals) occurs as folate. Folate is only about pne-half as available for the body to use as is the folic acid in pills and supplements. Folate also is easily destroyed by sunlight, overcooking, or the storing of foods at room temperature for an extended period of time.

Good dietary sources of folate include:

• leafy green vegetables
• liver
• mushrooms
• oatmeal
• peanut butter
• red beans
• soy
• wheat germ

This condition usually results from a diet lacking in foods with high folic acid content, or from the body's inability to digest foods or absorb foods having high folic acid content. Other factors that increase the risk of developing folic acid deficiency anemia are:

• age
• alcoholism
• birth control pills, anticonvulsant therapy, sulfa antibiotics, and certain other medications
• illness
• smoking
• stress

Fatigue is often the first sign of folic acid deficiency anemia. Other symptoms include:

• anorexia nervosa
• pale skin
• paranoia
• rapid heart beat
• sore, inflamed tongue
• weakness
• weight loss

Diagnostic procedures include blood tests to measure hemoglobin, an iron-containing compound that carries oxygen to cells throughout the body. Symptoms may be reevaluated after the patient has taken prescription folic acid supplements.

Folic acid supplements are usually prescribed, and self-care includes avoiding:

• alcohol
• non-herbal tea, antacids, and phosphates (contained in beer, ice cream, and soft drinks), which restrict iron absorption
• tobacco

A person with folic acid deficiency anemia should rest as often as necessary until restored energy levels make it possible to resume regular activities. A doctor should be seen if fever, chills, muscle aches, or new symptoms develop during treatment, or if symptoms do not improve after two weeks of treatment.

Alternative therapies for folic acid deficiency anemia may include reflexology concentrated on areas that influence the liver and spleen. Increasing consumption of foods high in folate is helpful. Eating a mixture of yogurt (8 oz) and turmeric (1 tsp) also may help resolve symptoms. A physician should be contacted if the tongue becomes slick or smooth or the patient:

• bruises or tires easily
• feels ill for more than five days
• feels weak or out of breath
• looks pale or jaundiced

Although adequate folic acid intake usually cures this condition in about three weeks, folic acid deficiency anemia can make patients infertile or more susceptible to infection. Severe deficiencies can result in congestive heart failure.

Eating raw or lightly cooked vegetables every day will help maintain normal folic acid levels, as will taking a folic acid supplement containing at least 400 mcg of this vitamin. Because folic acid deficiency can cause birth defects, all women of childbearing age who can become pregnant should consume at least 400 mcg of folic acid daily; a woman who is pregnant should have regular medical checkups, and take a good prenatal vitamin.