Folate deficiency
Classification and external resources
Folic acid (B9)
ICD-10	D52. E53.8
ICD-9	266.2
DiseasesDB	4894
MedlinePlus	000354
eMedicine	med/802
MeSH	D005494

Folate deficiency is a lack of folic acid in the diet and the signs are often subtle.

[edit] Symptoms

Loss of appetite, and weight loss can occur. Additional signs are weakness, sore tongue, headaches, heart palpitations, irritability, and behavioral disorders.^[1]

Women with folate deficiency who become pregnant are more likely to give birth to low birth weight and premature infants, and infants with neural tube defects. In adults, anemia (Macrocytic, Megaloblastic anemia) can be a sign of advanced folate deficiency. In infants and children, folate deficiency can slow growth rate.

A study suggests that folate deficiency increases a person's risk for noise-induced hearing loss, especially in married white men.^[2]

Late studies suggested an involvement in tumorogenesis (especially in colon) through demethylation/hypomethylation of fast replicating tissues.

Some of the symptoms can also result from a variety of medical conditions other than folate deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given.

[edit] Causes

A deficiency of folate can occur when the body's need for folate is increased, when dietary intake of folate is inadequate, or when the body excretes (or loses) more folate than usual. Medications that interfere with the body's ability to use folate may also increase the need for this vitamin.^{[3][4][5][6][7][8]} Some research indicates that exposure to ultraviolet light, including the use of tanning beds, can lead to a folic acid deficiency. [1]

[edit] Situational

Some situations that increase the need for folate include:

• pregnancy and lactation (breastfeeding)
• tobacco smoking
• malabsorption, including coeliac disease
• kidney dialysis
• liver disease
• certain anemias

[edit] Pharmacological

Medications can interfere with folate utilization, including:

• anticonvulsant medications (such as phenytoin, and primidone)
• metformin (sometimes prescribed to control blood sugar in type 2 diabetes)
• sulfasalazine (used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis)
• triamterene (a diuretic)
• methotrexate, an anti-cancer drug also used to control inflammation associated with Crohn's disease, ulcerative colitis and rheumatoid arthritis.

Folic acid supplements are normally given with sulfasalazine. The purpose of methotrexate is to inhibit dihydrofolate reductase and thereby reduce the rate de novo purine and pyrimidine synthesis and cell division. It may therefore be counter-productive to take a acid supplement with methotrexate. Although the folic acid inhibition of sulfasalazine is normally seen as a side effect, it is possible that it is a part of the therapeutic effect of the drug, given that methotrexate, a frank folic acid inhibitor, is often given if sulfasalazine fails. It would therefore be wise to consult with a physician before taking a folic acid supplement along with sulfasalazine or methotrexate.

[edit] Prevention and treatment

When cooking, use of steaming or of a food steamer can help keep more folate content in the cooked foods, thus helping to prevent folate deficiency (see USDA reference in the steaming article).

Folate deficiency during human pregnancy has been associated with an increased risk of infant neural tube defects. Such deficiency during the first four weeks of gestation can result in structural and developmental problems. NIH guidelines^[9] recommend oral B vitamin supplements to decrease these risks near the time of conception and during the first month of pregnancy.

[edit] References

[edit] External links

• 496631815 at GPnotebook