FOLIC ACID AND ANEMIA

Folic acid

Folic acid, or rather folates, are water-soluble vitamins whose biologically active form is represented by "tetrahydrofolic acid (THF).
Folic acid is found above all in offal and in some foods of vegetable origin (of these, especially in beans, tomatoes and oranges). Some studies (carried out on different areas of the national territory) have highlighted the trend collective to take insufficient quantities of folic acid; this condition, in itself disadvantageous, worsens significantly in the elderly and especially in the male: deficiency estimated at 12% in women and 20% in men.
Folic acid is thermolabile; it is absorbed in the intestinal portion of the fast and mainly in fashion active (via a carrier) at pH 6, but also passively at a higher pH. The metabolic function of folic acid is to generate coenzymes useful for the transport of monocarbon units in the metabolism of amino acids and in the synthesis of nucleic acids, interacting biochemically with cobalamin (vit.B12); in short, folic acid participates in the production of nucleic acids (DNA and RNA - the defect of which causes anemia), in the transformation of homocysteine into methionine and in the metabolism of other amino acids.
It follows that the reduction of the metabolic activity of folic acid can cause various imbalances, among which the most important is undoubtedly the reduction of DNA and RNA synthesis; due to the reduced ability to replace "old" cells or damaged with "new" cells, tissues that need a turnover more frequent (cell turnover) are subjected to serious functional alterations. This condition has a heavy impact on the nervous tissue and in particular on the development of the spinal cord of the fetus (spina bifida) and on the cerebral degeneration of the elderly; moreover, the reduced ability to synthesize nucleic acids also significantly affects erythropoiesis by the bone marrow (the production of red blood cells) causing or aggravating the "anemia.
The recommended intake of folic acid is 200 µg / day, which doubles for the pregnant woman (in order to prevent neural complications of the newborn). Some studies carried out on undernourished patients have shown a good collective tolerance even at doses that reach i 5mg / day, albeit with the risk of concealing the deficiency manifestations due to insufficient cobalamin (vitamin B12).

Folic acid deficiency anemia

L"anemia is one of the reflex complications attributable to the reduced metabolic function of folic acid and / or cobalamin (vitamin B12). Such a condition can arise for several reasons:

Dietary deficiency of folic acid: as anticipated, folic acid is contained both in offal and in foods of plant origin. It is true that it is a heat-sensitive vitamin, therefore, it can be deduced that its integrity is lost with cooking food. Therefore, the contributions deriving from cooked offal or stewed legumes should not be fully considered, while the folates deriving from raw vegetables should be more intact; a "last consideration" must be made regarding the bioavailability of folic acid in foods. Some studies on the absorption capacity of folic acid have shown that VEGETABLE foods also contain chelating molecules capable of hindering the uptake of these vitamins; for example, beans have a folate bioavailability that reaches 80% while orange only 20%. To ensure the minimum amount of folate and to avoid the onset of anemia, it is advisable to consume RAW food of vegetable origin daily.

Alteration of the absorption of folic acid: it is generally rare but frequent in patients subject to surgical resections of one or more parts of the digestive tract, who often manifest anemia.

Use of drugs that hinder the metabolism of folic acid: some molecules such as methotrexate, i barbiturates they contraceptives they are responsible for the metabolic alteration involving folic acid. In the case of a similar drug therapy, the subject must take greater care of the nutritional intake of folate in order to avoid the onset of anemia.

Symptoms

Anemia caused by the ineffectiveness of folic acid is characterized by the medullary production of NOT mature, larger, more colored and less efficient erythrocytes.
The characteristic symptoms of this anemia are superimposable and often concomitant with those of cobalamin deficiency; in addition to the generalized fatigue typical of all anemic forms, there is an involvement of the gastrointestinal system (presence of anti-mucosal antibodies) but above all of the nervous system, through the manifestation of numbness, absence of reflexes and lack of motor coordination.

Wanting to classify folic acid deficiency anemia, we could define that:

while making an "appropriate distinction of the etiological cause, it is a set of symptoms and clinical manifestations that can be superimposed on pernicious and / or megaloblastic anemia. In fact, folic acid acts synergistically with cobalamin in the synthesis of nucleic acids and therefore the deficiency of one, the other or both, often favors the appearance of an almost similar clinical picture.