FOLIC ACID SELF STUDY

Carolyn Jenkins MSN, RN-BCSusan Eviston RD,LD

Sarah Greenslade CDR, NESUpdated Fall 2012

Objectives for Folic Acid Self Study:

At the end of the self study, the participant will be able to:

1) Describe the structure and functions of Folic Acid.

2) Identify signs and symptoms and associated problems relating to deficiency in folic acid.

3) Recognize populations that might be at risk of decrease folic acid level.

4) Review two methods clients can use to assure adequate folic acid intake and the resulting health benefits.

• Folic Acid is a water soluble Vitamin B complex found in some vitamins and FORTIFIED foods.

• FORTIFIED foods have folic acid added to them. Some breakfast cereals are FORTIFIED with Folic Acid by the manufacturers.

• Folic Acid found naturally in the food we eat is called Folate.

STRUCTUREOF FOLIC ACID

Folic Acid (Folate) is a water soluble vitamin. Does this mean it can be stored in the body?

(Circle your answer)

A. Yes

B. No

If you answered B (No) you are correct.Folic Acid is NOT stored in the body.

• Folic Acid is a Water Soluble Vitamin. This means folic acid dissolves in water when swallowed, then goes in to the blood stream. The body keeps what it needs and excretes excess in the urine. Our bodies DO NOT store water soluble vitamins like folic acid. Everyone needs a continuous supply of water soluble vitamins to remain healthy.

• Vitamins stored in the body are called Fat Soluble Vitamins. When fat soluble vitamins are ingested, they dissolve in fat. In a person with a healthy digestive system, the body uses what it needs at that time and stores the rest in the body for future use. Fat soluble vitamins can build up in the body to toxic levels.

What does Folic Acid do in our body?(Circle your answer)

A. Assists with Red Blood Cell Production

B. Assists with forming digestive acids.

C. Assists with breaking down and using proteins.

D. Assists with formation of DNA, RNA and prevents changes in DNA that can lead to cancer.

E. All of the above.

Folic Acid:A. Assists with Red Blood Cell Production by carrying the

carbon molecule to hemoglobin in the red blood cells. Hemoglobin carries oxygen in the blood to all parts of the body.

If you answered E (All of the above) you are correct.

Folic Acid:B. Assists with forming digestive acids

by working with Vitamin B12 andVitamin C. Digestive acids help the

body digest and use proteins.

Folic Acid:C. Assists with breaking down and using proteins

including the breakdown of Homocysteine (amino acid).

HIGH PROTEIN FOODS

Folic Acid:

D. Assists with formation of DNA, RNA and prevents changes in DNA that can lead to birth defects and cancer.

What parts of the body do you think would be affected when folic acid levels are low? (Circle your answer)

A. Skin and nails.B. Heart and BrainC. Bones and teeth.D. Vision and hearing.

• WEAKNESS• FATIGUE• HEAD ACHE• BEHAVIOR CHANGE: INCLUDING IRRITABILITY, DEPRESSION

•SHORTNESS OF BREATH• RAPID BREATHING• RAPID HEART BEAT• PALE• ANEMIA (LARGE IMMATURE) RED BLOOD CELLS

MANY OF THE SIGNS & SYMPTOMS OF LOW FOLIC ACID ARE RELATED TO ANEMIA AND LOWER LEVELS OF OXYGEN CARRYING HEMOGLOBIN IN THE BLOOD.

• LOSS OF APPETITE• DIARRHEA• LOSS OF WEIGHT

If you answered B (heart and brain) you are correct.

DECREASED FOLIC ACID IS ALSO ASSOCIATED WITH:• Increased homocysteine levels associated

with heart problems and strokes.

• Some cancers, memory problems, and gastrointestinal problems.

• Birth defects including spina bifida and other neural tube defects, cleft lip and palate, miscarriages, preterm labor, and low birth weight.

What population is most at risk for a decreased folic acid level?

A.

B.

C.

(Circle your answer)

Adult Males

Reproductive Age Females

Children

• Reproductive age women• Pregnant• Breast Feeding• Inadequate diet• Malnutrition• Alcohol Abuse• Disturbance in digestion and absorption of

food• Anemias (ex: Sickle Cell)• Elderly• Cancer• Medications

oral contraceptives anti-inflammatories Antacids metformin for diabetes. Dilantin for seizures.

If you answered C (Reproductive Aged Women) you are correct.

Populations and medical reasons associated with Folic Acid Deficiency:

• There are 3,000 pregnancies affected by spina bifida or anencephaly, which are neural tube defects (NTDs) caused by the incomplete closing of the spine and skull.

• 50% to 70% of these NTDs could be prevented if women took 400 mcg of folic acid daily before pregnancy and 600 mcg a day when pregnant.

• Half of all pregnancies are unplanned.

• An estimated 1,000 more babies are born healthy since foods have been FORTIFIED with folic acid.

Each year in the United States:

http://www.cdc.gov/ncbddd/folicacid/data.html

South Carolina Department of Health and Environmental Control ML-009074

Hispanic/Latina Women

• Have the highest rate among women for having a child affected by neural tube defects including spina bifida or anencephaly.

• Have lower blood folate levels and are less likely to consume foods FORTIFIED with folic acid.

• Are less likely to have heard about folic acid, to know it can prevent birth defects, or take vitamins containing folic acid before pregnancy.

http://www.cdc.gov/ncbddd/folicacid/data.html

• Reproductive age women• Pregnant• Breast Feeding• Inadequate diet• Malnutrition• Alcohol Abuse• Disturbance in digestion and absorption of food• Anemias (ex: Sickle Cell)• Elderly• Cancer• Medications

oral contraceptives anti-inflammatories Antacids Metformin for diabetes. Dilantin for seizures.

The populations and medical reasons listed below are associated with Folic Acid Deficiency and should consume more Folate rich foods and take Folic acid supplements:

A. Oranges, AvocadosB. Butter, EggsC. Rice, Noodles D. String Beans, Cauliflower

Which foods are high in Folate, the naturally occurring Folic Acid?

(Circle your answer)

FRUIT GROUP FOODS HIGH IN FOLATE(THE NATURALLY OCCURRING FOLIC ACID)

• AVOCADOS• ORANGE JUICE• ORANGES• HONEYDEW & CANTALOUPE

If you answered A (oranges & Avocados) you are correct.

Fruits Serving Size Folate (μg) %DVAvocado 1/2c sliced 59 15Papaya 1c cubes 52 13Orange Juice 1c 47 12Strawberries 1c 40 10Cantaloupe 1c cubes 34 9Orange 1 small 29 7Banana 1 medium 24 6

Fruits

0

10

20

30

40

50

60

70

1/2c sliced 1c cubes 1c 1c 1c cubes 1 small 1 medium

Avocado Papaya Orange Juice Strawberries Cantaloupe Orange Banana

Food Item

Fo

late

(m

cg)

PROTEIN GROUPFOODS HIGH IN FOLATE(THE NATURAL OCCURRING FOLIC ACID)

• CHICKEN, BEEF, AND TURKEY LIVER• CRANBERRY BEANS• CHICK PEAS / HUMMUS• LIMA BEANS• KIDNEY BEANS• BLACK BEANS• GREAT NORTHERN BEANS• PINTO BEANS• NAVY BEANS• LENTILS • BAKED BEANS• BLACK EYED PEAS• SUNFLOWER SEEDS

Meat/Beans Serving Size Folate (μg) %DVBeef liver 3oz 215 54Lentils 1/2c 179 45Great Northern beans 1/2c 90 23Peanuts 1oz (approx 28) 41 10Vegetarian baked beans 1c 30 8Egg 1 whole 24 6

Meat & Beans

0

50

100

150

200

250

3oz 1/2c 1/2c 1oz (approx 28) 1c 1 w hole

Beef liver Lentils Great Northernbeans

Peanuts Vegetarian bakedbeans

Egg

Food item

Fo

late

(m

cg)

VEGETABLE GROUP FOODS HIGH IN FOLATE(THE NATURAL OCCURRING FOLIC ACID)

• OKRA• ARTICHOKE• BRUSSEL SPROUTS• BEETS• ASPARAGUS• SPINACH• BROCCOLI• CORN

Vegetables

0

20

40

60

80

100

120

140

1/2c 1c 5 spears 1c 1/2c 1/2c 2 spears(5in)

1/2c

Spinach(frozen,cooked)

Mustardgreens

(cooked)

Asparagus Spinach(raw )

Corn(canned)

Broccoli(frozen,cooked)

Broccoli(raw )

Romainelettuce

Food Item

Fo

late

(m

cg)Vegetables Serving Size Folate (μg) %DV

Spinach (frozen, cooked) 1/2c 115 29Mustard greens (cooked) 1c 102 26Asparagus 5 spears 100 25Spinach (raw) 1c 58 15Corn (canned) 1/2c 52 13Broccoli (frozen, cooked) 1/2c 51 13Broccoli (raw) 2 spears (5in) 40 10Romaine lettuce 1/2c 32 8

A. Table Salt B. Breakfast CerealC. Meat and FishD. Milk and Cheese

Do you know what foods are FORTIFIED with Folic Acid?

(Circle your answer )

FOLIC ACID FORTIFIED FOODS(BE SURE TO READ THE NUTRITION LABEL AND

INGREDIENT LIST)

• READY TO EAT CEREALS: INCLUDING WIC APPROVED CEREALS• OATMEAL• ENRICHED PASTA• ENRICHED EGG NOODLES• ENRICHED BREADS, BAGELS, MUFFINS• ENRICHED WHITE RICE

If you answered B (breakfast cereal) you are correct.

GRAINS RICH IN FOLATE(THE NATURAL OCCURRING FOLIC ACID

• WHOLE GRAINS & WHEAT GERM

Grains Serving Size Folate (μg) %DV

Cereal (100% fortified) 3/4c 400 100

Pasta (enriched, cooked) 1c 160 40Flour Tortilla (enriched) 1 10-in tortilla 140 35Oatmeal (instant, cooked) 1 package 125 31

Cereal (fortified) 3/4c 100 25White Rice (enriched,cooked) 1/2c 77 19Wheat germ (crude) 2 Tbsp 40 10Bread (fortified, whole wheat) 1 slice 14 4

Grains

0

50

100

150

200

250

300

350

400

450

3/4c 1c 1 10-in tortilla 1 package 3/4c 1/2c 2 Tbsp 1 slice

Cereal (100%fortified)

Pasta(enriched,cooked)

Flour Tortilla(enriched)

Oatmeal(instant,cooked)

Cereal(fortified)

White Rice(enriched,cooked)

Wheat germ(crude)

Bread (fortified,whole wheat)

Food Item

Fo

late

(m

cg

)

Food And Drug Administration(FDA)

Under the terms of the new FDA rule (February 29, 1996): • Fortification levels will range from 0.43 milligrams to 1.4

mg per pound of product. • Fortification of grain products at these levels will allow the

daily intake from all sources to remain below the recommended upper limit of 1 mg per day.

• The amount of folic acid that will be consumed through foods fortified at these levels is considered safe for all population (age/gender) groups.

• Manufacturers will be allowed to make claims on the labels that the fortified products contain folic acid and that adequate intake of the nutrient may reduce the risk of neural tube defects.

Junod. S.W.(2001). Folic Acid Fortification: Fact and Folly. Posted on FDA website and updated 4/14/2009.

http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SelectionsFromFDLIUpdateseriesonFDAHistory/ucm091883.htm

A. 100 microgramsB. 400 microgramsC. 750 microgramsD. 1000 micrograms

Do you know how much Folic Acid should be consumed by women of child bearing age? (Circle your answer )

The United States Public Health Service and Center for Disease

Control recommend that all women of childbearing age consume 400

micrograms of folic acid every day to reduce their risk of a pregnancy with birth defects including spinal bifida

and other neural tube defects.

http://www.cdc.gov/ncbddd/folicacid/recommendations.html

If you answered B (400mcg) you are correct.

Go to this web site: http://www.cdc.gov/ncbddd/folicacid/quiz.html• Read each question and then CLICK ON the answer you think is correct. • If you want more information before selecting your choice,  just click the HINT button beside the question. • When you finish the test, CLICK PRINT, and send a copy of the test with your self study verification and the evaluation to your supervisor.

How Much Do You Know About Folic Acid?

Try your hand at this quiz. 

References:

• Centers for Disease Control and Prevention. Folic Acid Data and Statistics. Retrieved 8/30/2012 from http://www.cdc.gov/ncbddd/folicacid/data.html

• Centers for Disease Control and Prevention. Folic Acid Recommendations. Retrieved 8/30/2012 from http://www.cdc.gov/ncbddd/folicacid/recommendations.html

• University of Florida. (2012). Florida Folic Acid Coalition. Folic Acid Food Chart. Retrieved 8/29/2012 from http://www.folicacidnow.net/folic_acid/food_chart.shtml

• Junod. S.W.(2001). Folic Acid Fortification: Fact and Folly. Posted on FDA website and updated 4/14/2009. Retrieved 8/30/12 from http://www.fda.gov/AboutFDA/WhatWeDo/History/ProductRegulation/SelectionsFromFDLIUpdateseriesonFDAHistory/ucm091883.htm

• Mason, M.K. (2009). Folic Acid ( Folate ). Retrieved 8/30/12 from http://www.moyak.com/papers/folic-acid-vitamin-B9.html

• National Institute of Health Office of Dietary Supplements. Dietary Supplement Fact Sheet: Folate. Retrieved 8/29/2012 from http://ods.od.nih.gov/factsheets/folate.asp

• South Carolina Department of Health and Environmental Control. Folate / Folic Acid. ML-009074 Revised 7/05.

• United States Department of Agriculture. Choose a Food Group. Retrieved 8/30/12 from http://www.choosemyplate.gov/food-groups/

• National Institute of Health General Medical Sciences. The Chemistry of Health Chapter 1: Actions and Reactions. Retrieved 8/30/2012 from http://publications.nigms.nih.gov/chemhealth/coh.pdf