FOLIC ACID SELF STUDY Carolyn Jenkins MSN, RN-BC Susan Eviston RD,LD Sarah Greenslade CDR, NES Updated 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.
STRUCTURE• Folic Acid is a water soluble OF FOLIC ACID 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.
Folic Acid (Folate) is a water solublevitamin. Does this mean it can bestored 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 inwater when swallowed, then goes in to the blood stream. The body keeps whatit needs and excretes excess in the urine. Our bodies DO NOT store watersoluble vitamins like folic acid. Everyone needs a continuous supply of watersoluble vitamins to remain healthy.• Vitamins stored in the body are called Fat Soluble Vitamins. When fat solublevitamins are ingested, they dissolve in fat. In a person with a healthy digestivesystem, the body uses what it needs at that time and stores the rest in the body forfuture 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.
If you answered E (All of the above) you are correct.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.
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 andprevents changes in DNA that can lead tobirth defects and cancer.
What parts of the body do you thinkwould be affected when folic acid levelsare low? (Circle your answer) A. Skin and nails. B. Heart and Brain C. Bones and teeth. D. Vision and hearing.
If you answered B (heart and brain) you are correct.MANY OF THE SIGNS & SYMPTOMS OF LOW FOLIC ACIDARE RELATED TO ANEMIA AND LOWER LEVELS OFOXYGEN CARRYING HEMOGLOBIN IN THE BLOOD. • WEAKNESS • FATIGUE • HEAD ACHE • BEHAVIOR CHANGE: INCLUDING IRRITABILITY, DEPRESSION •SHORTNESS OF BREATH • RAPID BREATHING • LOSS OF APPETITE • RAPID HEART BEAT • DIARRHEA • PALE • LOSS OF WEIGHT • ANEMIA (LARGE IMMATURE) RED BLOOD CELLS
DECREASED FOLIC ACID ISALSO 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 riskfor a decreased folic acid level? (Circle your answer) A. Adult Males B. Children C. Reproductive Age Females
If you answered C (Reproductive Aged Women) you are correct.Populations and medical reasonsassociated with Folic Acid Deficiency: • 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.
Each year in the United States:• 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. http://www.cdc.gov/ncbddd/folicacid/data.htmlSouth 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
The populations and medical reasons listed beloware associated with Folic Acid Deficiency andshould consume more Folate rich foods and takeFolic acid supplements: • 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.
Which foods are high in Folate, the naturally occurring Folic Acid? (Circle your answer) A. Oranges, Avocados B. Butter, Eggs C. Rice, Noodles D. String Beans, Cauliflower
If you answered A (oranges & Avocados) you are correct. FRUIT GROUP FOODS HIGH IN FOLATE (THE NATURALLY OCCURRING FOLIC ACID) • AVOCADOS • ORANGE JUICE • ORANGES • HONEYDEW & CANTALOUPE Fruits 70 60 50 Folate (mcg) 40Fruits Serving Size Folate (μg) %DV 30Avocado 1/2c sliced 59 15 20Papaya 1c cubes 52 13Orange Juice 1c 47 12 10Strawberries 1c 40 10 0Cantaloupe 1c cubes 34 9 1/2c sliced 1c cubes 1c 1c 1c cubes 1 small 1 mediumOrange 1 small 29 7 Avocado Papaya Orange Juice Strawberries Cantaloupe Orange BananaBanana 1 medium 24 6 Food Item
PROTEIN GROUP FOODS 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 250 200 Folate (mcg) 150 100Meat/Beans Serving Size Folate (μg) %DV 50Beef liver 3oz 215 54 0Lentils 1/2c 179 45 3oz 1/2c 1/2c 1oz (approx 28) 1c 1 w holeGreat Northern beans 1/2c 90 23 Beef liver Lentils Great Northern Peanuts Vegetarian baked EggPeanuts 1oz (approx 28) 41 10 beans beansVegetarian baked beans 1c 30 8 Food itemEgg 1 whole 24 6
Do you know what foods areFORTIFIED with Folic Acid? (Circle your answer ) A. Table Salt B. Breakfast Cereal C. Meat and Fish D. Milk and Cheese
If you answered B (breakfast cereal) you are correct. 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
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
Do you know how much Folic Acidshould be consumed by women ofchild bearing age? (Circle your answer ) A. 100 micrograms B. 400 micrograms C. 750 micrograms D. 1000 micrograms
If you answered B (400mcg) you are correct. The United States Public Health Service and Center for DiseaseControl recommend that all women of childbearing age consume 400micrograms of folic acid every day toreduce their risk of a pregnancy with birth defects including spinal bifida and other neural tube defects. http://www.cdc.gov/ncbddd/folicacid/recommendations.html
How Much Do You Know About Folic Acid? Try your hand at this quiz.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 HINTbutton beside the question.• When you finish the test, CLICK PRINT, and send a copy of the test with yourself study verification and the evaluation to your supervisor.
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