Folic Acid Self Study

1. FOLIC ACID SELF STUDY
Carolyn Jenkins MSN, RN-BC
Susan Eviston RD,LD
Sarah Greenslade CDR, NES
Updated Fall 2012

2. 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.

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. Folic Acid:
B. Assists with forming digestive acids
by working with Vitamin B12 and
Vitamin C. Digestive acids help the
body digest and use proteins.

9. Folic Acid:
C. Assists with breaking down and using proteins
including the breakdown of Homocysteine (amino
acid).
HIGH PROTEIN FOODS

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

11. 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 Brain
C. Bones and teeth.
D. Vision and hearing.

12. If you answered B (heart and brain) you are correct.
MANY OF THE SIGNS & SYMPTOMS OF LOW FOLIC ACID
ARE RELATED TO ANEMIA AND LOWER LEVELS OF
OXYGEN 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

13. 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.

14. What population is most at risk
for a decreased folic acid level?
(Circle your answer)
A. Adult Males
B. Children
C. Reproductive Age
Females

15. If you answered C
(Reproductive Aged Women)
you are correct.
Populations and medical reasons
associated 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.

16. 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.html
South Carolina Department of Health and Environmental Control ML-009074

17. 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

18. 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:
• 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.

19. 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

20. 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)
40
Fruits Serving Size Folate (μg) %DV
30
Avocado 1/2c sliced 59 15
20
Papaya 1c cubes 52 13
Orange Juice 1c 47 12 10
Strawberries 1c 40 10 0
Cantaloupe 1c cubes 34 9 1/2c sliced 1c cubes 1c 1c 1c cubes 1 small 1 medium
Orange 1 small 29 7 Avocado Papaya Orange Juice Strawberries Cantaloupe Orange Banana
Banana 1 medium 24 6 Food Item

21. 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
100
Meat/Beans Serving Size Folate (μg) %DV 50
Beef liver 3oz 215 54 0
Lentils 1/2c 179 45 3oz 1/2c 1/2c 1oz (approx 28) 1c 1 w hole
Great Northern beans 1/2c 90 23 Beef liver Lentils Great Northern Peanuts Vegetarian baked Egg
Peanuts 1oz (approx 28) 41 10 beans beans
Vegetarian baked beans 1c 30 8 Food item
Egg 1 whole 24 6

22. VEGETABLE GROUP
FOODS HIGH IN FOLATE
(THE NATURAL OCCURRING FOLIC ACID)
• OKRA
• ARTICHOKE
• BRUSSEL SPROUTS
• BEETS
• ASPARAGUS
• SPINACH
• BROCCOLI
• CORN
Vegetables
140
120
Vegetables Serving Size Folate (μg) %DV 100
Folate (mcg)
Spinach (frozen, 80
cooked) 1/2c 115 29 60
Mustard greens 40
(cooked) 1c 102 26 20
Asparagus 5 spears 100 25 0
Spinach (raw) 1c 58 15 1/2c 1c 5 spears 1c 1/2c 1/2c 2 spears 1/2c
Corn (canned) 1/2c 52 13 (5in)
Broccoli (frozen, Spinach Mustard Asparagus Spinach Corn Broccoli Broccoli Romaine
cooked) 1/2c 51 13 (frozen, greens (raw ) (canned) (frozen, (raw ) lettuce
Broccoli (raw) 2 spears (5in) 40 10 cooked) (cooked) cooked)
Romaine lettuce 1/2c 32 8 Food Item

23. Do you know what foods are
FORTIFIED with Folic Acid?
(Circle your answer )
A. Table Salt
B. Breakfast Cereal
C. Meat and Fish
D. Milk and Cheese

24. 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

25. GRAINS RICH IN FOLATE
(THE NATURAL OCCURRING FOLIC ACID
• WHOLE GRAINS & WHEAT GERM
Grains
Grains Serving Size Folate (μg) %DV
Cereal (100% 450
fortified) 3/4c 400 100
400
Pasta (enriched, 350
cooked) 1c 160 40
300
Folate (mcg)
Flour Tortilla 250
(enriched) 1 10-in tortilla 140 35
200
Oatmeal (instant,
150
cooked) 1 package 125 31
100
Cereal (fortified) 3/4c 100 25 50
White Rice 0
(enriched,cooked) 1/2c 77 19 3/4c 1c 1 10-in tortilla 1 package 3/4c 1/2c 2 Tbsp 1 slice
Wheat germ Cereal (100% Pasta Flour Tortilla Oatmeal Cereal White Rice Wheat germ Bread (fortified,
(crude) 2 Tbsp 40 10 fortified) (enriched, (enriched) (instant, (fortified) (enriched,cooked) (crude) whole wheat)
cooked) cooked)
Bread (fortified,
Food Item
whole wheat) 1 slice 14 4

26. 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

27. Do you know how much Folic Acid
should be consumed by women of
child bearing age? (Circle your answer )
A. 100 micrograms
B. 400 micrograms
C. 750 micrograms
D. 1000 micrograms

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

29. 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 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.

30. 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