Why Would a Person Have to Take Folic Acid?

November 26, 2025 •

4 min read

According to the CDC, over 22% of women of childbearing age in the US have insufficient folate levels to prevent neural tube defects. This highlights a crucial reason why a person may have to take folic acid, particularly for reproductive health. However, its importance extends far beyond pregnancy, impacting cardiovascular, neurological, and mental well-being for a wide range of individuals.

Quick Summary

Explores the numerous medical reasons for folic acid supplementation, including its vital role in preventing birth defects, managing folate deficiency anemia, and supporting cardiovascular, cognitive, and mental health. Covers common causes of deficiency and the importance of fortification.

Key Points

Pregnancy Health: Folic acid is considered critical for women of childbearing age to potentially prevent serious neural tube birth defects like spina bifida and anencephaly.
Anemia Prevention: It is used to address and prevent folate-deficiency anemia, which can cause symptoms like fatigue and weakness due to the production of abnormally large red blood cells.
Cardiovascular Support: Folic acid may help lower high levels of homocysteine in the blood, an amino acid linked to an increased risk of heart disease and stroke.
Mental and Cognitive Function: Low folate has been associated with mood disorders, and supplementation may help improve symptoms of depression and cognitive decline, especially in older adults.
Enhanced by Fortification: Because it is considered so crucial, folic acid is added to fortified foods like enriched grain products, which helps the general population maintain adequate levels.
Management of Chronic Conditions: Folic acid can be considered necessary for individuals with conditions like kidney disease, certain digestive disorders, or those taking specific medications such as methotrexate.
Distinguishing Formats: Folic acid is the synthetic version, which is generally more readily absorbed by the body than natural folate found in foods like leafy greens.

The Primary Role of Folic Acid: Pregnancy and Birth Defects

For many, the most well-known reason to take folic acid is its critical role in preventing major birth defects. Folic acid is the synthetic, more stable form of folate, a B-vitamin (B9) essential for producing and repairing DNA. This process is crucial for rapid cell growth and development, especially during the early stages of fetal development. The neural tube, which develops into the baby's brain and spinal cord, forms in the very first weeks of pregnancy, often before a woman even knows she is pregnant.

Preventing Neural Tube Defects (NTDs)

If the neural tube does not close properly, it can lead to serious conditions known as Neural Tube Defects (NTDs), such as spina bifida and anencephaly. Anencephaly is a severe birth defect where a baby is born without parts of the brain and skull, while spina bifida involves a gap in the baby's spine. Research consistently shows that adequate folic acid intake before conception and during the first trimester can reduce the risk of NTDs by over 70%. Since approximately half of all pregnancies are unplanned, health experts recommend that all women who are capable of becoming pregnant consider ensuring adequate folic acid intake. This proactive measure ensures sufficient levels are available to protect a developing fetus from the earliest possible moment.

Folic Acid and Anemia: Treating Deficiency

A person may also need to take folic acid to treat or prevent a type of anemia caused by a folate deficiency. A deficiency can occur due to inadequate dietary intake, certain medical conditions, or excessive alcohol use.

Symptoms and Complications of Folate Deficiency

Folate deficiency can lead to a specific type of anemia called megaloblastic anemia, where the red blood cells are abnormally large and fewer in number. Symptoms can include:

Extreme fatigue and lack of energy
Pale skin
Sore, red tongue and mouth ulcers
Memory problems and confusion
Irritability
Shortness of breath

Treatment typically involves addressing the deficiency, and for those with long-term malabsorption issues, ongoing support may be required. Correcting the deficiency allows the body to produce healthy, properly functioning red blood cells again.

Benefits for Cardiovascular and Mental Health

Beyond pregnancy and anemia, folic acid offers significant benefits for both heart and mental health, often in conjunction with other B vitamins.

Supporting Heart Health

Elevated levels of the amino acid homocysteine in the blood are associated with an increased risk of heart disease and stroke. Folate plays a crucial role in converting homocysteine into another amino acid, methionine. Without sufficient folate, homocysteine levels rise. Supplementing with folic acid has been shown to potentially lower homocysteine levels, which might reduce the risk of heart disease and improve cardiovascular health. Some studies also suggest it may help reduce high blood pressure.

Aiding Mental and Cognitive Function

Low folate levels have been linked to a higher risk of mood disorders, including depression, and can exacerbate symptoms. Some research suggests that taking folic acid supplements alongside antidepressant medication can improve treatment outcomes for some individuals, particularly those with a folate deficiency. Furthermore, folate is involved in the synthesis of neurotransmitters that regulate mood, such as serotonin and dopamine. Older adults with low folate levels are also at higher risk for cognitive decline and dementia, and supplementation has shown potential benefits in some cases.

Specific Groups with Increased Needs

Certain individuals and groups have a higher need for folic acid due to various medical conditions or life stages.

Other Conditions and Medications

Kidney Disease: Patients on kidney dialysis may require higher folate intake due to increased loss of the vitamin.
Digestive Disorders: Conditions like celiac disease and Crohn’s disease can impair the absorption of folate from food.
Genetic Factors: Some people have a genetic mutation (MTHFR polymorphism) that affects their body's ability to convert folate into its active form. These individuals may require a different form of folate or specific supplementation.
Methotrexate Use: Folic acid can help reduce the toxic side effects of methotrexate, a medication used for conditions like rheumatoid arthritis and psoriasis.
Alcohol Use: Excessive alcohol consumption can interfere with folate absorption and metabolism, often leading to deficiency.

Folic Acid vs. Folate: A Comparison

To better understand the need for supplements versus food, it's helpful to distinguish between folic acid and folate.


Feature	Folate	Folic Acid
Source	Naturally occurs in foods such as dark leafy greens, legumes, and citrus fruits.	Synthetic, manufactured form added to fortified foods (like breads, cereals, and pastas) and supplements.
Absorption Rate	Variable and less readily absorbed by the body.	More readily and efficiently absorbed by the body.
Stability	Less stable and can be easily destroyed during cooking or processing.	Chemically stable and not easily destroyed by heat.
Bioavailability	Depends on food source and individual metabolism.	Higher, more consistent bioavailability, making it a reliable way to increase folate levels.
Primary Use	Integral part of a healthy, balanced diet.	Used for targeted supplementation to address deficiency or for preventive measures like during pregnancy.

Conclusion

While a balanced diet rich in folate-containing foods is always recommended, there are numerous specific health reasons why a person would have to take folic acid. From preventing neural tube defects in early pregnancy to managing anemia and supporting heart and brain health, folic acid supplementation plays a vital and often critical role. Given the widespread benefits and the risks associated with deficiency, taking a supplement could be a simple and effective strategy for many people to safeguard their overall health, particularly for those with increased needs or inadequate dietary intake. Consulting a healthcare provider is the best way to determine if supplementation is necessary.

Frequently Asked Questions

All women who could become pregnant are often advised to consider ensuring adequate folic acid intake. This is because neural tube defects occur in the first few weeks of pregnancy, often before a woman realizes she is pregnant.

Symptoms of a folate deficiency can include fatigue, extreme weakness, a pale complexion, shortness of breath, irritability, and a sore or red tongue. If untreated, it can lead to megaloblastic anemia.

Yes, men can potentially benefit. Folic acid plays a role in DNA production and healthy cell growth, which supports general health, and some studies suggest it may aid fertility and potentially improve heart health by regulating homocysteine levels.

Folate is the naturally occurring form of vitamin B9, found in foods like spinach and beans. Folic acid is the synthetic, man-made version, typically found in fortified foods and supplements and is generally more easily absorbed by the body.

Yes, some medications, such as certain anti-seizure drugs and those for inflammatory conditions, can potentially interfere with folate absorption and metabolism, which may necessitate supplementation.

While it's difficult to get too much from food alone, excessive intake from synthetic sources like supplements can be a concern. High levels can potentially mask a vitamin B12 deficiency, which could lead to nerve damage. It's important to discuss appropriate intake with a healthcare provider.

Some research indicates that low folate levels are linked to depression. Folic acid supplementation, particularly when used in combination with antidepressants, may potentially improve symptoms in some individuals, especially those with an existing deficiency.