Iron and folic acid are two micronutrients that play important roles in many bodily functions. These substances are not produced by the body and must be obtained through diet or supplementation.
The Roles of Iron and Folic Acid
Iron is a mineral that supports many bodily processes. About 70% of it is found in hemoglobin, which transports oxygen throughout the body. Iron is also present in myoglobin, a protein in muscle cells that stores oxygen. Beyond oxygen transport, iron participates in energy production by acting as a cofactor for enzymes that convert nutrients into energy. It contributes to the synthesis of collagen and certain neurotransmitters, and supports immune function.
Folic acid, a form of vitamin B9, is a water-soluble B vitamin that the body does not store, requiring a regular supply. It is essential for creating new red blood cells. Folic acid is also involved in the synthesis and repair of DNA and other genetic material, supporting cell division and growth. It works alongside vitamins B12 and C to break down, use, and create new proteins.
Understanding Iron and Folic Acid Deficiency
Insufficient iron levels can lead to iron-deficiency anemia, a condition where the body cannot produce enough healthy red blood cells. Initial symptoms may be subtle, but as the deficiency worsens, individuals might experience extreme fatigue, weakness, pale skin, and shortness of breath. Other signs can include dizziness, cold hands and feet, brittle nails, headaches, and unusual cravings for non-nutritive substances like ice or dirt, a condition known as pica.
Untreated iron-deficiency anemia can result in more severe health complications. The heart may have to pump harder to compensate for reduced oxygen, leading to a rapid or irregular heartbeat, or even an enlarged heart or heart failure. In children, severe iron deficiency can lead to delayed growth and development, as well as increased susceptibility to infections.
A lack of folic acid can result in folate deficiency, often leading to megaloblastic anemia, where red blood cells are abnormally large and few. Symptoms of folate deficiency can include pale skin, decreased appetite, irritability, lack of energy, diarrhea, and a smooth, tender tongue. For pregnant individuals, folate deficiency significantly increases the risk of neural tube defects in the developing fetus, including spina bifida and anencephaly.
Populations with Increased Needs
Certain groups have higher iron and folic acid requirements. Pregnant individuals need additional iron to support the growth of the fetus and placenta, and increased maternal red blood cell mass. Iron also helps prevent anemia during pregnancy, a common condition that can lead to premature births and low birth weight babies.
Folic acid is important for pregnant individuals to prevent neural tube defects, which form early in pregnancy. The World Health Organization recommends that individuals who are or might become pregnant take 400-800 micrograms (mcg) of folic acid daily, ideally starting at least three months before conception.
Young children, especially infants, have increased iron needs due to their rapid growth and development, for brain development, blood, muscle, and immune system strength. Full-term infants have sufficient iron stores for their first four to six months, after which they need external iron sources from their diet. Premature or low birth weight babies are at a higher risk of iron deficiency due to their faster growth after birth.
Adolescents also experience increased iron requirements due to growth spurts and, for girls, menstrual blood loss. Physical activity can further increase iron needs in this age group. In adolescent girls, iron deficiency is a common nutritional concern.
Dietary sources of iron include:
Lean meat, seafood, and poultry
Iron-fortified breakfast cereals and breads
White beans, lentils, kidney beans, and peas
Spinach
Nuts
Some dried fruits like raisins
Folic acid can be found naturally in dark green leafy vegetables, dried beans and peas, and citrus fruits. Many foods are also fortified with folic acid, such as:
Enriched bread
Pasta
Rice
Cereals
To enhance iron absorption from plant-based sources, consume them with foods rich in vitamin C, such as oranges or strawberries.
Effective Supplementation Approaches
Iron and folic acid supplementation is a global public health strategy to combat deficiencies and improve health. Fortification, the addition of these micronutrients to staple foods like flour, rice, or salt, is a widespread and cost-effective intervention to reduce deficiencies. This approach helps prevent nutritional anemia and reduces the risk of neural tube defects in infants.
Targeted supplementation programs play a role. The World Health Organization (WHO) recommends daily oral iron and folic acid supplementation for pregnant individuals, with 30-60 mg of elemental iron and 400 mcg of folic acid, starting as early as possible in pregnancy. These supplements are advised to reduce the risk of maternal anemia, low birth weight, and preterm birth.
Adherence to supplementation programs is an important factor in their effectiveness. Education and counseling on the benefits of iron and folic acid supplements can increase adherence. Community-based distribution programs, often involving community health workers, can improve access to supplements and provide consistent supplies.
For optimal absorption, iron supplements are best taken on an empty stomach. Taking iron with a source of vitamin C, such as orange juice, can enhance its absorption. Conversely, certain substances like milk, calcium supplements, and high-fiber foods can hinder iron absorption and should be avoided. If gastrointestinal side effects like nausea or constipation occur, taking the supplement with a small amount of food or splitting the dose may help, though this might slightly reduce absorption.