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Ácido fólico

¿Qué es?

El folato y el ácido fólico son formas de vitamina B9 que se usan para la deficiencia y para prevenir complicaciones del embarazo. Muchos alimentos contienen folato o se les agrega ácido fólico.

Desde 1998, se ha agregado ácido fólico a cereales fríos, harina, panes, pastas, productos de panadería, galletas y galletas saladas, según lo exige la ley federal. Los alimentos que son naturalmente ricos en ácido fólico incluyen verduras de hoja, quimbombó, espárragos, ciertas frutas, frijoles, levadura, hongos, hígado y riñón de animales, jugo de naranja y jugo de tomate. El ácido fólico también está disponible como suplemento y, a menudo, se usa en combinación con otras vitaminas B.

El ácido fólico se usa para prevenir y tratar los niveles sanguíneos bajos de folato (deficiencia de folato) y los niveles sanguíneos altos de homocisteína (hiperhomocisteinemia). Las personas que están embarazadas o que podrían quedar embarazadas toman ácido fólico para prevenir defectos de nacimiento graves como la espina bífida. El ácido fólico también se usa para muchas otras afecciones, como depresión, accidente cerebrovascular, deterioro de la memoria y las habilidades de pensamiento, y muchas otras.

¿Qué tan efectivo es?

Natural Medicines Comprehensive Database (La Base Exhaustiva de Datos de Medicamentos Naturales) clasifica la eficacia, basada en evidencia científica, de acuerdo a la siguiente escala: Eficaz, Probablemente Eficaz, Posiblemente Eficaz, Posiblemente Ineficaz, Probablemente Ineficaz, Ineficaz, e Insuficiente Evidencia para Hacer una Determinación.

La clasificación de la eficacia para este producto es la siguiente:

Eficaz para...

  • Deficiencia de folato. La ingesta de ácido fólico mejora la deficiencia de folato.

Probablemente eficaz para...

  • Niveles altos de homocisteína en sangre (hiperhomocisteinemia). Esta afección se ha relacionado con enfermedades cardíacas y accidentes cerebrovasculares. La ingesta de ácido fólico reduce los niveles de homocisteína en personas con niveles normales o altos de homocisteína y en personas con insuficiencia renal.
  • Toxicidad provocada por el fármaco metotrexato. La ingesta de ácido fólico parece reducir las náuseas y los vómitos del tratamiento con metotrexato.
  • Defectos congénitos del cerebro y la columna vertebral (defectos congénitos del tubo neural). El consumo de ácido fólico de 600 a 800 mcg por vía oral al día durante el embarazo reduce el riesgo de estos defectos de nacimiento. El ácido fólico puede provenir de la dieta o de los suplementos. Algunas personas que están en alto riesgo deben recibir 4000-5000 mcg al día.

Posiblemente eficaz para...

  • Disminución de las habilidades de memoria y pensamiento en personas mayores. La ingesta de ácido fólico, con o sin otros suplementos, puede mejorar la memoria y las habilidades de pensamiento en las personas mayores que tienen una disminución mayor de lo esperado en las habilidades de pensamiento a esa edad. Pero no parece funcionar en personas mayores que experimentan la disminución habitual de las habilidades de pensamiento para su edad.
  • Depresión. La ingesta de ácido fólico junto con antidepresivos parece mejorar los síntomas en algunas personas con depresión.
  • Alta presión sanguínea. La ingesta diaria de ácido fólico durante al menos 6 semanas reduce la presión arterial en algunas personas con presión arterial alta que no están tomando otros medicamentos para la presión arterial.
  • Agrandamiento de las encías causado por el fármaco fenitoína. La aplicación de ácido fólico en las encías parece prevenir este problema. Pero la ingesta de ácido fólico no parece ayudar.
  • Accidente cerebrovascular. En áreas del mundo que no agregan ácido fólico a los productos de granos, tomar suplementos de ácido fólico puede reducir el riesgo de accidente cerebrovascular. Pero los suplementos no parecen ser útiles para las personas que viven en países que sí agregan ácido fólico a los productos a base de cereales.
  • Un trastorno de la piel que provoca la aparición de manchas blancas en la piel (vitiligo). La ingesta de ácido fólico parece mejorar los síntomas de esta afección.

Posiblemente ineficaz para...

  • Bajos niveles de glóbulos rojos sanos (anemia) debido a la deficiencia de hierro. Agregar ácido fólico a un suplemento de hierro no ayuda a tratar la anemia mejor que tomar un suplemento de hierro solo.
  • Deterioro de las habilidades cognitivas y de la memoria que ocurren normalmente con la edad. La ingesta de ácido fólico no parece prevenir el deterioro de la función mental que ocurre normalmente con los adultos sanos que envejecen.
  • Cataratas. La ingesta de ácido fólico con vitamina B6 y vitamina B12 no previene las cataratas. De hecho, podría aumentar la cantidad de cataratas que deben eliminarse.
  • Diarrea. La ingesta de ácido fólico no parece prevenir la diarrea en los niños que están en riesgo de desnutrición. De hecho, incluso puede aumentar el riesgo de tener diarrea que dure más de unos pocos días.
  • Prevención de caídas. La ingesta de ácido fólico con vitamina B12 no parece prevenir las caídas en las personas mayores que también toman vitamina D.
  • Infertilidad masculina. La ingesta de ácido fólico, solo o con otros ingredientes, no parece mejorar la fertilidad masculina.
  • Muerte de un bebé nonato o prematuro. La ingesta de ácido fólico durante el embarazo no parece reducir el riesgo de que un bebé muera justo antes o después del nacimiento. Pero ayuda a prevenir otros problemas de salud en el bebé.
  • Cáncer de los glóbulos blancos (leucemia). La ingesta de ácido fólico durante el embarazo no reduce el riesgo de este tipo de cáncer en los niños.
  • Huesos débiles y quebradizos (osteoporosis). En personas de edad avanzada con osteoporosis, la ingesta de ácido fólico con vitamina B12 y / o vitamina B6 no parece prevenir la fractura de huesos.
  • Rendimiento físico en adultos mayores. La ingesta de ácido fólico con vitamina B12 no parece ayudar a las personas mayores a caminar mejor ni a tener manos más fuertes.
  • Presión arterial alta durante el embarazo. Los suplementos de ácido fólico en dosis altas no parecen reducir la presión arterial durante el embarazo ni el riesgo de desarrollar una afección llamada preeclampsia.
  • Infección de las vías respiratorias. La ingesta de ácido fólico no parece prevenir las infecciones pulmonares en los niños con riesgo de desnutrición.

Probablemente ineficaz para...

  • Crecimientos no cancerosos en el intestino grueso y el recto (adenoma colorrectal). La ingesta de suplementos de ácido fólico no previene los crecimientos en el intestino grueso o el recto.
  • Una condición hereditaria caracterizada por problemas de aprendizaje (síndrome del X frágil). La ingesta de ácido fólico no mejora los síntomas del síndrome de X frágil.
  • Parto prematuro. La ingesta de ácido fólico durante el embarazo no disminuye el riesgo de tener un bebé prematuro. Pero ayuda a prevenir otros problemas de salud en el bebé.
Existe interés en usar el ácido fólico para otros propósitos, pero no hay suficiente información confiable para decir si podría ser útil para estos usos.

¿Es seguro?

Cuando se toma por vía oral: Es probable que la mayoría de las personas no tomen ácido fólico en dosis de no más de 1 mg al día. Las dosis superiores a 1 mg al día pueden ser peligrosas. Estas dosis pueden causar malestar estomacal, náuseas, diarrea, irritabilidad, confusión, cambios de comportamiento, reacciones cutáneas, convulsiones y otros efectos secundarios.

Otra forma de ácido fólico, L-5-metiltetrahidrofolato (L-5-MTHF), también se puede encontrar en suplementos. Este tipo de ácido fólico es posiblemente seguro para la mayoría de las personas en dosis de hasta aproximadamente 400 mcg al día.

Existe cierta preocupación de que tomar demasiado ácido fólico durante un tiempo prolongado pueda causar efectos secundarios graves. Algunas investigaciones sugieren que tomar ácido fólico en dosis de 0.8 a 1.2 mg al día podría aumentar el riesgo de cáncer o aumentar el riesgo de ataque cardíaco en personas que tienen problemas cardíacos.

Advertencias y precauciones especiales:

Embarazo y lactancia: Se recomiendan 300-400 mcg de ácido fólico al día durante el embarazo para prevenir ciertos defectos de nacimiento. La cantidad máxima recomendada de ácido fólico durante el embarazo o la lactancia es de 800 mcg al día para los menores de 18 años y de 1000 mcg al día para los mayores de 18 años. No use más a menos que lo indique un profesional de la salud.

Otra forma de ácido fólico, L-5-metiltetrahidrofolato (L-5-MTHF), también se puede encontrar en suplementos. Este tipo de ácido fólico posiblemente sea seguro para tomar en una dosis de hasta 400 mcg al día durante el embarazo o la lactancia.

Niños: Es probable que los niños tomen ácido fólico por vía oral en las cantidades recomendadas para su edad. Pero los niños deben evitar tomar ácido fólico en dosis superiores a los límites máximos diarios. Estos límites son 300 mcg para 1-3 años, 400 mcg para 4-8 años, 600 mcg para 9-13 años y 800 mcg para 14-18 años.

Otra forma de ácido fólico, L-5-metiltetrahidrofolato (L-5-MTHF), también se puede encontrar en suplementos. Este tipo de ácido fólico posiblemente sea seguro en los niños.

Procedimientos para ensanchar las arterias estrechas (angioplastia): El uso de ácido fólico, vitamina B6 y vitamina B12 podría empeorar las arterias estrechas. Las personas que se están recuperando de este procedimiento no deben usar ácido fólico.

Cáncer: Las primeras investigaciones sugieren que la ingesta diaria de 0.8 a 1 mg de ácido fólico podría aumentar el riesgo de cáncer. Hasta que se sepa más, las personas con antecedentes de cáncer deben evitar las dosis altas de ácido fólico.

Trastorno convulsivo: La ingesta de suplementos de ácido fólico, especialmente en dosis altas, puede empeorar las convulsiones en personas con trastornos convulsivos.

Deficiencia de vitamina B12: Tomar suplementos de ácido fólico podría mejorar ciertas pruebas de laboratorio en personas con niveles bajos de vitamina B12. Esto puede hacer que parezca que la deficiencia de vitamina B12 mejora cuando no es así. Si no se trata, esto podría causar daño permanente a los nervios.

¿Existen interacciones con medicamentos?

Moderadas
Tenga cuidado con esta combinación
5-Fluorouracilo
Existe cierta preocupación de que tomar grandes cantidades de ácido fólico con 5-fluorouracilo pueda aumentar algunos efectos secundarios del 5-fluorouracilo, especialmente los problemas estomacales. Hable con su proveedor de atención médica antes de tomar ácido fólico.
Capecitabina (Xeloda)
Existe cierta preocupación de que la ingesta de grandes cantidades de ácido fólico pueda aumentar los efectos secundarios de la capecitabina, especialmente los problemas estomacales como la diarrea y los vómitos. Hable con su proveedor de atención médica antes de tomar ácido fólico.
Fenitoína (Dilantin)
El cuerpo descompone la fenitoína para eliminarla. El ácido fólico podría aumentar la rapidez con que el cuerpo descompone la fenitoína. La ingesta de ácido fólico y fenitoína podría disminuir la eficacia de la fenitoína y aumentar la posibilidad de convulsiones.
Fenobarbital (Luminal)
El fenobarbital se usa para las convulsiones. La ingesta de ácido fólico puede disminuir la eficacia del fenobarbital para prevenir las convulsiones.
Fosfenitoína (Cerebyx)
La fosfenitoína se usa para las convulsiones. El cuerpo descompone la fosfenitoína para eliminarla. El ácido fólico puede aumentar la rapidez con que el cuerpo descompone la fosfenitoína. La ingesta de ácido fólico junto con fosfenitoína podría disminuir los efectos de la fosfenitoína para prevenir las convulsiones.
Pirimetamina (Daraprim)
La pirimetamina se usa para tratar infecciones parasitarias. El ácido fólico podría disminuir los efectos de la pirimetamina para el tratamiento de infecciones parasitarias.
Primidona (Mysoline)
La primidona se usa para las convulsiones. El ácido fólico puede provocar convulsiones en algunas personas. La ingesta de ácido fólico junto con primidona podría disminuir la eficacia de la primidona para prevenir las convulsiones.

¿Existen interacciones con hierbas y suplementos?

Té verde
Existe cierta preocupación de que el extracto de té verde pueda evitar que el ácido fólico actúe como debería en el cuerpo. Esto podría provocar una afección similar a la deficiencia de ácido fólico.
Zinc
El ácido fólico puede interferir con la absorción de zinc. Pero las personas que obtienen suficiente zinc en su dieta no necesitan preocuparse por este efecto.

¿Existen interacciones con alimentos?

El ácido fólico se puede tomar con alimentos o sin alimentos.

Pero beber té verde podría reducir los niveles de ácido fólico en el cuerpo. Si tiene niveles bajos de ácido fólico, evite beber té verde.

¿Como se usa normalmente?

El ácido fólico es un nutriente importante. La cantidad que se debe consumir a diario se denomina cantidad diaria recomendada (RDR). La dosis diaria recomendada de ácido fólico se proporciona como equivalentes de folato en la dieta o EFD. Esto se debe a que el cuerpo absorbe el ácido fólico en los suplementos mejor que el folato que se encuentra en los alimentos. 1 mcg de EFD es lo mismo que 1 mcg de ácido fólico que se encuentra en los alimentos. Pero 1 mcg de EFD es lo mismo que 0.6 mcg de suplementos de ácido fólico.

Otros nombres

5'-methyltetrahydrofolate, 5'-methyltetrahydrofolic acid, 5'-MTHF, Acide Folique, Acide Ptéroylglutamique, Acide Ptéroylmonoglutamique, Acido Folico, B Complex Vitamin, Complexe de Vitamines B, Complexe Vitaminique B, Dihydrofolate, Dihydrofolic Acid, Folacin, Folacine, Folate, Folinic Acid, L-methylfolate, Methylfolate, Méthylfolate, Methylfolic Acid, Pteroylglutamic Acid, Pteroylmonoglutamic Acid, Pteroylpolyglutamate, Tetrahydrofolate, Tétrahydrofolate, Vitamin B9, Vitamine B9.

Metodología

Para saber más sobre cómo este artículo fue escrito, refiérase a la metodología de la Base exhaustiva de datos de medicamentos naturales.

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