Folic Acid Supplements may Benefit Patients with IBD
Homocysteine and Bone Mineral Density (BMD) in IBD
Inflammatory bowel disease patients present an increased risk of low BMD, leading to osteoporosis. Among others, risk factors of osteoporosis in IBD include malnutrition, low body mass, malabsorption, or use of corticosteroids. Although the studies describing the association between IBD and homocysteine focused on non-IBD individuals, the researchers suggest that hyperhomocysteinemia may constitute a potential additional factor of low BMD among IBD patients.
Microbiota and Folate Metabolism in IBD Patients
Many factors can affect the gut microbiota in patients with inflammatory bowel disease, such as age, inhabitable environment, culture, habits, medical history, and the applied treatment.
The researchers reported that the probiotic supplementation containing Bifidobacterium and Lactobacillus Plantarum strains may increase folic acid production in patients with IBD and have a protective function for colonocytes in the course of this disease. Additionally, they noted that microbial folate synthesis may also be affected by certain drugs such as metformin and sulfonamides.
They wrote, “a proper supply of folic acid has a beneficial impact on the development of the gut microbiota, and certain bacteria strains provide an optimal level of folate in patients suffering from IBD.”
The authors concluded, “Folic acid is a water-soluble group B vitamin, and its deficiency may lead to clinical complications, especially among patients suffering from IBD. Folic acid participates in the metabolism of homocysteine, high levels of which are associated with an increased risk of cardiovascular diseases and osteoporosis. Additionally, vitamin B9 is essential for the synthesis of nucleic acids and proteins. Therefore, providing adequate amounts of folic acid may prevent complications in this specific group of patients.”
They further added, “Nevertheless, research regarding the association between folic acid, IBD, and bone mineral density is scarce. Therefore, future studies are necessary in order to investigate the potential benefits of folic acid use among IBD patients, which may improve both the course of the disease and the quality of life.”
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Folic acid deficiency may lead to an increased risk of numerous diseases, such as cardiovascular disease, neoplasms, and cognitive impairment. Vitamin B9 deficiency might also result in hyperhomocysteinemia and disorders of protein and DNA synthesis.
In a recent review article, researchers have reported that IBD patients present a higher risk of folic acid deficiency and require particular supervision. The article was published in the journal Nutrients on 12 November 2021.
Folic Acid in IBD:
Folic acid plays an important role in IBD patients. In a metanalysis, Yun et al. demonstrated that level of folate in IBD patients was significantly lower when compared to that of healthy groups. Studies have shown that the supplementation of folic acid may decrease the occurrence of side effects, mainly gastrointestinal disease, inflammation of the mucosa, and myelotoxicity. Dr Alicja Ewa Ratajczak and team noted, "In the case of IBD, folic acid deficiency is one of the most common causal agents of non-iron deficiency anaemia (NIDA), which may decrease the quality of life in patients. Simultaneously, patients suffering from IBD are at a higher risk of folic deficiency (e.g., with inflammation in the small intestine or following resection) and require adequate supervision."
Folic acid in Colorectal Cancer:
Patients with long-term ulcerative colitis or Crohn's Disease present an increased risk of colorectal cancer (CRC) associated with inflammation and dysplasia. Additionally, CRC related to IBD is associated with chromosomal instability, microsatellite instability, and hypermethylation. In the experimental study by Biasco et al., a three-month-long supplementation of folic acid resulted in decreased cell proliferation. A meta-analysis indicated that the supplementation of folic acid plays a protective role against the development of colorectal cancer. However, Dr Alicja Ewa Ratajczak et al, noted that there is no large, randomized study on the role of folic acid in the prevention of CRC in patients suffering from IBD.
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