Folic acid is essential for the production of DNA, RNA, and proteins. Although folic acid may reverse the megaloblastic red blood cell aspects of pernicious anemia, it will not reverse the neurologic changes associated with pernicious anemia. It is found in fresh leafy green vegetables, yeasts, and liver. Folic acid is absorbed in the small and large intestines in the form of polyglutamates. At the brush border of the intestinal cells, excess glutamates are removed from the folate molecule, making a functioning intestinal mucosa necessary for absorption.
The adult daily recommended dosage of folic acid is 400 pg/day.2 Dietary supplementation of 100 pg/day will reverse the red cell changes of pernicious anemia but will not reverse the neurologic effects; therefore, preparations with more than 100 pg are available only through prescription. Except for the problem with masking of the hematologic changes of pernicious anemia, there are no known adverse effects to the ingestion of large doses of folic acid.
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