Does Everyone With Sickle Cell Need a Folic Acid Supplement?

It’s one thing to deal with the emotional and psychological trauma that comes with a chronic illness diagnosis, and it’s another thing entirely to navigate the treatment, or more specifically, the management plan that comes with it.

I know medical doctors mean the best, or at least I want to believe they do. But I find it irritating how eager some seem to be to dispense prescriptions without considering a patient’s circumstance and concerns.

I understand and appreciate that care plans are based on research and experience. But I also believe that current standard care plans aren’t suitable for every patient and should be personalized.

I have several gripes with sickle cell care plans. Maybe it’s because I’ve seen them fail for some of my family members, or perhaps it’s because some strategies don’t sit right with me based on new scientific research. Or, sometimes it’s simply because I don’t believe prescriptions always needs to be the way forward.

Yes, I need to disentangle my thoughts, but before that, I’ll explain my gripe with one aspect of the current sickle cell care plans: taking a high-dose folic acid supplement daily.

Folic acid is the synthetic form of naturally occurring folate, a type of vitamin B that’s essential for DNA production and repair and red blood cell production. Medical professionals believe it is vital for people with sickle cell because these patients need to make red blood cells more frequently than people without sickle cell, and they may be at increased risk of folate deficiency. Folate may also reduce the symptoms of anemia.

The issue is that it’s unclear whether folic acid supplements influence sickle cell severity. Besides, folic acid supplements can mask vitamin B12 deficiencies, which can cause severe neurological problems. A new Phase 1 clinical trial (NCT04011345) is currently underway to investigate the impact of folic acid supplementation in children with sickle cell disease.

Folate is easily obtained via diet

It is rich in green leafy vegetables such as spinach, broccoli, and chard, and all types of beans and lentils, including red kidney beans, black beans, brown beans, and red, green, and brown lentils. The best thing about getting folate through diet is that your body can absorb what it needs and excrete the remainder. So, the risk of overeating folate and developing adverse effects are minimal compared with a supplement.

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Getting folate through diet also means you get other beneficial nutrients such as protein, vitamin A, vitamin C, iron, and zinc, which are crucial for health, unlike a supplement that provides only a single nutrient.

Considering all this, and especially that folic acid supplements don’t seem to benefit people with sickle cell, I don’t understand why it is a mandatory part of the care plan for everyone.

I understand some people may be deficient with poor diets and may need to supplement. But I don’t know why supplementing is a blanket approach and why medical professionals don’t suggest diet as the primary folate source for people without deficiencies who can eat healthy diets.

Diet is my son’s primary folate source. As I mentioned in a previous column, he takes a multivitamin supplement mainly for vitamin D. That multivitamin also contains a small amount of folic acid that literally supplements his diet.

What are your thoughts on folic acid supplementation? Please share in the comments below. 

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Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to sickle cell disease.