Folic acid is a term that many people have heard before, whether in connection with pregnancy or a healthy diet. But what exactly is folic acid, why is it so important and how is it measured in laboratory medicine in Germany? I

What is folic acid?

Folic acid, also known as vitamin B9, is an essential vitamin that the body cannot produce itself. We have to get it from food, for example from green vegetables such as spinach, broccoli or lettuce, but also from wholegrain products, pulses or liver. Folic acid plays a central role in the body: it helps to form new cells, supports the production of DNA and is important for growth and development. Folic acid is particularly well known for its importance during pregnancy, as it can reduce the risk of malformations in the baby, such as the so-called neural tube defect.

Why is folic acid important?

Folic acid is not only crucial for pregnant women, but for all of us. It ensures that red blood cells are formed, which transport oxygen throughout the body. A lack of folic acid can lead to anemia, where you feel tired, weak or short of breath. Folic acid also helps to regulate homocysteine levels in the blood – a substance that can increase the risk of cardiovascular disease in high quantities. In Germany, doctors pay particular attention to whether there is enough folic acid in the body because a deficiency is widespread, for example in the case of an unbalanced diet, alcohol problems or certain diseases such as coeliac disease.

Folic acid has a special status for pregnant women: the Robert Koch Institute and other health authorities in Germany recommend taking an additional 400 micrograms of folic acid daily via food supplements even before pregnancy. This protects the unborn child and supports the development of the nervous system.

How is the folic acid value determined?

In Germany, folic acid levels are usually measured via a blood test in laboratory medicine. This is particularly important if a deficiency is suspected – for example in the case of symptoms such as tiredness, pale skin or suspected pregnancy planning. A small amount of blood is taken from the patient’s vein, often from the arm. This blood is then sent to the laboratory.

There are various laboratory methods for determining folic acid. A so-called immunoassay is often used. This involves the use of antibodies that react specifically to folic acid. These antibodies are provided with a marker that glows or produces a color when it binds folic acid. A device then measures how strong the signal is and calculates how much folic acid is in the blood. Another method is HPLC (high-performance liquid chromatography), which is more accurate but is used less frequently because it is more complex.

The folic acid value is usually given in nanograms per milliliter (ng/ml) or micromoles per liter (µmol/l). In Germany, values between around 3 and 17 ng/ml in the blood serum are considered normal, although the exact range can vary slightly depending on the laboratory. The folic acid content in the red blood cells is also often measured because it shows how much folic acid is available in the body in the long term. The normal range here is usually 140 to 600 ng/ml.

What happens to the results?

Once the folic acid value has been determined, the doctor discusses the result with the patient. If the value is too low, this may indicate a deficiency. The doctor will then look at the possible causes: Is the person eating too little food containing folic acid? Is there an illness that interferes with absorption? Or is the body not absorbing folic acid properly, for example due to intestinal diseases? It is often recommended to adjust the diet or take folic acid tablets, especially for pregnant women or people with a proven deficiency.

However, if the value is too high – which is rare – this could indicate an overdose from dietary supplements. This is usually harmless, as excess folic acid is excreted in the urine, but it is checked anyway.

Conclusion

Folic acid is a small vitamin with a big effect. In Germany, laboratory medicine helps to keep an eye on folic acid levels in order to detect deficiencies early and avoid health problems. Whether for cell formation, blood health or pregnancy – folic acid is indispensable. With a simple blood test and modern technology, doctors can ensure that the body has enough of it to support good health. Simply put, folic acid keeps us fit – and laboratory medicine helps to monitor this.

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