From the FDA Drug Label
Although most patients with malabsorption cannot absorb food folates, they are able to absorb folic acid given orally. In the presence of alcoholism, hemolytic anemia, anticonvulsant therapy, or chronic infection, the maintenance level may need to be increased.
The oral absorption of folic acid is not directly compromised in cases of chronic alcohol abuse. However, the maintenance level of folic acid may need to be increased in the presence of alcoholism 1.
From the Research
Yes, oral absorption of folic acid is compromised in cases of chronic alcohol abuse. Chronic alcohol consumption interferes with folate absorption in the small intestine, reduces hepatic uptake and retention of folate, and increases urinary excretion of folate 2. Alcohol directly damages the intestinal mucosa and inhibits the expression of folate transporters, particularly in the jejunum where most folate absorption occurs. Additionally, alcohol alters the enterohepatic circulation of folate and impairs the conversion of folate to its active form, methyltetrahydrofolate.
This malabsorption contributes to the folate deficiency commonly seen in alcoholics, which can lead to megaloblastic anemia and neurological complications. The decreased concentration of serum folic acid may occur in 80% of alcoholics, as noted in a study published in 2011 3. Furthermore, a study from 2013 found that chronic alcoholism leads to decreased activity of folate transporters in lipid rafts, resulting in reduced hepatic folate uptake in rats 4.
For patients with chronic alcohol use disorder, healthcare providers often recommend higher doses of oral folic acid supplementation (typically 1-5 mg daily rather than the standard 400 mcg) or may consider parenteral administration in severe cases. Addressing alcohol use is essential for long-term improvement in folate status, as continued drinking will perpetuate malabsorption issues regardless of supplementation. Key factors contributing to malabsorption in alcoholics include dietary folic acid and protein deficiency, pancreatic insufficiency, abnormalities of biliary secretions, and direct effects of alcohol on the gastrointestinal tract 5.
Some of the key clinical consequences of disturbed folic acid and homocysteine metabolism in alcohol abusers include macrocytic and megaloblastic anemia, neurological disorders, and an increased risk of cardiovascular diseases 3. Therefore, it is crucial to prioritize the management of alcohol use disorder alongside folic acid supplementation to mitigate these risks.