People’s Pharmacy: Too much folic acid may pose COVID-19 risks

Q. Many years ago, I complained to my doctor about restless legs. She prescribed folic acid (1 milligram daily). It has to be prescription, not over the counter. It works!

A. Folic acid is a B vitamin. The 1 milligram dose is available both by prescription as well as over the counter. The recommended daily allowance is 400 micrograms, less than half the amount you are taking.

We searched high and low and could find no good evidence to support the use of folic acid supplements to treat restless leg syndrome. Many doctors consider this supplement innocuous, since B vitamins are water soluble.

There is one caution, however. A recent study based on data from the U.K. Biobank found an unexpected link between prescribed folic acid supplements and susceptibility to COVID-19 (BMJ Open, Aug. 24, 2022).

Even worse, people who caught COVID-19 while taking high-dose folic acid were more than twice as likely to die of the infection. The authors suggest that this B vitamin may make it easier for the virus to multiply.

Q. I suffer from persistent constipation. I have tried numerous laxatives and do not like any I’ve used. Can you recommend a laxative that works well, can be used regularly, and does not leave a residual aftermath that is difficult to clean up?

A. We discourage regular use of strong laxatives. Not only do they sometimes lead to accidents, but they can also disrupt the balance of fluid and minerals in the body.

Finding the cause of persistent constipation could be helpful. Many medications can contribute to this problem, as can certain conditions such as hypothyroidism or Parkinson’s disease.

There are numerous natural approaches for managing constipation, from increased fiber intake and “hot lemonade” to sugarless gum or flax seed. You may find our eGuide to Overcoming Digestive Disorders helpful. This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com. It lists medications that can cause constipation and offers 10 tips to combat constipation.

Q. I’ve had chronic kidney disease for more than 20 years. Over the past eight months, my kidney function has worsened quite a bit.

My nephrologist has put me on Farxiga to try to prevent further deterioration. Fortunately, I have not suffered from any side effects, but I have not found any information on how successful this treatment will be. Is this medication capable of significantly stabilizing my loss of kidney function and is it worth the cost involved in purchasing Farxiga?

A. Farxiga (dapagliflozin) was originally approved to treat Type 2 diabetes in 2014. Subsequently, it has been shown to reduce the risk of heart failure and complications of chronic kidney disease.

A placebo-controlled trial found that people taking Farxiga were only half as likely to have further serious decline in kidney function (Lancet Diabetes & Endocrinology, January 2021).

As you note, Farxiga is pricey, at about $650 for a month’s supply. Because the Food and Drug Administration has approved the drug’s use for CKD, your insurance company should cover it.

Side effects may include fungal infections in the genital area, urinary tract problems, constipation, nausea and dizziness upon standing. People with diabetes may be more susceptible to a condition called ketoacidosis. Symptoms include digestive upset, fatigue and difficulty breathing. Diabetic ketoacidosis is a medical emergency.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”