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The following may contribute to a deficiency of folic acid: • A defect in utilization, as in alcoholics • Increased needs in pregnant women and cancer patients • Metabolic interference by drugs • Folate losses in hemodialysis • Enzyme or cofactor deficiency necessary for generation of active folic acid Individuals using supplements or consuming either breakfast cereals or green leafy vegetables have significantly greater plasma folate and lower homocysteine levels than those who do not