Tag Archive for: folic acid

Should I Use Folate or Folic Acid?

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In the past few years, there has been a trend toward using folate, the natural form of vitamin B9, versus using folic acid, the synthetic form. Many times I’ve answered the question “Which form is better? I’ve heard…” I said on Tuesday that the study on folic acid, blood lead levels, and autism had a lesson. That lesson is this:

Folic acid from enriched foods or supplements is equivalent to folate from foods or supplements.

The body efficiently converts folic acid to folate, and from that point, there’s no difference in the benefits to the mothers or their babies. Even in women who have the MTHFR mutations, folic acid is still beneficial.

This won’t close the door on people who insist that folate is the better choice, but we know their assertions aren’t based on research. Every study on the impact of folate/folic acid on pregnant women and their offspring used folic acid. That’s the form that was put into grain-based foods beginning in 1998 with the objective of reducing birth defects; the reduction in birth defects has been estimated at 70%. Further research has demonstrated benefits to the children of mothers who supplemented with folic acid, such as reductions in allergies, asthma, and ADHD.

The Bottom Line

The results from the study on the benefits to the offspring of women who may have been unintentionally exposed to lead is that folic acid intake is directly related to prevention of harms to their babies. It also illustrated that megadosing is not required. The lesson is that folic acid, whether added to grain products or in supplements, is an effective form of B9 to accomplish that goal.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

Folic Acid, Lead, and Autism

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Every once in a while, a research study provides an important lesson as well as some interesting findings. Let’s begin with the study.

During 2008 through 2011, researchers selected almost 1,900 pregnant women as subjects from 10 cities across Canada for the study. The overall goal was to identify environmental impacts on the mothers and children; this is an ongoing study. In this case, researchers looked at children who were diagnosed with autism, based on standard diagnostic criteria. Understand that autism is on a spectrum, and they used behaviors associated with autism when the children were three or four years old. They also tested maternal lead levels, folate levels, and folic acid intake in early pregnancy.

Researchers found there was an inverse relationship between blood lead levels and folic acid intake—as folic acid intake increased, the blood levels of lead decreased. The autism scores were also lower in the children of mothers who had sufficient folic acid intake, verified by their blood folate levels; 400 mcg intake was sufficient, and taking more folic acid didn’t provide additional benefit.

What does it mean? No one has to megadose folic acid to benefit their unborn children in response to environmental toxins. And even if pregnancy isn’t part of your future, the folic acid had a protective effect; if you suspect you have lead pipes, additional folic acid is a good idea.

What was the lesson? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1289/EHP14479

The Bottom Line on Chlorpyrifos

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Today’s health news is full of controversy, some based on reality but most not. Typically, I would have concluded that the op-ed piece was just that: an opinion that exaggerated the facts to put forth a specific point of view. But before I go further, let me be clear: I’m not in favor of any pesticides if they can possibly be avoided. But we also live with the necessity of feeding billions of people and can’t afford to lose crops; we judge fruits and vegetables by appearance because we no longer know the grower personally. There may be some chemicals that are necessary to get that done. The issue comes down to the question of safety. That’s where all the research I read comes into play.

PON1

When I attempted to find the statistics on chlorpyrifos, I came across a large body of research that examined how organophosphates such as chlorpyrifos were eliminated by the body. The paraoxonase 1 gene (PON1) makes enzymes that help the liver and kidney detoxify chemicals such as chlorpyrifos (1). Research on several groups of subjects show that if exposure doesn’t exceed the detoxification capacity of the body, the current tolerance limits are safe for most people.

The problem is similar to what we find in other genes: there are mutations of the PON1 gene that affect the ability of the gene to produce enough enzymes to detoxify the body effectively (2). If the body isn’t able to detoxify itself, the amounts of chlorpyrifos in the body can exceed safe levels. That means that those with the PON1 mutation may be most at risk for chlorpyrifos exposure.

Or maybe not. Again it comes down to exposure. In a study of farm workers chronically exposed to chlorpyrifos, there was no difference in the gene mutations with the ability to detoxify (3). In another study, blood samples with normal and mutated PON1 genes were exposed to high and low levels of chlorpyrifos; the high levels negatively affected the mutated version of the PON1. The low levels, reflective of typical environmental exposure, showed no negative effect (4).

The issue is one of exposure, whether someone has the PON1 mutation or not. Research shows that mothers and children who live in agricultural areas are more at risk to having higher levels of organophosphates in their systems. What isn’t clear is the impact of genetic mutations that result in health issues.

In a recently published paper, researchers found that infants born to mothers with the PON1 mutation and exposed to environmental organophosphates had smaller head circumferences relative to size (5). Whether that translates to reduced IQ or other neurological conditions remains to be seen.

The Impact of Nutrients on Chlorpyrifos Exposure

Several studies demonstrated potential benefits of nutrients on chlorpyrifos exposure. PON1 is also related to cardiovascular health. In a study of over 400 subjects, those subjects with a mutated version of the PON1 gene and with higher amounts of polyphenols from fruit and vegetable intake did better in measures of cardiovascular risk such as high cholesterol (6).

In another study, subjects who consumed organic honey as a supplement experienced less damage and better DNA repair after chronic exposure to organophosphates (7). The polyphenols in the honey were identified as the primary factor related to the repair process.

Finally, in a study of pregnant women and their offspring, researchers examined the affect of folic acid intake in those women who were and were not exposed to organophosphates (8). Those who had a greater than 800 mcg intake during their first month of pregnancy when exposed to pesticides had fewer children with autism spectrum disorder.

While all of this research is recent, it seems clear that nutrients can have a positive impact on people who are exposed to organophosphates such as chlorpyrifos and other pesticides.

The Bottom Line

When I began the research on one statement in an op-ed piece, I never imagined it would end up here, but you go where the research takes you. While this research trip took us to the USDA, the PON1 gene, and some nutrients that can be protective against exposure to chlorpyrifos, one fact I was unable to find was that we are exposed to excess amounts from the fruits and vegetables we eat. That statement in the op-ed was false. But in that journey, we learned a lot. It’s not where you begin; it’s where you finish.

Four final points:

  • I think the ban on chlorpyrifos should be reinstated. Tolerance limits doesn’t mean it’s safe for everyone, and not every harmful impact has been examined.
  • Whether the discontinuance is reinstated or not, eat your fruits and vegetables after you wash them carefully. The value of the nutrients for your health exceeds any risk from chemicals that may be present.
  • Add some extra insurance by taking your supplements.
  • If you’re a golfer, you may want to learn the course’s pesticide schedule and avoid those days.

What are you prepared to do today?

Dr. Chet

 

References:
1. www.ncbi.nlm.nih.gov/gene/5444.
2. Toxicology. 2013 May 10;307:115-22. doi: 10.1016/j.tox.2012.07.011.
3. Toxicol Appl Pharmacol. 2012;265(3):308-15. doi:10.1016/j.taap.2012.08.031.
4. Toxicol Lett. 2014 Oct 1;230(1):57-61. doi: 10.1016/j.toxlet.2014.07.029.
5. Ann Glob Health. 2016; 82(1): 100–110. doi:10.1016/j.aogh.2016.01.009.
6. J Transl Med. 2016 Jun 23;14(1):186. doi: 10.1186/s12967-016-0941-6.
7. Mol Nutr Food Res. 2016 Oct;60(10):2243-2255.
8. Environ Health Perspect. 2017 Sep 8;125(9):097007. doi: 10.1289/EHP604.

 

The Bottom Line on Folic Acid

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Based on the studies covered in the Tuesday and Thursday posts, you may be confused about what you should do when it comes to folic acid, especially if you’re pregnant or thinking about getting pregnant. I read a lot of research to come up with this analysis and here’s what I found.

There are three areas of concern:

  • Too much folic acid could mask a B12 deficiency during pregnancy; there’s no research to support that. It can happen in the elderly who have problems absorbing B12, but doesn’t seem to happen in women of child-bearing age.
  • Excess blood folic acid may be related to tumor acceleration; there’s some rodent research to suggest some relationship but nothing in humans. They have also cited research on folic acid supplementation and prostate cancer. I examined numerous studies and there’s no clear relationship; some show some type of relationship, others show a reduction in risk.
  • There may be some effect on the children of mothers who get too much folic acid; there’s one study that suggest an increase in asthma in offspring but most studies seem to demonstrate a protective effect.

Where does that leave us? Most of the studies are not done very well when it comes to folate and folic acid intake. The folic acid intake is dependent on Food Frequency Questionnaires, which have severe limitations. The methodology for determining blood folic acid levels vary from study to study. The associations between intake and problems are weak at best.

But when it comes to pregnancy, there may be a solution. In a recent study, researchers examined the relationship between neural tube defects and the red blood cell folate level. As the estimated levels increased, the risk of neural tube defects decreased. The level which seemed to provide the lowest risk of neural tube defects was greater than 1,000 nmol/L. This was a single study and used interesting statistical techniques, but it seemed to provide for more precise folic acid supplementation.

 

The Bottom Line

The benefits of folic acid on neural tube defects have been impressive, and the concern over excess supplementation may be legitimate or not. It could be that women process folic acid too well or not well enough and that could impact dietary and supplementation intake. Research on the MTHFR polymorphisms continue with no recommendation for its diagnostic use at this time.

If you’re concerned, talk with your physician about getting a blood folate test. Levels of RBC folate levels can be estimated from that result. One key point: the test would be most beneficial before conception because neural tube defects happen in the first month of pregnancy. Still it’s one way to be more cautious in spite of the limited risk.

Let me close by saying that in all the research I did, what I could not find is any association between reasonable folic acid intake and miscarriages or other issues during pregnancy. Folic acid appears to be safe and protective and should be a part of prenatal nutrition.

If you want to know more about having the healthiest baby you can, check out Healthy Babies: From Conception to Breastfeeding. It’s available as a CD or MP3 download.

What are you prepared to do today?

Dr. Chet

 

Reference: BMJ 2014;349:g4554 doi: 10.1136/bmj.g4554

 

Prenatal Nutrition: More on Folic Acid

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The second study on folic acid supplementation before pregnancy examined similar blood and red blood cell folic acid levels at different times during pregnancy and in cord blood (1). The difference was that half of the subjects were randomly provided with 400 mcg folic acid to take during their second and third trimesters. As you would expect, the women who supplemented their diets had higher levels of all variables than controls.

The difference between the two studies I’ve examined was that even with supplementation, the unmetabolized folic acid levels were virtually undetectable in cord blood in this study. Moreover, the red blood cell levels of folic acid were considered to be in the normal range in spite of the supplementation.

Two studies. One suggests that prenatal supplements should consider reducing the amounts, while the other suggests that there’s no effect in the most common amount found in supplements. I’ll make sense of this in Saturday’s post.

What are you prepared to do today?

Dr. Chet

 

Reference: J Nutr 2016;146:494–500.

 

Prenatal Nutrition: Should You Worry About Folic Acid?

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I’ve been working on updating the research for the second edition of the Healthy Babies CD, and that includes nutrients such as probiotics, vitamin D, and one of the most important nutrients, folic acid. Since folic acid was added to cereal grains in 1998, there have been significant reductions in neural tube defects, but folic acid is not without controversy: the concern is getting too much folic acid from foods and supplements. There have been some studies suggesting a relationship between excess folic acid and an increased risk of some diseases. This week, I’m going to cover three studies that examine folic acid before and during pregnancy to help clarify things.

In a study published in 2015, researchers examined the levels of folic acid and unmetabolized folic acid (UFA) in the mother’s blood early in the pregnancy, at delivery, and in the umbilical cord blood. They found that folic acid and red blood cell (RBC) folic acid did not significantly change. There were differences between those who did and did not supplement with folic acid. They did find UFA in the blood and cord blood. The researchers felt that the RBC folic acid blood levels and the UFA were too high and that folic acid supplements should be changed to reflect the high readings.

Are their conclusions warranted? Let’s take a look at another study that examined the same variables the following year. I’ll let you know what a difference a year makes on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Am J Clin Nutr 2015;102:848–57.