Tag Archive for: prenatal supplements

The Bottom Line on Folic Acid

/in /by

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

/in /by

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?

/in /by

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.