Medicine For People!

December 2004: Folic Acid and Your Health, Wellness Tune-up

  • Folic Acid and Your Health
    • Note to Our Readers
    • How Megan Cheated Fate
    • Daily Requirements Hard to Obtain Through Diet Alone
    • Genes Determine Need
    • Folic Acid and Abnormal Pap Smears
    • Folic Acid and Estrogen
    • B-vitamins Work Together
  • Rant O' The Month - Too Slow to Act
  • Monroe Street Clinic News
  • Wellness Tune-up
  • Solutions for Weight Loss

Folic Acid and Your Health

Note to Our Readers

Last month we wrote about the ways vitamin supplements can prevent serious disease. This month we continue that discussion by focusing on folic acid, a member of the B-vitamin family. Even the most conservative physicians now agree that folic acid prevents neural tube defects, but few understand that folic acid requirements vary between individuals or that this nutrient is essential to the functioning of DNA and female hormones. To make this story more understandable, we introduce you to Megan, our hypothetical friend.

How Megan Cheated Fate

Tuesday April 7, 2015 was the day Megan cheated fate. That day she went to work, dealt with the usual and not-so-usual challenges but overall had another enjoyable day. As she drove home, she went over plans for the office lunch she was organizing the following day. At home Megan called her daughter to ask how granddaughter Anna's flu was doing.

Had things gone differently, this would have been the day Megan visited her doctor to learn that her breast biopsy showed cancer. Suddenly Anna's flu wouldn't have seemed so important and anticipation of another pleasant day would have been transformed to dread. Why did this day not go as fate had determined? What made the difference?

Let's take Megan back to the year 2004 at the time of her annual physical, when her doctor called to tell her that her pap smear had come back abnormal. She had been lucky that day, because Dr Forsight had recently become interested in the role of folic acid in abnormal pap smears and breast cancer. He'd noted that studies often showed conflicting results and, in his curiosity, had looked more carefully into the issue. He was well aware of the general medical consensus that healthy people don't need to take vitamins. But he also knew that his patients were all individuals; what might be true, on the average, for a thousand patients in a study, didn't always hold true for every individual patient in his office.

Dr Forsight explained to Megan that an atypical pap smear could indicate that she was not getting enough folic acid to meet her individual requirements. Megan protested that she ate only whole foods, mostly organic, and did not consume sugar, excessive baked goods, or other sources of "empty calories." Why would she need vitamin supplements?

Daily Requirements Hard to Obtain Through Diet Alone

Dr Forsight explained to Megan that even a person with a good diet may not get the 400 micrograms of folic acid per day recommended for the average person. Folic acid is present in green leafy vegetables, but you have to eat a lot to take in 400 micrograms a day. Dr Forsight quoted a recent German study: "An adequate intake of at least 400 microgram of folate per day is difficult to maintain even with a balanced diet, and high-risk groups often find it impossible to meet these folate requirements. (Zeitschrift fur Kardiologie 2004 Jun; 93 (6):439-53).

Genes Determine Need

Folic acid deficiency can arise not only from inadequate intake but also from an increased requirement for the nutrient. Based upon Megan's pap smear, Dr. Forsight was concerned that she might be one of those individuals who needed more than the normal amount of folic acid. About half of all people have a variant genetic blueprint for the enzyme methylenetetrahydrofolate reductase (MTHFR) or catechol-o-methyl-transferase (COMT). For more about MTHR go to this National Institutes of Health WebPage.

Folic Acid and Abnormal Pap Smears

Dr Forsight told Megan that women with atypical pap smears are more likely to have low folic acid levels. Even though studies looking at the value of folic acid in reversing such pap smears were still not convincing to most physicians, he suggested that Megan take a much higher than normal dose of folic acid to see if it would help her.

Folic acid deficiency is not the only cause for an abnormal pap. In about 20 percent of Dr Forsight's patients, nutritional measures did not improve the pap smear. If Megan turned out to be one of the 20 percent, Dr Forsight would refer her to a gynecologist for a special diagnostic test and, if necessary, a procedure to freeze her cervix and kill suspicious cells. Dr Forsight might also determine that, although Megan was asymptomatic, she carried the human papilloma virus, a usually silent sexually transmitted virus that can predispose the cervical cells towards cancer. He would use both conventional and nutritional means to return her pap smear to normal.

Folic Acid and Estrogen

Dr Forsight told Megan that different women handle estrogen differently. Estrogen is created to send a feminizing signal to women's tissues. After it's done its work, the estrogen is then discarded in the same way that you throw away a letter after you read it. This disposal process can follow a couple of different paths. Women who don't have enough folic acid are more likely to push estrogen down a pathway that leads to more toxic forms of estrogen. Toxic forms stress the cervical tissues and make the DNA more likely to mutate into an aggressively dividing type. It's possible to tell if that is happening by looking at estrogen breakdown products in the urine. Megan's urine sample showed a less-than-optimal ratio between harmful and beneficial estrogen breakdown products. For this reason, Dr Forsight recommended that she increase her intake to at least 5 milligrams of folic acid a day. Non-prescription folic acid usually comes in tablets no greater than 400 micrograms (0.4 milligrams) in size, by government regulation. Rather than take a dozen such tablets, Dr Forsight prescribed an easier-to-take formulation.

B-Vitamins Work Together

Dr. Forsight also asked Megan to take a B-complex vitamin supplement. Folic acid is a member of the B-vitamin family, a group of nutrients that work best in a balanced relationship. If, for instance, a person has a significant B12 deficiency and they take high doses of folic acid, symptoms of the B12 deficiency can become more pronounced and much slower to resolve. So whenever we prescribe folic acid, we ensure an adequate intake of vitamin B12 with it. Adding B6 will extend the protection from the breast and cervix to the heart as well. Megan learned that thvitamins B6, B1, and B2 are plentiful in brassica family plants, which include cabbage, broccoli, cauliflower, brussel sprouts and kale. Vitamin B-12 is found in animal sources such as eggs, meat and fish, with liver being the best source. In addition to supplements, eating brassicas and a source of vitamin B-12 would help route her discarded estrogens down a friendlier pathway, reducing their risk of setting off a cancer.

Megan saw Dr Forsight many times over the years. From time to time he would review the latest research on folic acid and reaffirm her requirement for it. Megan was able to pass on to her daughter the information that folic acid prevents a common type of birth defect, called a neural tube defect, and that doses higher than the government-recommended amount are more protective She learned that folic acid has a positive influence in preventing heart disease and other forms of cancer, especially when taken with B6 and B12.

In 2004 Megan had a subtle folic acid deficiency and her body broke down estrogen in an unfavorable way. She looked as normal as her neighbor and there was nothing on a standard blood test or physical exam to distinguish her. Yet, without folic acid, she was at increased risk of breast and cervical cancer. Megan had a healthy diet, but she would not have been able to eat enough green vegetables to meet her genetically determined increased need for folic acid. Thanks to her physician's concern and all those B-vitamin pills she took over the years, Megan never needed that breast biopsy and she never got that bad news.

Rant O' the Month - Too Slow to Act

Some thirty years ago, a British physician published his observation that birth defect rates, specifically neural tube defects, were much lower in his patients who took folic acid. Study after study followed to verify this, and by the mid-1980s every nutritionally oriented physician I knew was well aware of this. They also knew that after a woman realizes that she's pregnant, it is too late for her physician's prescription for folic acid to do her any good. People began to petition the government to adjust its regulation of the food industry to take this fact into account. Excessive folic acid fortification of food could conceivably harm people with untreated pernicious anemia, so the Food and Drug Administration thought it through carefully. About three decades after that original publication, they finally required folic acid fortification to ensure an intake of about 0.2 milligrams per day.

In 2002 British researchers noted that the current folic acid fortification levels (0.2 milligrams daily) reduce the risk of neural tube defects by about 20 percent. Increase that to 0.4 milligrams daily and you reduce the risk by 36 percent. Increase it to 5 milligrams and you cut the risk by 85 percent. One drop of a liquid folic acid preparation contains 5 milligrams. It is not easy to find such a preparation, but once you have, what could be easier to take? Were all women of childbearing age to take such a supplement, the number of children born with a neural tube defect would fall from about 3200 per year currently to about 600 per year. There would be a few women with hidden B12 deficiency who might have problems if they took no B12, causing the folic acid to bring out their illness. I believe women should have this information and be able to make the choice they think best.

Monroe Street Clinic News

Wellness Tune-Up

Around the beginning of 2005 we will offer a screening protocol to identify and treat people with hidden vitamin deficiencies or those with higher needs. The test will identify nutrients that are not exerting proper function in the cells. This should allow us to identify weaknesses in the physiology that could lead to illness if not treated.

Technology is rapidly evolving to determine how each individual handles pharmaceuticals. This technology will allow us to prevent many adverse drug effects and more accurately determine individual doses of drugs. We are tracking this technology and will offer it to you as the price-benefit ratio improves.

Solutions for Weight Loss

Janet Goldenbogen, our bariatric nurse educator, will be offering these courses.

DON'T DIET LIVE IT - 4 month, proven, successful, intensive support group. You'll learn whole foods nutrition concepts and effective ways to deal with the emotions of eating. Thursdays beginning January 13. 7-9pm $27/week includes books.

HEALTH BITES - a biweekly motivational/educational health forum Mondays from 7-8:30pm Each class is $20 and may be taken by itself. January 3, 2005 - Take Charge of Your Life and Your Weight January 17 - Get Rid of Belly Fat February 7 - Food as Medicine



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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.