Good and Plenty

Good and Plenty

Mainstream medicine’s curious relationship with folic acid is amusing. By and large, most mainstream doctors are dismissive of alternative health care and supplement use. Some will tell you, flat out: “Vitamin supplements are pointless. Don’t waste your money.” And yet, the idea that pregnant women need folic acid supplements to help prevent birth defects is unquestioned (which it should be).

Now this curious relationship is getting put to the test, as the results of a surprising new study raise the question: How can we get more folate into more moms-to-be?

The answer isn’t as simple as it might seem.

Eating for two

Researchers at the University of Toronto’s Department of Nutritional Sciences interviewed about 60 pregnant and lactating women to assess their dietary folate intake. Nearly all the women were college educated and lived in high-income households. In other words, these are the types of women who should me most aware of the necessity of folate intake during pregnancy and lactation.

Results showed that more than one third of the women had inadequate folate intake during pregnancy, and just over 30 percent had inadequate folate intake during lactation.

All of these women may have been getting plenty of folate through supplements, but this study measured only the dietary intake. The researchers estimate that nearly every woman in the study would have had an inadequate intake of dietary folate if not for the 1998 government mandate that all grain products must be fortified with folic acid, the synthetic form of folate.

The Toronto team also estimated that if the government boosted required grain fortification to twice the current level, the percentage of women with inadequate folate intake would drop dramatically to only about three percent. That sounds like a plan, doesn’t it? Yes, but there’s just one little problem. And an interesting story to go along with it.

A little of this a little of that

The Toronto research revealed that the average folate intake for pregnant women was 562 mcg per day, and 498 mcg per day among lactating women. But a few years ago the FDA established a regulation that forbids supplemental doses of folic acid over 800 mcg because high folate levels can mask a vitamin B-12 deficiency in older people. So if the folic acid fortification of grains was doubled, the risk of birth defects might drop, but undetected B-12 deficiency among the elderly might rise.

What a pickle! The government mandates that anyone who eats grains will get a dose of a dietary supplement, whether you want it or not. But the government has also taken measures to restrict intake of the supplement. Huh! It’s almost as if whoever is in charge here HAS NO CLUE!

Of course, the easy way to address potential B-12 deficiency is to eat more meat, fish and eggs, or use a B-12 supplement. But you can’t count on everyone to take those steps. So (just thinking out loud here – I’m not actually suggesting it), the FDA could mandate that all grains be fortified with folic acid AND B-12.

But why stop there? In previous e-Alerts, HSI Panelist Allan Spreen, M.D., has noted that 100 mg per day of vitamin B-6 helps make folate more effective, and an additional 400-500 mg of magnesium per day helps make B-6 more effective. So if the FDA followed the logical progression here – bing! – just like that, they’d put grain product manufacturers in the multivitamin business, completely contrary to the mainstream dogma that supplements aren’t necessary because you get all the nutrients you need from a balanced diet blah blah blah.

Eat up!

You really can get all the folate you need by eating plenty of spinach and other dark green vegetables, brewers yeast, lima beans, cantaloupe, watermelon, wheat germ, and liver from organically raised animals.

But the key word above is “plenty.” And the obvious reality is that most people don’t consume “plenty” of nutritious foods. For instance: Would two spinach salads each day be overkill? Not at all, according to the results of a study from Louisiana State University. When LSU researchers examined six years of dietary records for more than 17,000 adults they found that folic acid levels rose by about 40 percent with every salad consumed.

And as for fortified grains, I wouldn’t depend on them. There’s just no telling if all the good intentions and regulations (not to mention the guy working the late shift at the Wonder Bread plant) actually deliver an adequate amount of folic acid in every slice of bread.

Sources:
“One-Third of Pregnant and Lactating Women May Not Be Meeting Their Folate Requirements from Diet Alone Based on Mandated Levels of Folic Acid Fortification” Journal of Nutrition, Vol. 136, No. 11, November 2006, jn.nutrition.org
“Salad Eaters More Likely to Get Key Nutrients” Clarisse Douaud, NutraIngredients, 9/19/06, nutraingredients.com