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Folate, pregnancy, Neural Tube Defects and more

In the 60s it was suggested that low folate status was one specific risk factor for Neural Tube Defects (NTD) including Spina Bifida. What began with recommendations to supplement with folic acid during pregnancy expanded into mandatory food fortification in many countries, including Australia[i] in the mid to late 1990’s.

Both of these approaches have had a positive impact in reducing the incidence of NTD – reducing, not eliminating. Could the absence of total prevention of NTD as well as other health conditions be linked to over-use of the synthetic form of this B-vitamin?

In food fortification and commercial supplements, the synthetic form of folic acid is used. This type of mass-medication does not take into account individual or age-related needs.  While folic acid results in high serum levels, it remains questionable if the required quantity to ensure a healthy pregnancy is actually metabolised by women, in particular with the rise in MTHFR and related polymorphisms. Other health conditions that have been linked with this increase of folate intake, as a direct consequence of mandatory fortification of enriched flour and cereals, is an upsurge in colorectal cancer.[ii]  A further danger of high serum folate levels due to folic acid fortification is that it masks the effects of vitamin B-12 deficiency which can lead to anaemia and cognitive impairment.[iii]

When it comes to supplements, there are notable differences in ingredient quantities when comparing Australian, U.S. and European products.  This may be attributed to the fact that Europe, which includes the UK, has not adopted folic acid food fortification.

While there is no doubt that a healthy whole-food diet is the foundation to health in all stages of life, the degradation of our soils and use of agri-chemicals has significantly impacted the nutrient content and availability of some nutrients.  During times of increased need, supplementation becomes necessary.  With a marked rise in availability of over-the-counter supplements as well as online products, the consumer is faced with the dilemma of deciding which product is best.  Unfortunately, it is often the best marketing that wins out.

When it comes to supplements, it is always important to consult a qualified Naturopath who is able to assess your individual needs and recommend quality products.

Factors increasing need for folic acid include but are not limited to:

  • Individuals who do not take in adequate folate with foods
  • Women preparing for pregnancy
  • Women with a family history of NTD among close relatives
  • Women pregnant with a female child
  • Hispanic women
  • Women affected by epilepsy, taking anti-epileptic drugs (including valproic acid or carbamazepine)
  • Women with a high body mass index (BMI)
  • Women affected by pre-gestational diabetes
  • Individuals with identified genetic polymorphisms relating to folate metabolism
  • Individuals taking Methotrexate

As a final note, no B-vitamin should be taken on its own – always supplement with a B-complex and, if there is an increased need for any of the others, your practitioner will advise you.

You can learn more about vitamins and minerals as well as natural food sources in Conversations with my Daughter:  How to Have a Healthy Baby available now on Amazon and from