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Folic Acid - The Good, The Bad and the LikelyFolic acid is one of those hero nutrients. It was the first vitamin the government recommended wesupplement – pregnant women are told to take 400mcg per day. It also cuts your risk for heartdisease, especially strokes, improves your mood, protects against some cancers and Alzheimer’s,and has pretty amazing memory-boosting properties. Surely we should all be guzzling lots of it in foodand in supplements? By the way, folic acid in food is called ‘folate’. It’s rich in greens (foliage – henceit’s name), beans, lentils, nuts and seeds.

Recommended daily intakes are usually between a minimum of 200mcg and 800mcg. Optimal levelsare generally considered to be about 400mcg a day. Have a look at the menus below. Each provides400mcg.

Did you eat one of these yesterday?

Most people would say no. A higher level of 800mcg is not easy to obtain by diet alone. It would bethe equivalent of 2.5lbs of strawberries, for example. Yet it is exactly this kind of level that seems toconfer the most benefit for your brain. In studies with people over age 50, supplementing 800mcgversus placebo for three years resulted in an improvement in memory the equivalent of being 5.5years younger.1

The main reason why folic acid is so vital for the heart and brain appears to be because it is vital for abiochemical process called methylation. This builds the protective sheath on nerves, repairs DNA,makes neurotransmitters, and detoxifies your body. Folic acid is one of six ‘methylation’ nutrients (theothers being B2, B6, B12, zinc and TMG) that lower your homocysteine and help you feel mentallysharp. These nutrients are synergistic and, in my opinion, should always be taken together.

There are good reasons for saying this. For example, the classic sign of either folic acid or B12deficiency is tiredness. If a person is low in B12, but supplements folic acid, often the tiredness goesaway – but the more insidious nerve damage caused by ongoing B12 deficiency continues.

Given that folic acid protects pregnant women from giving birth to babies with neural tube defects(NTDs) – also called spina bifida – and the high rate of NTDs among babies born to young women inusually unplanned pregnancies, the US government decided to fortify food with folic acid in 1996, withCanada following suit in 1998. Since then, NTDs in the States have dropped by more than 20%.

In the UK, it’s claimed the same move could prevent between 77 and 162 NTD cases a year. On topof this, extra folic acid may cut the number of strokes by 18%, according to research just published inThe Lancet. Deaths from stroke in both America and Canada have fallen since fortification.2 The UKFood Standards Agency wants to follow suit and fortify food in Britain.

• A salad with Romaine lettuce, endive, half an avocado and a handful of sunflower seeds,accompanied by a glass of orange juice.

• Spinach and lentil or millet bake with a serving each of broccoli and parsnips.

• A fruit salad with papaya, kiwi fruit, orange and cantaloupe melon in orange juice, plus a handful ofunsalted peanuts.

• An orange, a large serving of broccoli, spinach, Brussels sprouts and a bowl of miso soup.

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On the face of it, fortification sounds like good news. Stroke risk down, heart disease down, spinabifida down. But I, and others, predicted that there might be an increase in colorectal cancer and inAlzheimer’s in the elderly, especially those deficient in B12. For this reason, I oppose food fortificationwith folic acid on its own. And these predictions appear to be coming true.

In the US, absolute rates of colorectal cancer began to increase in 1996 and the same happened inCanada in 1998, following folic acid fortification.3 In support of this, a large Swedish study found thatpeople with a high level of folate in their blood had a significantly increased risk of colorectal cancer.4If these trends pan out to be true then, for every NTD baby saved, 20-50 will develop colorectalcancer, and for every stroke prevented, one person will develop colorectal cancer.

The reason appears to be that folic acid, certainly in isolation, while being very good at stoppingnormal cells becoming cancer cells, seems to encourage the growth of pre-cancerous cells in the gut.About one in five middle-aged people have pre-cancerous cells in their colon and most middle agedmen have them in their prostate too. For these people, too much folic acid, especially in combinationwith a bad diet, could be bad news.

Last year a study in the US found that elderly people with low B12 intakes (due to poor diet) but highfolic acid (from fortification) were five times more likely to have memory decline.5 In the UK, 10% ofthe elderly have low levels of B12. Giving these people extra folic acid can hide the symptoms of lowB12, making it likely they will not be tested for this and their deficiency will be missed. Thecombination of high folic acid and low B12 may also make any mental problems worse. Scaling downfrom American figures, we can predict that 150,000 elderly people could have more memory problemsas a result if fortification of flour with folic acid goes ahead in Britain as planned.

Now, before you start throwing away your folic acid supplements, let’s consider why folic acid is bothgood – and bad. One possibility is that enough is good for you and too much folic acid is bad for you.For example, in animal studies, rats with a low folate diet had less beneficial serotonin in the brain butso did rats with very high levels of folic acid.6 Similarly, in humans, excess folate may worsendepressive symptoms. A study in 1997 found that taking above 15,000mcg a day (a lot!) causedmental changes in healthy volunteers – sleep alterations, hyperactivity and irritability – similar tosymptoms of folate deficiency.7

The second possibility is that folic acid works synergistically with other nutrients such as B12, B6, zincand so on – which is an established fact – and that giving folic acid on its own to people who areeating the average poor diet (and especially older people whose absorption of B12 is often very poor),can encourage cancer cell growth if they already have cancer cells in the gut. This possibleexplanation makes sense given that there is no evidence that high levels of folate in food have thedrawbacks shown with fortification. In fact, the more fruit and vegetables you eat, the lower your riskof colorectal cancer. This suggests that the combination of folate with other nutrients works morebeneficially. I’m putting my money on the synergistic benefit of these methylation nutrients as a majorfactor, but only more research will definitively answer these questions.

The government is finally starting to listen to the arguments against food fortification and the ChiefMedical Officer, Sir Liam Donaldson, has asked the Food Standards Agency's board to seriouslyconsider this evidence of potential harm.

The FSA is still hell-bent on fortification and, instead, want to impose a maximum level of 200mcg offolic acid in supplements. This seems to me like a damage limitation exercise in the light of an ill-thought-through fortification policy. The reason why I don’t think this is the right thing to do is thatmany people, myself included, will continue to eat whole, unrefined foods, which will not be fortified.

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There is no evidence that for people like me, supplementing 400mcg a day and probably eating thesame, has a greater risk of anything.

However, one in ten people have inherited a type of a gene that increases homocysteine – andtherefore need extra folic acid to lower it. For these people, and for anyone with high homocysteine,200mcg a day is definitely not enough. Why deny these 5 million people in Britain the right to achievean optimal intake of folic acid? If teenage girls were screened for homocysteine in the same way thatwe are all being screened for cholesterol, wouldn’t that be a more targetted approach thansupplementing refined flour, and then denying everyone access to folic acid supplements above200mcg? The trouble is British doctors don’t test for homocysteine. In Germany, two millionhomocysteine tests are run every year. In the UK, it’s more like 20,000.

One of the best ways to know your ideal folic acid intake is to know your homocysteine level (seewww.healthproductsforlife.com for details of a home test). If it’s high, it’s important to lower it and weknow what kind of vitamin levels do this most effectively (see table below). It doesn’t take long, so ifyou do take large amounts to correct high homocysteine, don’t keep taking them forever. Recheckyour homocysteine score after three months and adjust your supplements accordingly.

Personally I’m in favour of multivitamins containing all of the homocysteine-lowering nutrients, plusspecific homocysteine-lowering formulas, taken if your homocysteine level is high. I also never givefolic acid alone to anyone, not even a pregnant woman. Where is the logic in giving only one out of sixkey methylation nutrients?

Apart from resisting folic acid fortification until we know more, and coming up with a more targetedway of nourishing girls who may become pregnant, my advice is to supplement up to 400mcg a dayeven if you are not pregnant, but together with B6, B12 and zinc, and keep eating greens, beans andfruit. But don’t take more unless your homocysteine is high and you want to lower it.

References

1. J Durga, Effect of Folic Acid Supplementation on Cognitive Function. 5th International Conferenceon Homocysteine Metabolism, 25-30 June 2005, Milan, Italy.

2. Q Yang et al. Improvement in Stroke Mortality in Canada and the United States, 1990 to 2002,Circulation (2006), vol. 113, pp. 1335-1343.

H SCORE GOOD OK HIGH V.HIGH<6 6-9 9-15 >15

Supplement Multivitamin

+2homo-cysteineformula

+3homo-cysteineformula

+4homo-cysteineformula

Folic acid 250µg 500µg 750µg 1000µgMethyl B12 250µg 500µg 750µg 1000µgB6 20mg 40mg 60mg 80mgB2 10mg 20mg 30mg 40mgZinc 5mg 10mg 15mg 20mgTMG 500mg 1g 1.5g 2gNAC 250mg 500mg 750mg 1000mg

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3. J B Mason et al, Temporal Association between Folic Acid Fortification and an Increase inColorectal Cancer Rates May Be Illuminating Important Biological Principles: A Hypothesis, CancerEpidemiology Biomarkers & Prevention (2007), vol. 6, pp. 1325-1329.

4. Van Guelpen et al, Low Folate Levels May Protect Against Colorectal Cancer, Gut (2006), vol. 55,pp. 1461-1466.

5. M S Morris et al, Folate and Vitamin B-12 Status in Relation to Anemia, Macrocytosis, andCognitive Impairment in Older Americans in the Age of Folic Acid Fortification, American Journal ofClinical Nutrition (2007), vol. 85, pp. 193–200.

6. M I Botez et al, Relapsing Neuropathy, Cerebral Atrophy and Folate Deficiency: A CloseAssociation, Applied Neurophysiology (1979), vol. 42(3), pp. 171-83.

7. J E Albert and M Fava, Nutrition and Depression: the Role of Folate, Nutritional Reviews (1997),vol. 55, pp. 145-149.