Folic Acid: It Seems Wise to Take a Supplement

February 7, 2005

Folic acid reduces the blood pressure, but only if you take a folic acid supplement, as you will not get enough simply through your diet. At the same time, folic acid protects your heart and brain from blood clots.

Since long, it has been documented that the B-vitamin folic acid (B9) prevents congenital neural tube defects. In Canada, all kinds of flour have been enriched with folic acid during the past 8 years, and 80% of the congenital neural tube defects have thus been prevented. In the USA, enrichment is also obligatory, but in Britain, expectant mothers are left to themselves. They have to figure out for themselves to take a supplement – before they become pregnant!

The main source of folic acid is leafy green vegetables (the latin “folium” means “leaf”). Many people do not like these leafy greens and folic acid deficiency is therefore more common than any other vitamin deficiency. Unfortunately, the deficiency probably does not only harm the unborn baby but does also increase the mortality of coronary thrombosis and cerebral apoplexy in adults. But this is not all: Folic acid deficiency probably also increases the risk of hypertension.

The connection between folic acid deficiency and hypertension that has been unknown till now was discovered when an eight-year study was concluded involving 156,000 American nurses *1). The risk of the nurses having hypertension while being 27 – 44 years of age was only half as great when they took 1 mg (1000 mcg.) of folic acid a day compared to when they took 0.2 mg. In both the US and Britain, 0.2 mg. is just below the average daily folic acid intake which is 0.25 mg. It is almost impossible to get 1 mg. of folic acid a day – which is four times as much – without taking a supplement.

With regard to apoplexy and coronary thrombosis, much interesting knowledge has been produced during recent years:
In the US, where enrichment of flour with folic acid began in 1996, the mortality rate following apoplexy has droppped dramatically – in all groups of society, that is, and for both men and women – so the results are rather regardless of lifestyle, etc.

Before 1996, the annual drop in mortality as a result of apoplexy was about 1%. This drop was the result of improved treatment and prophylaxis. However, in the succeeding three years, mortality rates dropped three times as fast, i.e. with a total of 10 – 15%! Statistically, this has been explained by the fact that the average American now has twice as much folic acid in his/her blood as before *2).

Moreover, apoplexy is far more dangerous if you are deficient in folic acid. This was recently demonstrated on mice. They were given an artificial apoplexy in that their cerebral artery was simply clamped. It turned out that the cerebral damage was only half as great in the mice that had been given enough folic acid *3).

Folic acid seems to be able to protect the heart as well. This appeared most recently when Italian doctors studied 900 patients hospitalized with or without coronary thrombosis. The patients were divided into three groups according to their estimated daily intake of folic acid. Among the patients admitted to the cardiology department, most of them belonged to the group that got the least folic acid!

The third of the patients that got the least folic acid had twice as great a risk compared to the third of the patients that got the most folic acid. When vitamin B6 intake was also taken into account (vitamin B6 collaborates with folic acid), the ones who got the most folic acid only had a relative risk of 29% *4).

It is not the folic acid itself that protects the heart and the brain. However, folic acid reduces the blood content of the harmful amino acid homocysteine which attacks the blood vessels.

About 10% of the population are unaware that they have a hereditarily increased homocysteine level in their blood (and therefore need more folic acid). Recently, it was discovered that these 10% suffer apoplexy significantly more often than others *5, 6). It was already known that these people already have an increased risk of suffering coronary thrombosis *7).

Nobody has yet performed a blinded study in which supplements have been used to efficiently lower the blood contents of homocysteine. However, this kind of research is now being encouraged *8). Yet, with our existing knowledge, it seems wise to take a folic acid supplement. The ideal dosage may be around 0.8 mg. (800 mcg.) a day.

By: Vitality Council

References:
1. Forman JP, Rimm EB, Stampfer MJ, Curhan GC. Folate intake and the risk of incident hypertension among US women. JAMA. 2005 Jan 19;293(3):320-9.
2. American Heart Association’s 44th annual Conference on Cardiovascular Disease Epidemiology and Prevention.carole.bullock@heart.org
3. Endres M, Ahmadi M, Kruman I, Biniszkiewicz D, Meisel A, Gertz K. Folate deficiency increases postischemic brain injury. Stroke. 2005 Feb;36(2):321-5.
4. Taivani A et al. Folate and vitamin B6 intake and risk of acute myocardial infarct in Italy. Eur J Clin Nutr 2004;58:1266-72
5. Al-Delaimy WK, Rexrode KM, Hu FB, Albert CM, Stampfer MJ, Willett WC, Manson JE. Folate intake and risk of stroke among women. Stroke. 2004 Jun;35(6):1259-63.
6. Casas JP et al. Homocysteine and stroke: Evidence on a causal link from mendelian randomisation. The Lancet 2005;365: 224-32
7. Klerk M, Verhoef P, Clarke R, Blom HJ, Kok FJ, Schouten EG; MTHFR Studies Collaboration Group. MTHFR 677C–>T polymorphism and risk of coronary heart disease: a meta-analysis. JAMA. 2002 Oct 23-30; 288(16):2023-31.
8. S Schwammenthal et al. Homocysteine, B-vitamin supplementation, and stroke prevention. From observational to interventional trials. Lancet Neurol. 2004;3(8):493-5.

jama.ama-assn.org
www.lancet.com
stroke.ahajournals.org
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Folic Acid is Still Healthy

December 11, 2004

New media storm has no basis in the scientific data. To the long list of cheap and trashy attacks on dietary supplements another one can be added for folic acid, which is a recent hit-and-run victim of the Danish newspaper B.T. with its screaming headline: ”Supplement can cause cancer.”

To make such a sensational claim, this tabloid ignored the authors’ very clear statement that it may only be a statistical fluke. But we have seen this kind of cut-and-slash media coverage before.

The article actually covers an old study from 1967, which was dug up from its grave and published in the British Medical Journal. [1] It seems that some 3,000 women participated in this study, which was not double-blind controlled.

Instead, the supplements were given to the subjects using six different tablets, separately colored, and taken from numbered drawers. Of these 3,000 women, 31 died from breast cancer during the 37 years that had passed, and of these 31, 6 women got 0.2 mg folic acid, 8 got 5 mg folic acid, and 17 got a placebo.

Clearly, no statistical certainty follows from this result, which means that it may only be an accidental incident. The study was supported financially by the pharmaceutical company, GlaxoSmithKline.

As mentioned, the authors themselves stated that the result may be accidental.

Many earlier scientific studies had shown the contrary to be true. In fact, the official comment by the professors Oakley and Mandel in the British Medical Journal [2] clearly dissociates them from the media-sensationalized conclusion, when they write that these earlier studies taken together actually demonstrate that higher supplementation of folic acid would decrease, rather than increase, the risk of cancer.

Furthermore, they draw attention to the fact that every single year folic-acid enrichment of American foods alone saves more people from blood clots in the brain and heart than the number of people dying from traffic accidents in the USA.

Be wary of this study, which is old. Its proponents are trying to have their cake and eat it too because when old scientific studies speak of the benefits of dietary supplements or natural medicine, they are often accused of being based upon an ”old standard,” and of not ”living up to the present standard.”

In decency the same can be said about old studies that are negative towards dietary supplements. These days a lot are dragged out from the old moth bag.

The problem is not so much these old studies, as it is the media, which smell sensationalism and thereby frighten the population from taking these supplements that are so important, when taken properly. But proper use demands information, and the population is not allowed to be informed.

By: Vitality Council

References:
1. Charles D, Ness AD, Campbell D, Smith GD, Hall MH. Taking folate in pregnancy and risk of maternal breast cancer. BMJ 2004:329:1375-6.
2. Ockley GP, Mandel JS. Commentary: Folic acid fortification remains an urgent health priority. BMJ 2004;349;1376.

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Overlooked B-vitamin Might Prevent Alzheimer’s Disease

September 27, 2004

In the search for substances that might prevent Alzheimer’s disease, the focus has mainly been on antioxidants like Vitamin E and Gingko biloba as well as the B-vitamins B12, B6, and folic acid. However, an American study now indicates that the quite unnoticed B-vitamin Niacin as being able to play a role too.

For 90 years, it has been clear that niacin is important to the nervous system and that severe niacin deficiency can cause dementia – as part of the deficiency disease pellagra. The wonder is that, until now, nobody has made a link between this kind of dementia and Alzheimer’s disease.

So far, the study has involved 6158 inhabitants of Chicago. They were all above 65 years of age and the plan was to register their diet and follow them every third year with psychological tests for dementia. They succeeded in doing so with 3718 of the trial subjects. Among these, 815 people who did not have Alzheimer’s disease at the beginning of the trial were randomly chosen. They were divided into five groups according to their intake of niacin.

131 people in the latter group were diagnosed with Alzheimer’s disease during the following four years. It turned out, however, that in the 20% who had the lowest intake of niacin (on average 12.5 mg. a day), the incidence of Alzheimer’s disease was more than three times as high compared to the ones with the highest intake (22.4 mg. a day or more). This was the result after statistical adjustments for known or suspected causes of the disease had been performed.

Both dietary niacin and niacin from vitamin tablets were included in the study. Good dietary sources of niacin are whole meal, liver, meat, fish, milk, legumes, – and coffee! Brewer’s yeast is also a good source of niacin, but, unfortunately, the same does not apply for beer! The average Englishman gets 2/3 of his niacin from meat, beverages, milk, and cheese, while only 1/8 comes from vegetables.

By: Vitality Council

References:
1. Morris MC, Evans DA, Bienias JL, Scherr PA, Tangney CC, Hebert LE, Bennett DA, Wilson RS, Aggarwal N. Dietary niacin and the risk of incident Alzheimer’s disease and of cognitive decline. J Neurol Neurosurg Psychiatry. 2004;75(8):1093-9.
2. National Food Agency of Denmark (Levnedsmiddelstyrelsen): Nutrient recommendations, 1992 (Naeringsstofanbefalinger, 1992).

jnnp.bmjjournals.com
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Vitamin B12 helps against itching

September 6, 2004

Chronic itching can be effectively remedied with vitamin B12 – at least if the itching is due to childhood eczema, also called atopic eczema. The highly skin-soothing effect has been demonstrated by six German dermatologists in a quite simple experiment with 49 patients.

The itch-injured patients were each given two tubes of cream. One was a neutral moisturizer, while the other contained vitamin B12, otherwise available as tablets or as a solution for injection. In the following eight weeks, the patients lubricated the neutral cream on one side of the body and the B12 crem on the other side. After the eight weeks, both patients and doctors evaluated the result.

The effect was convincing. In approx. 60% of the cases the B12 vitamin cream, after both the doctor’s and the patient’s opinion, had resulted in a “good” or “very good” result. On the side of the body that had been treated with the moisturizer, the result was almost inevitably “moderate” or “bad”. Here too, doctors and patients agreed.

The B12 vitamin cream was exceptionally well tolerated and is quite harmless. The mode of action is thought to be that the vitamin in certain contexts is an effective antioxidant neutralizing NO (nitrogen oxide) in inflammated tissue.
It was known in advance that when you block the formation of NO in asthma medically, itching and rashes decreases. The new thing is that the same effect is achieved in this simple way by blocking NO when it is formed.

Itching is also a problem in many other skin diseases, just as many elderly suffer from chronic itching. If the vitamin works with other itchy conditions, it is unknown. An estimated 10% of elderly people in Britain suffer from vitamin B12 deficiency.

By: Vitality Council

 

Reference:
Stucker M, Pieck C, Stoerb C, Niedner R, Hartung J, Altmeyer P Topical vitamin B(12)-a new therapeutic approach in atopic dermatitis-evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial. Br J Dermatol. 2004;150(5):977-83.

www.blackwell-synergy.com/servlet/useragent

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B Vitamin (Folic Acid) May Strengthen the Bones

August 2, 2004

The vitamin B substance folic acid (Vitamin B9) may be able to counteract osteoporosis. This is concluded by an American and a Dutch population study, which were simultaneously publisized in the medical magazine The New England Journal of Medicine.

Folic acid prevents neural tube defect (spina bifida) which is a serious and relatively frequent congenital malformation. Moreover, it is assumed that the vitamin counteracts coronary thrombosis, strokes, and other sequelae from atherosclerosis. Folic acid deficiency is quite widespread. One of the results of folic acid deficiency is that the blood level of the amino acid homocysteine is raised to abnormal high levels.

In the Netherlands, a group of 2,406 people above the age of 55 located in Rotterdam and Amsterdam were followed over a period of up to nine years.

In the American study which was part of the well-known Framingham study, 1,999 elderly people participated and were followed for 15 years. In addition to fractures, a large number of other significant factors in the development of osteoporosis were registered: Smoking habits, age, height and weight, consumption of coffee and alcohol, calcium- and vitamin D intake, oestrogen supplements, etc.

The two studies demonstrated that a high level of homocysteine was linked to an increased risk of suffering hip fractures. Both studies showed that people who belong to the top 25% with regards to high homocysteine levels in their blood have twice as large a risk of breaking their hip as the ones who have much lower levels of homocysteine.

Several conditions point towards a cause and effect relationship here. For example, it was statistically rejected that the risk was related to and biased by other known causes of osteoporosis, such as smoking, a lack of dietary calcium, etc.

It is also known that osteoporosis is a pronounced phenomenon in the hereditary disease homocystinuria in which the levels of homocysteine are particularly high. Finally, it has been demonstrated in laboratory experiments that homocysteine weaken the cross-links in the wickerwork of connective tissue around which the bones are built.

According to the Dutch results, a high level of homocysteine – and thereby a resulting lack of folic acid – might be the cause of approximately 19% of all hip fractures!

By: Vitality Council

References:
1. Van Meurs Joyce B J et al. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med 2004;350:2033-41.
2. Mc Lean Robert R et al. Homocysteine as a predictive factor for hip fracture in older persons, N Engl J Med 2004;350:2042-9.
3. (Editorial) Raisz LG. Homocysteine and osteoportic fractures – culprit or bystander? N Engl J Med 2004;350:2089-90.

content.nejm.org
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Alcohol Causes Cancer, Vitamin B Prevents It

June 28, 2004

Studies show that the risk of intestinal cancer is increased by 30% in people who have more than 2 drinks a day. However, this risk seems to be completely neutralized by vitamin B9, aka. folic acid.

Cancer of the colon is among the most frequent kind of cancer and furthermore among the deadliest. Several studies have in later years shown that the risk of colon cancer is increased by alcohol intake. This is once again outlined in the partial result of a population study in which five countries participate involving approx. 490,000 men and women.

The recently published results show that the risk of intestinal cancer is increased by approx. 30% in people who have more than two drinks a day; without regard to the drink being wine, beer, or any other kind of alcohol. However, this risk seems to be completely neutralized by the B vitamin folic acid.

A connection between alcohol and breast cancer in women has also been established but also in this case, folic acid seems to have a protective effect.

The same thing applies for ovarian cancer. In March, a Swedish study of this subject was published: Among more than 66,000 women, the incidence of ovarian cancer was reduced by more than 75% in the ones who were given the most folic acid – regardless of them having more than two drinks a day.

Folic acid is a vitamin B which can be found in large amounts in greens and in liver. It is mostly known for its ability to prevent myelomeningocele in newborns – the most common of all serious congenital malformations.

The incidence of myelomeningocele has decreased in the USA after obligatory enrichment of flour with this vitamin was introduced in 1996. Folic acid deficiency is regarded as a very common suffering. A daily supplement of 400 mcg. is considered an appropriate amount for preventive measures.

By: Vitality Council

 

References:
1. Larsson SC, Giovannucci E, Wolk A. Dietary folate intake and incidence of ovarian cancer: The Swedish Mammography Cohort. J Natl Cancer Inst. 2004 Mar 3;96(5):396-402.
2. Eunyoung Cho et al. Alcohol Intake and Colorectal Cancer: A Pooled Analysis of 8 Cohort Studies. Annals of Internal Medicine 2004;140:603-613.
3. Giovannucci E et al. Alcohol, low-methionine-low-folate diets, and risk of colon cancer in men. J Natl Cancer Inst. 1995 Feb 15;87(4):265-73.

jncicancerspectrum.oupjournals.org
www.annals.org
www.iom.dk

Alcohol Counteracts the Effect of Folic Acid in Women

October 29, 2003

Epidemiologic study shows folic acid deficiency in women with a daily alcohol consumption of 2-3 drinks and thereby increased risk of chronic joint disease, coronary disease (blood clots) and breast cancer.

By. Vitality Council

Reference:
American Journal of Epedemiology 2003;158:760-771.

aje.oupjournals.org
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Hesitation in Health Sector Costs Lives!

June 2, 2003

According to the British Medical Journal thousands of deaths in Denmark are due to the authorities not  being willing to take the available documentation on folic acid  into account.

350,000 deaths due to cardiovascular disease could have been avoided the last ten years if the British authorities had used the available knowledge about the effect of folic acid, according to the British Medical Journal who refers from a London conference (BMJ 2003; 326: 1054).

By: Vitality Council.

 

References:
BMJ 2003;326:1054.
Canadian Medical Association Journal 2002;167:241-5.

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Inertia on folic acid has caused thousands of unnecessary deaths

May 17, 2003

As many as 350,000 deaths could have been prevented over the last decade if the UK government had acted on the compelling evidence for the benefits of folic acid, a conference was told last week. Had flour been fortified with folic acid when the evidence regarding neural tube defects was published, thousands of people would not have died from coronary heart disease.

Godfrey Oakley, visiting professor at the department of epidemiology at the Rollin School of Public Health of Emory University, Atlanta, said: “The failure to require mandatory fortification of flour with folic acid is public health malpractice.” He was speaking at a conference in London organised by Dr Jean-Pierre Lin, consultant paediatric neurologist responsible for the spina bifida services at Guy’s and St Thomas’s hospitals on behalf of the charity the Little Foundation and MacKeith meetings (a product of publishers MacKeith Press).

Recent evidence shows not only the benefits of folic acid in preventing neural tube defects but that it is protective against heart disease, strokes, deep vein thrombosis, and pulmonary embolism. Folic acid lowers concentrations of homocysteine, an amino acid that for about 15 years has been believed to be associated with heart attacks and strokes.

Dr David Wald, a cardiologist at Southampton General Hospital, said: “Until public health agencies fortify our diet with sufficient folic acid, people should consider taking an 800 µg supplement each day, especially if they have coronary heart disease.”

The Medical Research Council vitamin study was published in 1991 and gave compelling evidence that taking folic acid prevents up to three quarters of neural tube defects, such as spina bifida (Lancet 1991;338:132-7). Despite the publicity that the report generated, the incidence of neural tube defects has not declined in the United Kingdom over the last decade, despite quite a steep decline between 1970 and 1992.

The government recommends that women who are trying to conceive take 400 µg of folic acid a day. But experts point out that about half of pregnancies are unplanned, meaning that many women start taking the vitamin only once they find out they are pregnant or not at all. Specialists say that the optimal time for women to take the vitamin is from stopping contraception to 12 weeks after conception.

Public health doctors and charities such as the Association of Spina Bifida and Hydrocephalus have called on the UK government many times to fortify flour with folic acid. They point out that 39 countries around the world, including the United States and Canada, now either fortify flour or have agreed to do so, and that the rate of neural tube defects has fallen in these countries. In Nova Scotia, where fortification was implemented in 1998, the incidence fell from 2.58 per thousand people in 1991-7 to 1.17 per thousand people in 1998-2000 (Canadian Medical Association Journal 2002;167:241-5).

No country in the European Union, however, has yet decided to fortify flour. The folic acid working group of the European Surveillance of Congenital Anomalies is soon to publish a report, concluding that most women in Europe do not take folic acid around the time of conception, despite education programmes in some countries encouraging them to do so.

The group collated data from 17 countries showing that the overall incidence of neural tube defects in Europe has not declined over the 1990s. Even women who do take folic acid often do not start until after conception. The report will recommend that EU countries adopt a policy of fortifying flour with folic acid.

If flour were fortified at the recommended level on a worldwide scale 100 000 pregnancies resulting in neural tube defect would be prevented each year, according to Professor Nick Wald, of the St Bartholomew’s and the Royal London School of Medicine and Dentistry.

He said, “There is no evidence or reason to regard fortification at any of the doses proposed as a risk to health, and there is compelling evidence that failure to fortify causes considerable harm.”

The meeting was held the day before the UK’s Food Standards Agency issued a report warning people against taking too many vitamin supplements. The Birth Defects Foundation issued a press release urging women to keep taking folic acid, after receiving a flood of calls to its telephone.

By: Anna Ellis,

BMJ. 2003;326(7398):1054.

Folic Acid Supplementation may Minimize the Risk of Three of the Biggest Circulatory Diseases

November 23, 2002

A study, a so called meta analysis of 92 studies involving 20,669 patients, was published in the British Medical Journal (BMJ) the 23 November 2002.

Earlier studies have found a connection with a too high value of the substance Homocysteine in the body with coronary diseases like blood clots in the heart, blood clots in the legs, and in the brain.

Homocysteine is increased by deficiency of several vitamin Bs, especially vitamin B12, vitamin B6 and folic acid, and by a common genetic defect that reduces the activity of an enzyme in the folic acid metabolism. The result of this defect is a condition called “functional vitamin B deficiency”, which means a need for greater intake of folic acid in the exposed ones.

Increased homocysteine – no matter the cause – has shown to be significantly related to the three following diseases. By a reduction in the homocysteine of the blood of 3 mikromol/l it was possible to decrease the incidents of heart diseases with 16%. Deep venetrombose, with or without lung emboli, with 25%. The reduction in the frequens of blood cloths in the brain (strokes) was 24%.

The authors conclude:
That by reducing the homocysteine concentration with 3 mikromol/l (which alone can be obtained by increasing the folic acid intake, editor) the risk of heart disease can be reduced with 16%, the risk of deep venetrombose with 25%, and the risk of stroke with 24%.

By: Per Tork Larsen, DSOM

Reference:
British Medical Journal; Nov, 2002.

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