Folic acid for stroke – and to remember

June 12, 2007

You must remember your folic acid, otherwise you forget it.
This sounds like nonsense, but its not.

Folic acid helps keep the brain in good shape, and if you don’t get enough you might have problems thinking clearly and remembering when you get older.

Folic acid is the vitamin that fertile women should take (0.4 mg per day) unless they are 100% sure that they will not become pregnant. Far from all do this, even though folic acid prevents children from being a lifelong invalids due to spinal chord herniation (spina bifida) and reduces the risk of cleft lip and palate! That it is preventative is so called new knowledge (1) which is to say that it was pointed out, but ignored, over twenty years ago.

But folic acid also helps the memory and thought ability. Who do we know this? The English neurologist Edward Reynolds demonstrated it 40 years ago in hi article in The Lancet. He showed that 26 epilepsy patients who suffered folic acid deficiency due to their medicine improved when they received folic acid (2). This has since been forgotten.

Now there are new studies. One had negative results. Its authors concluded that folic acid has no effect on cognitive function, which did not improve for study participants who received 0.4 mg folic acid daily (without vitamin B12, in which they were mildly deficient) (3).

There is a simple explanation for this: the only lasted 24 weeks. This is not long enough, which will be explained below, but first a couple of other results.

An issue of the American Journal of Clinical Nutrition from last February included an article which outlined that the more pronounced folic acid deficiency in elderly people, the poorer (statistically) their cognitive function. The likelihood of decreasing cognitive function was more than doubled in those with a deficiency of folic acid (4). There are many people with folic acid deficiency because folic acid is primarily found in liver and leafy vegetables, which many people push to the side if their plates.

20% fewer strokes
Lack of folic acid is shown roughly by finding increased blood levels of the substance, homocysteine. It is an amino acid which is poisonous to the blood vessels (among other things) and which is believed to lead to atherosclerosis, but that the body nonetheless creates. Normally it is neutralised in part by folic acid. If you lack folic acid, you homocysteine levels rise.

A link between lowered cognitive function and homocysteine has been shown in Sweden (5). There it was shown that elderly people with documented memory problems often had high levels of homocysteine. This was only true with the poor memory was found along with atherosclerosis, which homocysteine is believed to promote!

In addition, Dutch researchers recently showed in a randomised trail that a supplement of folic acid (o.8 mg daily) for 50 – 70 year olds not only reduced their levels of homocysteine, but also statistically improved the “brain functions which have a tendency to decline with age.” Memory, reaction time, and the ability to speak quickly and fluently were bettered. The study lasted for three years, which is a necessary time period (6).

If that is not enough, a comprehensive study of eight randomised studies has recently shown that the risk of stroke resulting from atherosclerosis generally is reduced by 20% when taking folic acid supplements. The studies which lasted longer than three years showed the best results. Participants who had already had a stroke were less protected and if those who were lucky enough to live in a country where food is enriched with folic acid (USA, Canada) showed fewer effects.

We should remember our folic acid. The daily dosage should be between 0.4 and 0.8 mg daily.

By: Vitality Council


1. Bille C et al. Folic acid and birth malformations. BMJ 2007;334:433-34.
2. Reynolds E. Folate and aging. Lancet 2007;;369:1601.
3. Eussen SJ et al. Effect of oral vitamin B12 with or without folic acid on cognitive function in older people with mild vitamin B-12 deficiency: A randomized, placebo-controlled trial. Am J Clin Nutr 2006;84(2):361-70.
4. Haan M et al. Homocysteine, B-vitamins, and the incidence of dementia and cognitive impairment: Results from the Sacramento area latino study on aging. Am J Clin Nutr 2007;85:511-7.
5. Nilsson K et al. Plasma homocysteine is elevated in elderly patients with memory complaints and vascular disease. Dement Geriatr Cogn Discord 2007;23(5):321-6.
6. Durga J et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: A randomised double blind controlled trial. The Lancet 2007;369:208-16.
7. Xiaobin Wang et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. The Lancet 2007;369:1876-82.

False Propaganda Against Vitamins

November 30, 2005

A frightening warning in an article in the Danish newspaper, Ekstra Bladet, claims that people will get sick from taking Vitamin B and injure their hearts by consuming Vitamin E. These claims are twisted and false.

Condescending evaluations of vitamin supplements are quite common. They rarely come from experts, but often from people who know something about something else and therefore think they know something about everything.

As a rule, it is stated that the vitamins only provide expensive urine and do not help against anything at all. Sometimes this message is spread rather too thickly.
The vitamins are poisonous! As the other day in a large published article in the newspaper Ekstra Bladet: You get sick from nutritional supplements, the headline stated. Further down, it became clear that you would not only get sick. You would die!

Whenever these kinds of statements appear, people get scared. They cannot imagine that anyone will write anything in Ekstra Bladet if it is not true. But unfortunately there are writers who don’t bother with that. This is evident from the mentioned article, which is mainly based on two gross, false claims. Here we comment on them in reverse order.

“The last new thing was the B vitamin folic acid, which should also be able to protect against heart disease. Recently, a large Norwegian study showed that folic acid did not make users less prone to heart disease. On the contrary, they got sick from the pills”.

Is that right? No. It is wrong. In the Norwegian randomised trial (it was called NORVIT), approx. 900 people who had had blood clots in the heart were supplemented with 0.8 mg of folic acid per day for 3-4 years. The table shows the relative mortality and incidence of heart clots in those who received folic acid and those who received inactive pills (placebo.)

……………………..………..……Folic acid……Placebo
Blood clot in the heart…….57,9…………….59,2
Total mortality………………….28,7…………….31,7

As seen, the overall mortality was 9% lower if folic acid was given instead of placebo. The risk of blood clots was also reduced. How does that agree with the fact that people “got sick (meaning heart disease) from the pills”? The answer is that it is not true. Admittedly, none of the differences were statistically significant. It was a trend. But that is not the same as the study showing the opposite of the trend.

And now to the first claim. It is about vitamin E. It was claimed that vitamin E should protect against heart disease, it says, but “when the major scientific studies came, it turned out that it… gave… heart failure, bleeding and an increased risk of dropping dead”.

Heart failure. That claim must come from the HOPE-TOO study, the only one of the many studies with a total of well over 100,000 participants in which heart failure has been found to be caused by vitamin E treatment.

4,000 people with severe atherosclerosis participated in HOPE-TOO. Those who received vitamin E (400 IU/day) had slightly more often weakened heart. The difference was statistically uncertain, i.e. that it could be accidental. The absence of heart failure in all the other studies suggests the same.

On the other hand, a slightly reduced risk of lung cancer was found in HOPE-TOO, and it was reliable. But since this has not been found in other studies either, it is unreasonable to mention it. It could be random anyway.

Another peculiarity of HOPE-TOO was that even though the participants were given 25 times the recommended amount of vitamin E, it could not be seen in the blood tests. On average, the participants had very little vitamin E in their blood, despite the large supplements. The concentration in the blood (17.6 mmol/l) was even at the lower end of the normal range (12-42 mol/l). Either the participants have not taken the vitamins, or they have e.g. taken them on an empty stomach so that they were not absorbed from the intestine. So where does the vitamin E study end up?

In other words: Here a single, guaranteed misleading, result from one small experiment is misused – as “fact”. It is cheating and distortion. And for the record: That you should start bleeding, let alone die from vitamin E in the mentioned doses, is out of thin air. In contrast, the vitamin prevents, in animal experiments, gastric bleeding caused by aspirin.

Professor Maret Traber, Oregon State University, is considered one of the world’s leading vitamin E researchers. She recommends vitamin E for a number of chronic health problems, including heart disease. Louis Ignarro, who received the Nobel Prize in 1998 for his research on blood vessels, unequivocally recommends vitamin E and C for the prevention of atherosclerosis. It works, he says.

Of course, what even such big celebrities think is no argument in itself. It is the substance that counts. Yet. If you are free to choose your advisers, you are likely to prefer the most knowledgeable – and the most reliable.

By: Niels Hertz  MD

1. A. Astrup. Du bliver syg af kosttilskud. Sund og Slank. Ekstra Bladet. 26.11.05.
2. The HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer. JAMA 2005;293:1338-47.
3. Bonaa KH. NORVIT: Randomized trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. Program and Abstracts from the European Society of Cardiology Congress 2005; September 3-7, 2005; Stockholm, Sweden. Hot Line II. Iflg. Linda Brooks. NORVIT: The norwegian vitamin trial. Medscape Sept. 2005. (Not published in printed media.)

Vitamin B12 And Folic Acid Reduce The Risk Of Blood Clots In The Brain

October 31, 2005

After Americans enriched their diet with folic acid in 1996, the frequency of blood clots in the brain was reduced by 15%. Now research shows that added supplementation of Vitamin B12 will markedly lower this risk even further.

Immediately, it sounds simple: People with high levels of the amino acid homocysteine in the blood have an increased risk of blood clots in the brain and in the heart. You also know that you can lower homocysteine with folic acid and, to a lesser extent, with B6 and B12 vitamins. When the Americans began to enrich cereal products with folic acid from 1996, both the average American’s homocysteine and the rate of blood clot in the brain decreased by about 15% in three years.

“The money fits”, and then the result is almost obvious in advance, if you want to conduct a lottery experiment, where every other participant gets folic acid, B6 and B12 vitamins. Of course, they get fewer blood clots in the brain.

But the reality is more varied. In Norway, such an experiment (NORVIT) was conducted with 3,750 patients who had just survived a blood clot in the heart. For 3.5 years, they were supplemented with either folic acid (0.8 mg), vitamin B6 (40 mg), both or blind tablets (placebo). Among those who only received folic acid, mortality decreased approx. 10%, but not statistically certain. But in the other two groups the death tolls were increased, not statistically certain either.

Perhaps it is too late to start taking supplements when you are already severely calcified. Or, as will appear, perhaps it was more decisive that the Norwegians “forgot” to give the participants vitamin B12.

An experiment has also been carried out in the USA (VISP). It was with people who had recovered from a blood clot in the brain, but had an increased risk of a new one. Admittedly, the Americans did not initially find any effect either. Supplementation of folic acid (2.5 mg), vitamin B6 (25 mg) and vitamin B12 (0.4 mg) did not reduce or improve mortality or risk of blood clots in the brain. Therefore, the experiment was simply stopped after two years. It was useless, they thought.

B12 is useful if it is absorbed
A close explanation could be the aforementioned enrichment of cereal products with folic acid. After all, the average homocysteine had already fallen by approx. 15% in the Americans. During the trial, it only dropped a further 2%.

But the Americans have since studied the numbers more closely. In doing so, they discovered one important source of error in particular: Many of the 3,680 elderly participants had reduced absorption of vitamin B12 from the gut and therefore had relatively little B12 in their blood (less than 250 pmol/l). This is often seen in the elderly, and it is now known that these elderly need supplements of at least 1,000 micrograms of vitamin B12 per day. But the participants had only received 400.

What would it look like if you now disregarded these participants and concentrated on those with normal B12 uptake? It was decided to investigate. At the same time, participants with reduced kidney function were disregarded, as they also respond sluggishly to these supplements. Finally, participants who were previously receiving medical treatment with B12 were naturally disregarded.

There remained 2,155 people who had no problems absorbing B12. In this large group, the supplements both lowered homocysteine further and reduced the overall risk of death, blood clot in the heart or blood clot in the brain – by 21%! The treatment helped anyway; even a lot when the ability to absorb B12 was intact.

As stated, it appears that the fortification of cereal products with folic acid has reduced the Americans’ risk of blood clots in the brain by approx. 15%. Now it seems that a solid supplement of vitamin B12 on top of that can reduce it significantly more – but the many elderly people, who absorb vitamin B12 poorly, presumably need larger supplements.

This is the result at the moment. It must be verified before it is approved. But the indications are there.

By: Vitality Council

1. Toole JF, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA. 2004 Feb 4;291(5):565-75.
2. Bonaa KH. NORVIT: Randomized trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. Program and Abstracts from the European Society of Cardiology Congress 2005; September 3-7, 2005; Stockholm, Sweden. Hot Line II. Iflg. Linda Brooks. NORVIT: The norwegian vitamin trial. Medscape sept. 2005. (Ikke publiceret i trykt medie)
3. Spence DJ et al. Vitamin intervention for stroke prevention trial. An efficacy analysis. Stroke 2005;36:2404-2409.

You Must Plug The Hole Before The Boat Sinks

October 11, 2005

A Norwegian study has shown that if you have already experienced an acute myocardial infarction, the risk of another such infarction will not be reduced by taking folic acid, Vitamin B6, and Vitamin B12, even if homocysteine levels are lowered thereby.
If you get a great deal of folic acid, the blood content of the amino acid homocysteine will be relatively low. So much is certain. When the content is low, the risk of blood clots in the heart or brain hemorrrhage – other things being equal – is also low. It is also safe, but both are statistics only.

With these facts in the bag, one is tempted to think that supplementation with folic acid must be a good idea. As you know, folic acid is the B vitamin that young women should take to avoid having children with spina bifida. One can agree with the American Heart Association, which advises everyone to get 0.4 mg of folic acid a day, the same dose that women should take as a supplement.

In Tromsø in Norway, the so-called NORVIT trial (Norwegian Vitamin Trial) was the first to test whether supplements also help heart patients who have already had a blood clot in the heart. If the media is to be believed, it ended with a scare.

The results, which were presented in September at this year’s congress of the European Society of Cardiology (ESC), led directly to warnings against folic acid in the press: B vitamins could be dangerous for heart patients, it said, and our own Danish heart association was quick to announce, that folic acid is “still” not recommended for heart patients – even though the month before was said something close to the opposite.

But, as is so often the case, the reports were misleading. Strictly speaking, the Norwegian trial did not show that folic acid is dangerous. If you want to argue that it showed anything at all, it was that the risk of heart attack, stroke, or death decreased—albeit by only a few percent—in those who took 0.8 milligrams of folic acid a day for 3.5 years . However, this was not statistically certain.

The fact is that there were in fact not one, but three trials, with a total of 3,750 people, all of whom had had blood clots in the heart. One showed that a combination of folic acid, vitamin B6 and B12 led to approx. 20% more cases of blood clots in the heart than placebo (cheat pills). The second – the only one where only folic acid was used – showed no difference in reality. There was also no difference in the third trial, where the participants only received vitamin B6.

In one area, the experiments turned out to be successful: those who received folic acid achieved a drop in the blood homocysteine content of approx. 30%. Enough so that one could hope for a nice drop in the number of new blood clots. Which did not appear.

But the questions arise: Is it appropriate for heart patients to be careful about taking folic acid, vitamin B6 and vitamin B12 at the same time?
Or are we talking about completely different anatomical conditions with secondary prophylaxis than there are with primary prophylaxis? After all, you have had a blood clot.

Also at the congress, the ESC’s designated commentator, Ian Graham, doubted the result. He believed that the experiment might have been too small and too complicated to be credible.

One can go a step further and think that the result is purely due to chance. In any case, it is not supported by any theory.
It is more likely that folic acid is simply not suitable for preventing blood clots in severely arteriosclerotic patients. – In other words secondary prophylaxis.

There is a lot of evidence that folic acid – and low homocysteine – slows the development of atherosclerosis in healthy people – i.e. primary prophylaxis. But the usefulness of this function diminishes when the calcification is already very advanced. The bottom plug must be inserted before the boat is sunk.

If folic acid is to prevent blood clots, you probably have to start in good time. On the other hand, the vitamin has other benefits. Among other things. experiments convincingly indicate that it helps to keep the brain young, even in the elderly.

By: Vitality Council

Bonaa KH. NORVIT: Randomized trial of homocysteine-lowering with B-vitamins for secondary prevention of cardiovascular disease after acute myocardial infarction. Program and Abstracts from the European Society of Cardiology Congress 2005; September 3-7, 2005; Stockholm, Sweden. Hot Line II. Iflg. Linda Brooks. NORVIT: The Norwegian vitamin trial. Medscape Sept. 2005. (Not published in a printed media).

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.

Women who drink 2-3 glasses of red wine or more daily have an increased risk of developing chronic joint disorders, cardiovascular disease and breast cancer due to lack of folic acid.

A study by researchers at the Harvard School of Public Health in Boston shows that daily alcohol consumption not only reduces the effects of folic acid, but also significantly increases the risk of disease.

The researchers, who have just published the study in an article in the American Journal of Epidemiology, have followed approx. 83,000 women aged between 34 and 59 over a period of 16 years.

The researchers found the highest risk of getting cardiovascular disease and breast cancer in women who received only a small amount of folic acid – 180 micrograms – daily, and who also had a high alcohol consumption of 30 grams of alcohol a day or 2.5  Danish unit of alcohol. The greatest risk was found in women under 60 years of age.

Conversely, women who did not drink alcohol and received a lot of folic acid – 400-599 micrograms daily – had the lowest risk of developing the same diseases.

Against this background the Vitality Council comes with a call for women who drink more than 2-3 units of alcohol a day or 17-18 units of alcohol a week. Partly to reduce the intake of alcohol in accordance with the Danish Health and Medicines Authority’s recommendations and partly to take an extra supplement of folic acid:

“To prevent the increased risk of cardiovascular disease and breast cancer, women with a daily alcohol consumption should consider taking a folic acid supplement,” says Vitality Council Chairman, Specialist in general medicine, Claus Hancke.

“Thus, we do not want to encourage women to continue drinking. As the risk is significantly increased and the statistics show that about 15 percent or every sixth woman in the age group drinks more than the National Board of Health’s recommended maximum of 14 units of alcohol per week, one should take this seriously” the chairman of the Vitality Council points out.

As it is difficult to get enough folic acid through the diet, it is recommended to take a vitamin pill or a multivitamin tablet with folic acid. In the diet, especially vegetables like broccoli and kale are rich in folic acid.

The Danish National Board of Health already recommends pregnant women take approx. 400 micrograms of folic acid daily to prevent spina bifida in children.

By. Vitality Council

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

Hesitation in the 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).

Here, Professor Godfrey Oakley said, among other things:
“By not requiring mandatory addition of folic acid to the flour, the authorities have committed a fatal health policy error.” Oakley has the support of a number of colleagues, and cardiologist David Wald recommends, for example, that you take a dietary supplement of 800 µg of folic acid a day until the authorities do something about it.


By: Vitality Council.


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