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The Folic Acid Controversy

I have been getting lots of emails in regards to the April issue of Prevention magazine’s article entitled Is Your Breakfast Giving You Cancer?  In case you did not see it, you can find it online at  

http://www.prevention.com/health/nutrition/healthy-eating-tips/is-your-breakfast-giving-you-cancer/article/7518212f04527210VgnVCM10000030281eac____

This story has generated significant media and public concern regarding folic acid so I would like to tell you exactly what that means for you.

The Prevention magazine article presents research which suggests that folic acid fortification of white flour, rice, breakfast cereals, nutrition bars, beverages, most multi-vitamins and many other nutritional supplements, has lead to significant increases in cancer, particularly colon, prostate, and lung cancer.

“The more we learn about folic acid, the more it’s clear that giving it to everyone has very real risks,” says folic acid researcher David Smith, PhD, a professor of pharmacology at the University of Oxford in England, as quoted in the Prevention magazine article.

It is estimated that this practice of synthetic folic acid fortification has resulted in 15,000 additional cancers per year in the United States alone. However, other health concerns such as spina bifida and cardiovascular events have been significantly reduced because of folic acid fortification.  The key word here is synthetic.

In my practice, I fully understand and appreciate the critical roles that folates play in regard to health and I’m happy to report that is a way to benefit from folates without contributing to cancer risk and incidence. So the question changes from how much folic acid is too much to which kind of folic acid is safe.

Folate is a generic term for a group of water soluble B-vitamins that includes folic acid and naturally occurring folates in food. The terms “folic acid” and “folate” are often used interchangeably, but in reality, they are 2 very different things.

What is Folic Acid and How Does it Differ from Folates?

Folic acid refers to the fully oxidized synthetic compound (pteroylmono­glutamic acid) used in most dietary supplements and in food fortification (and the one reported on in the article), while folate refers to the various tetrahydrofolate derivatives naturally present in foods. 

Humans are unable to make their own folate, making it an essential nutrient that is typically obtained from the diet.  Important sources of natural folate are leafy green vegetables, fruits, legumes, liver, eggs, dairy products, and orange juice. Food folates are mainly pteroylpolyglutamate forms of tet­rahydofolate, 5-methyl-tetrahydrofolate (5-MTHF), 10-formyltetrahydrofolate and 5-formyltetrahydrofolate.  (This is technical I know, but hang in there with me).

Folic acid, which is again, the fully oxidized synthetic compound (pteroylmonoglutamic acid), is obtained in the diet mainly from folic acid-fortified grain products and folic acid-containing supplements. Unlike any of the natural folates in foods that are in reduced forms, folic acid is a fully oxidized compound. Human exposure to this form was non-existent until its chemical synthesis and use in food fortification and dietary supplements.

Health Concerns with Synthetic Folic Acid

The risk of higher than desired folic acid intake is compounded by concerns over the appearance of unmetabolized (unaltered) folic acid (pteroyl­monoglutamic acid) in the blood.

“Unlike folate, folic acid isn’t found in nature, so we don’t know the effect of the excess,” says folic acid researcher David Smith, PhD, a professor of pharmacology at the University of Oxford in England, in the Prevention magazine article.

It has been demonstrated that even a modest intake of less than 400 micrograms per day of synthetic folic acid from fortified foods or supplements may lead to the appearance of unmetabolized folic acid in the bloodstream. 

Unlike the natural folates (e.g., 5-methyltetrahydrofolate and 5-formyltetrahydrofolate), folic acid is not a normal metabolite and must be converted to a compound called tetrahydrofolate, which is its usable form. In some individuals, low enzymatic activity in the liver where folic acid is first metabolized, could result in unmetabolized folic which poses various risks including potential cognitive decline and susceptibility to certain cancers. In the article, this folic acid is what they are referring to, but not the same goes for the natural folates.

What We Are Doing About This Problem

For this reason, in the last few years (way before this article was even written) professional brands that I use have changed from the oxidized, synthetic form to a folic acid to a natural folate blend called NatureFolate. It is made from concentrated vegetable juice powder containing a blend of natural folates, including 5-methyltetrahydrofolate (5-MTHF) and 5-formyltetrahydrofolate with additional fortified 5-formyltetrahydrofolate as calcium folinate.

These are safe, natural forms which are quickly and easily utilized by the body. NatureFolate provides the proven benefits of optimal folate supplementation without the risks. All the products we carry including our Multi-Vitamins, B Supreme and the new Prenatal Vitamins contain this natural formulary blend.

A vast majority of nutritional supplement companies still use 100% folic acid in their supplement line. Others use methylated folates, such as 5-MTHF, in featured folate products only, while using folic acid in their multivitamins and formulary products. There are others that claim they only use “whole food” nutrients, when in reality one can simply read their labels and see products that contain some amount of food mash combined with synthetic USP vitamins, often including folic acid.

One well known company, when recently quizzed by a nutritionist as to why they haven’t changed to natural folates, replied that the costs of natural folates and of redoing all of their product stability testing would be too expensive. How inexpensive does a formulation change have to be for a company to choose to improve the safety of a product? How is this not an important enough issue to act right away?

While the cost of using a natural folate blend like NatureFolate is more expensive than folic acid for the manufacturer, the companies I carry are willing to make this investment in raw materials because their aim is to optimize wellness and never compromise safety. You can always trust that our brands have the highest potency and purity and keep up with necessary modifications based on emerging research.  

If you have any further questions about folates, need advice on what to take or want to see if your vitamin measures up, please do not hesitate to contact us.

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