Category Archives: folate

Folic acid linked with reduced risk of cancer

A new study has linked high intake of folate – including folic acid from supplements – with reduced risk of colorectal cancer.

The study, published last month in the journal Gastroenterology, investigated the link between folate intake and colorectal cancer in 99,523 participants.  These individuals provided information about their diet as part of the Cancer Prevention Study II Nutrition Cohort.

Asparagus
Asparagus is a great natural source of Folate. (5)

Lead researcher Victoria Stevens, PhD, of the American Cancer Society, said that “all forms and sources of folate were associated with lower risk of colorectal cancer.”

Folate, also known as Vitamin B9, is an essential nutrient required for the production and maintenance of new cells, including DNA synthesis and repair.  Because of this critical function, the relationship between folate intake and cancer development has been widely researched.

This most recent study, however, is the first to assess both natural folates (from food) and folic acid (the synthetic form, used in supplements).  It found that both forms of the vitamin were linked with decreased risk of cancer.  Low levels of folate have also been linked with conditions such as depression (2), breast cancer (3) and dementia (4).

Before taking a folic acid supplement it is recommended that you speak with your healthcare practitioner to check that it is right for you. When supplementing folic acid, it is often advisable to take it alongside, or as part of a Vitamin B Complex.  This is because the B Vitamins work together, so taking any one on its own can create a deficiency in the others.

Rich sources of folic acid include foods such as fortified breakfast cereals, enriched bread and fortified soy milk.  Taking a folic acid supplement, or a Vitamin B Complex supplement can help to ensure that you are getting enough of this essential nutrient.

Good sources of natural folate include:

  • asparagus
  • avocado
  • oranges
  • pulses, especially edamame beans, lentils and chickpeas
  • dark, leafy greens such as spinach, turnip greens and broccoli

Including these foods in your regular diet will help to boost your levels of folate.  As this B vitamin is water soluble, you should be careful to preserve this vitamin as you cook your food.  To preserve the folate content of your food, try steaming rather than boiling vegetables, or cook vegetables in soups and stews so that you don’t lose any vitamins leached into the water.

Written by Nadia Mason

References

1. Victoria L. Stevens, Marjorie L. McCullough, Juzhong Sun, Eric J. Jacobs, Peter T. Campbell, Susan M. Gapstur. (2011) High Levels of Folate From Supplements and Fortification Are Not Associated With Increased Risk of Colorectal Cancer. Gastroenterology 141(1): 98-105

2. Karakuła H, Opolska A, Kowal A, Domański M, Płotka A, Perzyński J. (2009). Does diet affect our mood? The significance of folic acid and homocysteine. Pol Merkur Lekarski 26 (152): 136–41.

3. Maruti SS, Ulrich CM and White E. (2009) Folate and one-carbon metabolism nutrients from supplements and diet in relation to breast cancer risk. Am J Clin Nutr 89:624–33.

4. Tettamanti, M. et al. (2007) Low folate and the Risk of Cognitive and Functional Deficits in the Very Old. Journal of the American College of Nutrition 25(6):502-8

5. Image courtesy of Paul.

 

 

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Study links folic acid supplementation and DNA changes in newborn babies

A new groundbreaking study (1) conducted by a UK team of research scientists has linked changes in the DNA of newborn babies, folic acid supplementation during pregnancy and birth weight.  This study was conducted at Keele and Nottingham Universities together with doctors at University Hospital of North Staffordshire and Derby Children’s Hospital and was funded by the World Cancer Research Fund (WCRF). 

I have previously written about the importance of folic acid during pregnancy for the prevention of neural tube defects, low birth weight and congenital heart defects.  This new study (1) showed that the levels of a critical metabolite of folic acid, homocysteine, in the blood of newborn babies is linked to modifications of their DNA (DNA methylation) in key genes and that such modifications might be used to predict birth weight (2).

To recap on homocysteine:  homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of heart disease and other disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels. 

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects such as spina bifida. It also protects against low birth weight, which has numerous short- and long-term consequences. It has been suggested that folic acid, though its metabolism to chemicals such as homocysteine, might secure these clinical effects via DNA methylation (2).  In this study the researchers examined the relationship between folic acid supplementation and its metabolites on DNA methylation in human blood from the umbilical cord, using a state-of-the-art ‘microarray’ techniques which simultaneously examines methylation at 27,578 sites in the DNA. 

In a press release, Professor Farrell, lead study scientist said: “It has been known for many years that folic acid supplementation is essential for women during pregnancy to reduce the risk of neural tube defects and low birth weight delivery. However, we had little idea as to how this worked. This study is the first to suggest that methylation of particular genes in the baby’s DNA may be the key to unlocking the secret of the action of folic acid”.  “Now we have identified which genes might be the link between folic acid and birth weight, we have opened the door to research that may allow doctors to predict the likelihood of low birth weight with greater certainty. Furthermore, it sheds light on the underlying causes of low birth weight and offers the potential to intervene earlier to prevent poor pregnancy outcomes such as premature delivery and pregnancy loss.

The work being done by this group of scientists illustrates the potential of DNA methylation ‘microarray’ technology to identify a new generation of clinical markers that will have a major impact, not only on the development of new therapeutic agents, but also on the way we manage a wide range of medical scenarios (1,2)

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects and low birth weight.  Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age.  The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant.  At this early stage of pregnancy this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida. 

If you are planning pregnancy or a woman of childbearing age who could fall pregnant it is certainly worth taking a multi-nutrient supplement which contains folic acid.  Specific supplements are available for pregnant women and those planning pregnancy and it is always a good idea to check with your doctor or midwife before starting supplementation.  Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products. 

(1) Fryer AA et al.  2011.  Quantitative, high-resolution epigenetic profiling of CpG loci identifies associations with cord blood plasma homocysteine and birth weight in humans. Epigenetics.  6(1). [Epub ahead of print]

(2)Press release.  Keele University.  Posted 2nd December 2010.  Folic acid supplementation in pregnancy, DNA methylation and birth weight in newborn babies.  http://www.keele.ac.uk/pressreleases/2010/title,34358,en.php

 

Written by Ani Kowal

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Folate might impact cholesterol levels

Folate (the naturally occurring form of folic acid), a B vitamin, is one that I have written a lot about, it has been linked to heart health, mood, pregnancy outcomes and much more.  In July I wrote about the B vitamins, folate and vitamin B12, being linked to heart disease

There has been a lot of research interest in the links between B vitamins and risk of cardiovascular disease (stroke and heart disease) over the last decade.  The rationale behind this is that there is evidence to suggest that elevated homocysteine levels are a risk factor for heart disease and low levels of the B vitamins B6, folate and B12 are linked to raised homocysteine levels.  For more information on homocysteine please click here

A recently published study(1) has found that folate may also be linked to cholesterol levels (another potential risk factor for heart disease).  The study looked at data for blood vitamin B12 and folate levels in over 1700 individuals.  They found that higher folate levels were associated with lower levels of low density lipoprotein cholesterol (LDL-cholesterol, the so called ‘bad’ cholesterol which has been linked to an increased risk of heart disease).  They also found that higher levels of folate were linked to higher levels of ‘good’ cholesterol, high density lipoprotein cholesterol (HDL-cholesterol).  The study authors also compared the individuals of the highest with those of the lowest levels of folate. They found that individuals with the highest folate  had higher levels of HDL-cholesterol, lower levels of LDL-cholesterol and a lower LDL-C: HDL-C- ratio, this is indicative of a favourable cholesterol profile.  In this study Vitamin B12 was not associated with the cholesterol profile.

The study authors call for more research to further investigate the link between folate and cholesterol levels.  The current study only provides a potential link, it does not prove that low folate levels are linked to raised LDL cholesterol levels.  The study does provide further evidence to suggest that there may also be a link between cholesterol and homocysteine levels, other studies have also suggested such a link.  These are very complex interactions and further research to elucidate links could provide really useful information on how diet can be used to reduce the risks of heart disease.

At the present time there is no conclusive evidence to suggest that B vitamins can reduce the risk of heart disease and supplements cannot be recommended as a preventative measure.  Having a good level of B vitamins in the diet is, however, important for health.  Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry.  Vitamin B12 is found mainly in meat, fish and poultry.  Eggs and cheese also contain B12 as does brewer’s yeast.  Folic acid is found in beans, green vegetables and wholegrains. 

Supplements should never be seen as an alternative to a healthy diet and it is wise to check with you doctor before starting any new supplement regiment.  If you are thinking about taking a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team

(1)Semmler A et al.  2010.  Plasma folate levels are associated with the lipoprotein profile: a retrospective database analysis.  Nutrition Journal.  9:31E-pub prior to print.  doi:10.1186/1475-2891-9-31 Published 28 July 2010

Written by Ani Kowal
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Another benefit of folic acid during early pregnancy

Folic acid is gaining quite a lot of attention, in 2009 I mentioned it with regards the prevention of birth defects, prevention of premature births, low birth weights and also ADHD.  Recently a study (1) has also found that folic acid use pre-pregnancy and in early pregnancy is associated with a reduced risk of congenital heart defects (heart abnormality present from birth) in newborns.



The study scientists(1) looked at over 600 mothers who had delivered infants with heart defects (but without any genetic or related abnormalities).  These were compared to a ‘control’ group.  Folic acid use was associated with a reduced risk of congenital heart disease in infants  “Use of periconceptional folic acid supplements (of at least 400micrograms a day) was related to approximately 20% reduction in the prevalence of any CHD. Given the relatively high prevalence of CHD worldwide, our findings are important for public health(1)


The authors note that the findings could be very significant since heart related birth defects can be quite common occurring in up to 2 newborns in every 100 worldwide.  When results were further broken down to look at specific heart defects it was found that women taking folic acid supplements had almost a 40% lower risk of having a child with a heart defect involving the septum, a part of the heart which separates one side of the heart from the other, compared to that of the general population (1).  This is a preliminary study but certainly deserves attention.  Further research would be necessary before any firm conclusions could be drawn



Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age.  The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant.  At this early stage this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida.



If you are planning pregnancy or a woman of childbearing age who could fall pregnant it is certainly worth taking a multi-nutrient supplement which contains folic acid.  Specific supplements are available for pregnant women and those planning pregnancy and it is always a good idea to check with your doctor or midwife before starting supplementation.



Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.



(1) van Beynum IM et al.  2009.  Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J. [Epub ahead of print]
Written by Ani kowal


 

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Attention Deficit Hyperactivity Disorder (ADHD) may be associated with low folate levels during pregnancy

Folate is in the news again, this vitamin of the B group is one that I have often written about especially with regards pregnancy and the prevention of birth defects, as well as links to premature births and low birth weights.  This time researchers (1) have linked low folate during pregnancy and ADHD in the child after birth.



The researchers (1) started their investigation by introducing the fact that good nutrition during pregnancy is really important and has been linked to foetal brain development.  Poor nutrition during pregnancy may adversely affect brian development and contribute to problems in childhood.  The researchers wanted to assess whether maternal folate status and maternal dietary folate intake during pregnancy was linked to brain growth and childhood behavioural difficulties in the children.



The study (1) followed a cohort of women from early pregnancy.  The mothers red blood cell folate levels were measured at 14 weeks of pregnancy and the total folate intake from food and supplements was assessed in early and late pregnancy.  When the children were born their head circumference and body weight were measured and then at the age of 8.75 years old 100 mothers reported on their children’s behaviour.



Lower maternal red blood cell folate levels and lower total folate intake were associated with higher incidence of childhood hyperactivity and problems with peer group at school in the children.  A higher red blood cell folate level was associated with greater head circumference at birth and lower levels of hyperactivity/inattention and peer problems in children.  Authors of the study note that the associations were small but “our data provide preliminary support for the hypothesis that lower folate status in early pregnancy might impair fetal brain development and affect hyperactivity/inattention and peer problems in childhood”.  The study only shows an association and it might be that mothers with a good folate level have overall better diets which impact brain development in foetus.



Previously written about ADHD and the importance of omega 3 fats in particular.  A balanced, healthy diet in pregnancy is vital for many reasons and may prevent a number of conditions.  Eating well and considering a pregnancy-safe multi-nutrient supplement is certainly worth discussing with your midwife or GP.  In a press release (2) the lead author noted:
Our findings further support the hypothesis that maternal nutrition contributes to an individuals’ development, with potential consequences for their behavior later in life.”  The long term effects of poor maternal nutrition may even branch out to the child’s ability to interact with peers or form social bonds (1,2).  The researchers also found that children born from mothers with a low folate status had a notably smaller head circumference at birth, which may indicate a smaller rate of prenatal brain growth in children adversely affected by low folate levels. The researcher note that the findings indicate a cause for concern among populations where the nutritional health of the mother is low, and women may be less likely to take folate supplements in advance of pregnancy.


 


(1)Schlotz et al.  2009.  Lower maternal folate status in early pregnancy is associated with childhood hyperactivity and peer problems in offspring. Journal of Child Psychology and Psychiatry, 2009; [Epub] DOI: 10.1111/j.1469-7610.2009.02182.x
(2) Wiley-Blackwell (2009, October 28). Attention-deficit/hyperactivity Problems Associated With Low Folate Levels In Pregnant Women. ScienceDaily. Retrieved October 28, 2009, from
http://www.sciencedaily.com/releases/2009/10/091028134631.htm
Written by Ani Kowal

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Folate may be related to cancer prevention in women

Folate is one of the B vitamins that I have written about with regards to preventing birth defects, allergies, heart disease, premature births and improving behaviour, mood, fertility and bone health.  On Monday I wrote about folate and age-related hearing loss.  A recently published study (1) has found that women who eat a diet rich in folate seem to have a reduced risk of developing colorectal cancer.



The B vitamin folate is found mainly in green leafy vegetables, asparagus, black-eyed beans and citrus fruits.  It plays an important role in the synthesis and replication of DNA which is why it is crucial in early pregnancy when the cells of the foetus are rapidly dividing, this is also the reason why it may play a role in cancer prevention.  The authors of this study (1) postulate that if folate is not available, or poorly available in the body it can result in ineffective DNA synthesis which may be linked to initiation and progression of colorectal cancer.  It might be that a low folate intake could be contributing to colorectal cancer by making genetic mutations more likely.


The study (1) included 596 individuals with colorectal cancer and 509 individuals who were cancer free, these are known as ‘controls’.  The participants were 30-79 years old.  When the study scientists investigated the diets of the individuals they found that there was a significant relationship between higher dietary folate intake and reduced risk of colorectal cancer in women.  Women who ate the most folate were at about two-thirds lower risk of the disease than women who consumed the smallest amount of the B vitamin.  The study does not prove that folate prevents against cancer but it certainly indicates that further studies into the relationship would be interesting.  Regularly including folate rich foods in the diet seems sensible for all women but especially those of childbearing age.



Women of childbearing age are generally encouraged to take a folic acid supplement, or a multi-nutirent supplement containing folic acid, since it is known that this can prevent spina bifida, a birth defect.  Recent evidence has found that folic acid may also be important during very early pregnancy for a whole host of other reasons too.  It certainly would also seem prudent for women to take a folate supplement or a folate-containing multivitamin daily to ensure adequate amounts.  Recently the BBC (2) reported a story urging women of childbearing age to take folic acid in a bid to prevent birth defects, something I have echoed in my blog posts.  The BBC piece focuses on the fact that many women start to take the vitamin too late.  Many women start to take folic acid once they know that they are pregnant but often this is too late since they may well be 3-6 weeks pregnant before they realise.  Folic acid is very important in the earliest stages of pregnancy and it seems sensible that women take the vitamin pre-conceptionally as a precautionary measure.  As mentioned the vitamin is also linked to reducing premature births, heart defects and allergies.  The story reports that up to 75% of spina bifida cases could be prevented by the mother taking folic acid three months before conception and during pregnancy.


(1)Kim J et al.  2009.  Folate intake and the risk of colorectal cancer in a Korean population. Eur J Clin Nutr. 2009 Sep;63(9):1057-64
(2)Experts urge wider folic acid use.  Eleanor Bradford.  BBC Scotland Health Correspondent 
http://news.bbc.co.uk/1/hi/scotland/8232089.stm
Written by Ani Kowal

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Higher folate levels recently linked to reduced risk of hearing loss

I have mentioned folate a lot in my blog posts but mainly in relation to women, especially pregnant women.  However, recent research presented at the at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA(1) has found that high folate intakes in men may be associated with a 20% decreased risk of hearing loss.



The study(1) involved 3,559 cases of men with hearing loss.  The study authors found that men over the age of 60 who have a high intake of foods and supplement high in folate had a 20% decrease in risk of developing hearing loss.  The authors believe this is the largest study to delve into the relation between dietary intake and hearing loss. They also believe their findings could allow for greater education, prevention, and screening efforts in a bid to prevent hearing loss.  Further studies would certainly be necessary as this study only shows an association and not cause and effect. 



Ten years ago a small study in women (2) found that poor folate levels were associated with age-related decline in hearing.  The study was conducted in 55 healthy women aged 60-71.  The women were tested for hearing function and categorised into two groups – those with normal hearing and those with impaired hearing.  Women with impaired hearing had a 31% lower blood level of folate than women with normal hearing.  In addition to this study a couple of years ago a research team (3) found that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.  The objective of this study was to determine whether folic acid supplementation slows age-related hearing loss.  728 men and women were involved.  Subjects received daily oral folic acid (800 micro-grams) or placebo supplementation for 3 years.  Folic acid supplementation slowed the decline in hearing of the speech frequencies associated with aging in a population (but did not affect the decline in hearing high frequencies).  The authors note that the results need to be replicated in further larger studies but that folic acid supplementation seemed to slow the decline of low-frequency hearing in folate-deficient, older adults.



Folic acid may be playing a role in the prevention of age-related hearing loss by improving blood circulation to the artery that supplies blood to the cochlea of the ear.  In addition, folic acid is also related to lowering elevated homocysteine levels.  Elevated homocysteine could be related to age-related hearing loss.  Most people are aware that high levels of homocysteine in the blood have been linked to an increased risk of heart problems.  Recently high homocysteine levels have also been linked to poor bone health, poor eye health (such as age-related macular degeneration) and other health problems.  To recap from my past blog posts: Homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of many disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.



Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.  Vitamin B6 is mainly found in meat, fish and eggs.  Vitamin B12 is found in liver, meats, eggs, milk and yeast extract. 


Vegetarians and vegans and those who feel they are not eating a varied, balanced diet may wish to consider taking a multiple B vitamin supplement to ensure good levels of these important B vitamins


 


(1)American Academy of Otolaryngology — Head and Neck Surgery (2009, October 6). Higher Folates, Not Antioxidants, Can Reduce Hearing Loss Risk In Men. ScienceDaily. Retrieved October 6, 2009, from http://www.sciencedaily.com/releases/2009/10/091005161116.htm
(2)Houston DK et al.  1999.  Age-related hearing loss, vitamin B-12, and folate in elderly women.  American Journal of Clinical Nutrition.  69(3):564-571.
(3) Durga J et al.  2007.  Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial.  Ann Intern Med.  146(1):1-9.
Written by Ani Kowal

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Folic acid may be linked to the prevention of congenital heart defects

Last week I wrote about folic acid and how it may be associated with a reduced risk of premature birth.  A recently published study (1) has found that folic acid may also reduce the risk of a baby being born with severe congenital heart defects (heart defects present from birth).



The study took place in Quebec, Canada(1).  The researchers wanted to see whether the fortification of food programme, that has been in place since 1998 and has already proved to be effective in preventing neural tube defects, had impacted the incidence of severe congenital heart defects.  The 1998 government policy requires the mandatory fortification of flour in Canada with folate.



The study(1) looked at infants who were born between 1990 – 2005 who had severe congenital heart defects.  The scientists then analysed the data to compare rates of heart defects before and after the food policy was in place.  Among the 1 324 440 births in Quebec between 1990-2005 there were 2083 infants born with severe congenital heart defects.  Analysis of the results showed no change in the birth prevalence of severe birth defects in the nine years before fortification, while in the seven years after fortification there was a significant 6% decrease per year.  The authors of the study conclude that the public health measures to increase folic acid intake in Canada were followed by a decrease in the birth prevalence of severe congenital heart defects. The findings support the hypothesis that folic acid has a preventive effect on heart defects.



According to Raluca Ionescu-Ittu, a PhD candidate on the team, “this decrease is very significant and probably underestimated. During the study period, there was an increase in other factors associated with a higher prevalence of congenital heart defects, so without the fortification we would probably have seen an increase in these defects.” (2)



Despite the positive findings the authors of the study stress the need for women of childbearing age, especially those planning a pregnancy, to take folic acid supplements and not rely on food as a source.  The fortification programme was aimed at the general population, women planning a pregnancy need extra folic acid, it is a good idea for pregnant women to take a folate supplement at least three months before becoming pregnant.  Data that I mentioned last week indicates that there are benefits to taking a folate supplement a year prior to conception.  Folic acid seems to have effects on various aspects of embryonic and infant development.  Natural sources of the vitamin, such as green vegetables, might not provide sufficient doses for pregnant women.  Most medical doctors therefore recommend supplements in addition to a healthy diet rich in folic acid. 



As I have previously stressed: it is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates.  A healthy diet really does affect the unborn child, probably in more ways than we currently know through scientific investigation.  It may also be worth to consider taking a broad spectrum multivitamin and mineral food-state supplement specifically designed for pregnancy in order to maintain good levels of all essential nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.



(1)Ionescu-Ittu R et al.  2009.  Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada. BMJ 2009;338:b1673
(2) McGill University Health Centre (2009, May 14). Folic Acid Effecive In Preventing Congenital Heart Defects, Canadian Research Shows. ScienceDaily. Retrieved May 19, 2009, from
http://www.sciencedaily.com¬ /releases/2009/05/090514111404.htm
Written by Ani Kowal

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Taking folic acid before pregnancy is associated with a reduction in premature birth

It is well known that women of childbearing age are recommended to take a supplement that contains folic acid, this is due to the fact that folate (folate is the naturally occurring form of folic acid) in very early pregnancy, before most women even know they are pregnant, can reduce the risk of birth defects especially spina bifida.  Unfortunately many women in the UK do not achieve good levels of folate in their daily diets or through supplements.  A concern in the UK is the rising levels of teenage pregnancy, these young women are often not taking nutrient supplements when they get pregnant and their diets may also be lacking in the vitamins, minerals and essential fatty acids that are vital for the developing foetus.



There may be additional benefits to taking folic acid supplements before conceiving a child.  A new study(1) has found that folic acid supplements prior to conception (and in early pregnancy) may help prevent premature births. The study links early and pre-pregnancy folic acid intakes to a reduced risk of premature births.  Prevention of premature birth is very important, infants born early, before 37 weeks of pregnancy rather than the normal 40 weeks, have an increased risk of many health and developmental problems.



It has previously been shown that women who deliver premature babies tend to have lower levels of folate in their blood but this study(1) wanted to look at the effect of folate supplementation on rates of premature birth.  The researchers assessed 34,480 pregnant women, about 20% of these had been taking folate supplements for a year or more before getting pregnant, 36% had been taking them for less than a year and 44% were not taking any supplements at all.  160 of the women delivered their babies before 32 weeks of pregnancy while 1,658 women delivered their babies before 37 weeks.



The data showed that using folate supplements for a year or more was associated with a 70% reduced risk of delivering a baby at 20-28 weeks.  Taking the supplements for less than a year was linked to 50% reduced risk of premature births compared to women who did not take supplements.  For deliveries between 28-32 weeks the risk was 50% lower for women on supplements for a year or longer and 30% lower for those taking supplements for less than a year compared to those women not taking supplements.  There was no relationship between folate supplement use and risk of delivering a baby between 32 and 37 weeks’ gestation.  The preventive effects of supplementation were most powerful for preventing the earliest, and hence riskiest, preterm births.



In brief: These findings show that folate supplementation for a year or more before conception is associated with a 50%–70% decrease in early, but not late, spontaneous preterm births and that the longer a woman takes folate supplements before becoming pregnant, the lower her risk of a preterm birth.  The study only shows a possible association between folate supplementation and reduction in the risk of premature birth.  Further randomised trials are necessary to provide confirmation of the link.  It could be that taking supplements is a general marker for healthy behaviour.  However, there is a body of evidence that suggests there could be biological reasons why folate may protect against premature birth.  Low folate levels are associated with increased intrauterine infection which is linked to early premature births.  Folate also seems to reduce inflammation within the body during pregnancy.  Since folate is necessary preconceptionally and in the early weeks of pregnancy in order to prevent birth defects it is definitely worth considering long term supplementation prior to conception.



It is important for any woman who is planning a pregnancy to aim to eat a consistently healthy diet rich in vegetables, fruits, healthy fats and unprocessed meats, fish and wholegrain unrefined carbohydrates.  It may also be worth considering a broad-spectrum food-state supplement specifically designed for pre-pregnancy in order to main good levels of all nutrients.  An omega 3 fatty acid supplement could also be considered, especially if oily fish and nuts/seeds are not regularly eaten.  Before deciding to take any supplement during pregnancy please discuss your thoughts with a GP, nurse or midwife.



(1) Bukowski et al.  2009.  Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study. PLoS Medicine. 6 (5): e1000061 DOI: 10.1371/journal.pmed.1000061


Written by Ani Kowal

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High folate levels linked to reduced allergies

Previously I have written about folic acid and the prevention of birth defects and also the necessity of this vitamin for heart health.  A newly published study (1) has found that this essential B vitamin may also suppress allergic reactions and reduce the severity of allergy symptoms and asthma symptoms. The research was conducted by the Johns Hopkins Children’s Centre.



The Johns Hopkins Children’s Centre is Maryland’s largest paediatric hospital (USA).  Hopkins Children’s offers the best care available in modern paediatric medicine and U.S. News & World Report ranks Hopkins Children’s among the top four children’s hospitals in the USA.



The scientists believe that this is the first human study to look at the link between the levels of folate in the blood and allergy.  Folate is the naturally occurring form of folic acid.  Previous evidence exists to show that folate can help regulate inflammation which is a big factor in allergy.  For more information on eating to help prevent and reduce allergy symptoms please read my previous posts on asthma and hay fever these are full of general tips, advice and supplement ideas.


In this current study(1) the researchers from the Johns Hopkins Children’s Centre reviewed the medical records of over 8,000 people aged 2-85.  The researchers looked at the effect of folate levels on allergic symptoms and on the levels of specific immune system markers, IgE antibodies, which tend to rise in response to an allergen (allergic trigger).



It was found that individuals with the highest levels of folate had the lowest levels of IgE antibodies in their blood.  These people also reported fewer allergies and allergic symptoms, less wheezing and had a lower likelihood of having asthma.  In a press release (2) the scientists said: “Our findings are a clear indication that folic acid may indeed help regulate immune response to allergens, and may reduce allergy and asthma symptoms,” They also say “But we still need to figure out the exact mechanism behind it, and to do so we need studies that follow people receiving treatment with folic acid, before we even consider supplementation with folic acid to treat or prevent allergies and asthma.”



Specific findings of the study (2):
*People with the lowest folate levels (below 8 nanograms per milliliter) had 40% higher risk of wheezing than people with the highest folate levels (above 18 ng/ml).
*People with the lowest folate levels had a 30% higher risk than those with the highest folate levels of having elevated IgE antibodies, markers of allergy predisposition.
*Those with the lowest folate levels had 31% higher risk of atopy (allergic symptoms) than people with the highest folate levels.
*Those with lowest folate levels had 16% higher risk of having asthma than people with the highest folate levels.
*The Hopkins team is planning a study comparing the effects of folic acid and placebo in people with allergies and asthma.



Many cereals and grain products are already fortified with folate, and folate is found naturally in green, leafy vegetables, beans and nuts.  As mentioned in the posts on asthma and hay fever an overall healthy diet rich in vegetables, fruits, omega 3 fats from oily fish and nuts/seeds (especially walnuts and flaxseeds), unprocessed wholegrains and unprocessed meats will go far in nourishing the body, keeping inflammation low, and helping it to deal effectively with potential allergic triggers.  Please do read the previous posts for more information on specific important nutrients to help prevent and treat allergyies. 


 


(1)Matsui EC and Matsui W.  2009.  Higher serum folate levels are associated with a lower risk of atopy and wheeze.  published online 01 May 2009.  The Journal of Allergy and Clinical Immunology.  DOI: 10.1016/j.jaci.2009.03.007.
(2) Press release, Folic Acid May Help Treat Allergies, Asthma 


Written by Ani Kowal

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