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Letters Folic acid fortification

Folic acid and vitamin B12 fortification of food for preventing neural tube defects in Europe

BMJ 2018; 361 doi: (Published 06 April 2018) Cite this as: BMJ 2018;361:k1572

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Re: Folic acid and vitamin B12 fortification of food for preventing neural tube defects in Europe

While I agree that FOLATE is essential to one’s health and unborn children, I very strongly disagree that Folic Acid is the appropriate answer!

Folic acid is a synthetic form of folate and it is estimated that close to 40% of world’s population is unable to process folic acid. I am part of that 40%. The cause of this is a MTHFR mutation. The acronym that names this gene provides instructions for methylenetetrahydrofolate reductase, the enzyme used to convert folic acid (vitamin B9) into folate’s active form, methyl-folate (5MTHF). There are actually two main possible MTHFR mutations, C677T and A1298C, and depending on whether you have either or both, on one or both strands of your DNA, will determine the extent to which the enzyme is affected (Up to 70%!). Methyl-folate (named 5MTHF) goes on to give its methyl group to other nutrients and substances—a process called “methylation.”

When you have a large amount of unprocessed Folic acid in the body it can lead to folic acid toxicity. Studies have suggested that the folic acid will bind to receptors further reducing the body’s production of Methyl-folate. It can also cause Hystamine levels to dangerously rise causing a variety of other health issues (hystamine needs methylation to be broken down, which methyl-folate is required for).

When the body does not produce enough Methyl-Folate other nutrients and processes are distrupted, including the production of neurotransmitters, detoxification of estrogen, and production of glutathione (an important anti-oxidant). This can result in autoimmune diseases, heart disease, congenital heart defects, cancers, infertility, miscarriages, Spina bifida, oral clefts, high blood pressure, psychiatric disorders, thyroid disorders, neuropathy...(the list goes on and on due to the amount of nutrients and processes requiring methylation). It also results in neural tube defects!

The blood tests will show you have adequate Folic Acid levels, but you will be severely deficient in methyl-folate (the important one) since the blood tests do not look for the activated form.

By fortifying everything with folic acid you are potentially causing neural tube defects for 40% of the world’s population (along with numerous other health threatening issues)! Those of us who have a MTHFR gene mutation are forced to actively avoid all sources of folic acid (including all fortified foods) and instead supplement with L-5-MTHFR, the activated form (methyl-folate), as well as Hydroxycobalamin (B-12 that reduced nitrous oxide) and Methylcobalamin (activated B-12 that supports methylation in tandem with methyl-folate) . These all are supplements that are easily bought.

The answer would be to use Methyl-folate (L-5-MTHFR) in fortification of foods instead! 40% of the population is not a small percentage and those of us with this gene mutation are essentially being poisoned by modern foods. Both Hydroxycobalamin and Methylcobalamin would be beneficial in preventing neural tube defects when used in conjunction with methyl-folate, as they aid in the methylation process. Cyanocobalamin (synthetic B-12) is garbage and should not be used! It requires a demanding process that uses up vital nutrients just to convert it into methylcobalamin and make it bioavailable and effective.

There is an incredible number of studies that state that: 40% of the population have this gene mutation, that folic acid is detrimental to the health of that population, methyl-folate is beneficial for 100% of the population, and using methylcobalamin and hydroxycobalamin in conjunction with methylfolate is recommended.

Competing interests: No competing interests

13 July 2018
Caitlin A Smith
New Haven, CT