Positive Health Online

Since the early 1980s we have known that folic acid deficiency is common in the UK. One of its effects is to cause devastating birth defects and prevent the development of a baby's brain and spinal cord. Due to much pressure from doctors who are not deficient in common sense, pregnant women are now routinely prescribed folic acid supplements. But people at risk of other problems due to folic acid deficiency have not been so fortunate.

Folic acid is a B complex vitamin which plays a key role in the metabolism of the amino acid methionine. Homocysteine – a substance produced during this metabolism – should under normal conditions only have a short life before being converted back to methionine. But if there is a shortage of B complex vitamins – particularly folic acid – homocysteine can accumulate and make blood cholesterol levels rise dangerously high. Due to a defective gene, this type of problem can be highly resistant to normal dietary improvements. On the other hand folic acid supplements can have a miraculous effect.

Wasting NHS Resources

One of my neighbours, an elderly man with severe angina, has been diagnosed with extremely high cholesterol. Despite following his dietician's advice, (and taking a daily cocktail of prescription drugs) his arteries are so clogged that in the past year he has had two heart attacks and several collapses leading to hospital stays of one to two weeks. I do not expect him to live very much longer.

So much work has now been published on homocysteine and B vitamins, you would think by now that even if the government's Chief Medical Officer does not care about lost lives, he would have counted up the difference in cost to the nation between folic acid supplements and multiple hospital stays – not to mention expensive drugs and heart surgery. Surely this is just a matter of common sense?

Other Health Problems

If the heart muscle suffers from oxygen starvation as a result of high cholesterol leading to impaired circulation, how can the brain and other organs escape the same fate? Naturally they do not. High homocysteine levels are strongly linked with the development of osteoporosis and Alzheimer's disease. Deafness and male erectile dysfunction have a similar connection.

Folic acid deficiency can also cause mental illness, but via a different mechanism. Without sufficient folic acid, the body cannot convert the amino acid tyrosine to adrenal hormones and dopamine. These hormones govern our moods, to such an extent that most of the drugs used to treat clinical depression work by artificially elevating levels of these hormones. Yet at least two studies on humans show that folic acid deficiency causes severe clinical depression and should be tested for whenever this condition occurs.[[1],[2] Rather than give a depressed patient expensive drugs (with side effects) to normalize his hormone levels, why not test for adequate folic acid and tyrosine and give supplements if necessary?

Food Absorption

Folic acid deficiency has potentially worse effects than any other, as it can reduce food absorption and so promote multiple other deficiencies which reduce protection against many diseases. The villi which line our small intestines are in turn lined with mucosal cells which absorb nutrients from food. The rapid turnover of these cells requires large amounts of folic acid to cope with the high needs of extra DNA synthesis.

The kidneys' tubules too have a lining of mucosal cells whose purpose is to reabsorb electrolytes, vitamins and minerals which would otherwise be rapidly lost in urine. A folic acid deficiency can prevent the repair and regeneration of these cells.

Preventing a Deficiency

There is much to be said for the current American practice of fortifying bread with folic acid. This could save countless lives in the UK, especially in Scotland, where 20% of men do not eat green vegetables regularly and 7% eat none at all.[3] Folic acid deficiency can also occur from poor food storage and preparation. Losses during food processing often amount to 65 per cent, leaving many foods with only one third of their original folic acid content. Prolonged boiling of green vegetables can cause losses of up to 50 per cent. Folic acid is one of the vitamins most easily destroyed by light and heat, therefore vegetables should be stored in the fridge and cooked for as short a time as possible. Whole-grains rather than their refined counterparts should be eaten on a daily basis.

The bioavailability of folic acid is reduced by alcohol intake, the contraceptive pill, aspirin, medications which reduce stomach acid, zinc deficiency, and vitamin B12 deficiency. Vitamin B12 deficiency causes folic acid to be trapped as methylfolate, which cannot be used by the body. Infection with Helicobacter pylori also seems to have a negative effect on folic acid absorption.

Certain body tissues can be more folate-deficient than others: for instance precancerous changes can occur in the cervix, lung or colon, which are reversible with folic acid supplementation.[4]

Best Food Sources of Folic Acid

Leafy green vegetables, especially raw spinach
Sprouted seeds
Liver
Freshly squeezed orange juice
Soya flour
Whole grains
Yeast extract

References

1. Lietha R et al. Neuropsychiatric disorders associated with functional folate deficiency in the presence of elevated serum and erythrocyte folate: A preliminary report. J Nutr Med. 4: 441-447. 1994.
2. Abou-Saleh MT et al. Serum and red blood cell folate in depression. Acta Psychiatr Scand. 80(1): 78-82. 1989.
3. The Scottish Diet. Report of a Working Party to the Chief Medical Officer for Scotland. HMSO. Edinburgh. 1994.
4. Heimburger DC. Localized deficiencies of folic acid in aerodigestive tissues. Ann NY Acad Sci. 669: 87-95. 1992.