Aug
01
2008

Positives And Negatives Of Folate

Ten years ago folate became the hero among the food additives. The decision was made to make it mandatory to enrich flour, pasta and other foods with folate with the goal to reduce the incidence of neural tube defects in newborns. Folate also was a valuable as a prenatal supplement. A study which involved seven provinces of Canada which was published in July 2007 in the New England Journal of Medicine showed that the supplementation has been a success in this respect, as neural tube defects had been reduced by 46 %. Folate also seems to have been of benefit in the reduction of strokes, as it has the propensity to lower blood homocysteine concentrations. In the meantime not all seems to be well, as there is a darker side to folate. Already decades ago studies warned that folic acid given to leukemia patients hastened the progression of the disease. In a publication of the American Medical Association results from a polyp prevention study were written up. The vitamin was associated with a higher rate of advanced adenomas (tumors of the colon). These findings cannot be easily ignored. On the one hand about 1,500 children are saved from a devastating birth defect; on the other hand the number of colon cancer cases increases by 15,000 per year. At this point there is no suggestion in Canada or in the US to abandon the food fortification with folate. In the U.K. the implementation of folate fortification has been delayed till more research is available.

Positives And Negatives Of Folate

As food supplementation with folate may be higher than necessary, it seems wise to exercise a measure of caution. Women with a family history of colonic polyps should be advised to take the minimum folic acid dose in their prenatal supplementation. As far as male patients are concerned doctors should excise caution before they advise patients that are over 40 about the perceived benefits of vitamin supplementation. Any of the perceived benefits ought to clearly outweigh the potential risky side effects, which is not only true for any medication but also for any vitamin supplement.

Reference: The Medical Post, July 8, 2008, page 1 and 23

Last edited December 4, 2012

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Mar
01
2007

Check For Vitamin B12 Deficiency In Elderly

Elderly patients frequently are seen at the doctor’s office because they are “feeling poorly”. Concerned family members mention that there is lack of energy, and mental impairment may also be present. Immediately there may be the question, whether these are symptoms of Alzheimers disease. The other observation may be that the older person is not eating properly. Family physicians will order laboratory tests including vitamin B12 levels. If a deficiency is shown, patients will be advised to take a vitamin supplement, and they may receive injections of vitamin B12.
The unfortunate fact is that vitamin B 12 levels are notoriously unreliable in the diagnosis of deficiency. As early as 1988 a publication in the New England Journal of Medicine showed that neuropsychiatric disorder due to vitamin B12 deficiency can be present in a patient who had normal blood levels and no other findings. It does take some other avenues to detect the deficiency. The blood can be tested for the metabolite called MMA (methylmalonic acid) which is raised with vitamin 12 deficiency. A second test is the measurement of HTC (holotranscobalamin), which is the fraction of vitamin B12 bound to the plasma protein transcobalamin, which delivers the vitamin to the tissues of the body.
Dr. Cherie McCracken and colleagues from the department of psychiatry at Liverpool University, England studied 42 men and 42 women ages 69 to 93.They were tested for cognitive functions like orientation, language, attention and memory. In addition researchers took measurements of the MMA and HTC, the tests mentioned above. None of the test persons had dementia due to the selection criteria, but 31% were cognitively impaired. Mental scores indicating cognitive impairment were associated with increasing age and MMA, and the areas of language comprehension, language expression and ideation practice (translating an idea into an action) were affected.

Check For Vitamin B12 Deficiency In Elderly

Check For Vitamin B12 Deficiency In Elderly

The reason for the correlation of MMA with impairment of brain function can be explained by the fact that MMA is toxic to the oxidative function of mitochondria. The process is like a chain reaction: when mitochondria are poisoned, the nerve cells will lack energy for proper function.
Despite this sophisticated interplay of blood levels and cell function in the brain, the message that comes from the researchers is very simple. The MMA has to be ordered as a test in elderly persons, and the next important step is supplementation with vitamin B12 to prevent deterioration in mental functioning.

More information about:

1. Causes of dementia: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/dementia/

2. Pernicious anemia: http://nethealthbook.com/anemia/anemia-from-deficient-red-blood-cell-production/megaloblastic-macrocytic-anemia/

Reference: The Medical Post, January 16, 2007, page 27

Last edited November 2, 2014