We all know that folic acid for pregnancy is great.  That’s why folic acid is one of the primary nutrients in prenatal vitamins.  However, folates and folic acid do much more for the body.  Below is an excerpt from an nutrition newsletter that I receive every day.  Occasionally it talks about pregnancy nutrition, but for the most part it reviews nutrition industry news.  Today however, there was a noteworthy article about a study that indicates that folic acid may also help reduce the risk of colorectal cancers.  If have reprinted the article in its entirety below; here is a link to the actual post  The article does also mention the benefit of folic acid for prenatal development, but the focus is primarily on the new body of science around folic acid as a nutrient.

By Stephen Daniells, 06-Jul-2009

Increased intakes of folate from the diet may reduce a woman’s risk of colorectal cancer by about 50 per cent, according to new findings from Korea.

The highest intakes of folate, a B-vitamin found in green leafy vegetables, chick peas and lentils, were associated with a 66, and 70 per cent reduction in a woman’s risk of cancers of the colon and rectum, respectively, report researchers in the European Journal of Clinical Nutrition (EJCN).

However, men did not benefit from the vitamin, said the researchers from Korea’s National Cancer Center, Hallym University, Inha University College of Medicine, and Seoul National University.

The study adds to an ever-growing body of case-control and prospective cohort studies have reported that increased intakes of folate may reduce the risk of colorectal cancer by 40 to 60 per cent.

Benefits for babies

An overwhelming body of evidence links has linked folate deficiency in early pregnancy to increased risk of neural tube defects (NTD) – most commonly spina bifida and anencephaly – in infants.

This connection led to the 1998 introduction of public health measures in the US and Canada, where all grain products are fortified with folic acid – the synthetic, bioavailable form of folate.

Preliminary evidence indicates that the measure is having an effect with a reported 15 to 50 per cent reduction in NTD incidence. In Chile, the measure has been associated with a 40 per cent reduction in NTDs. Parallel measures in European countries, including the UK and Ireland, are still on the table.

Contradictory results

Over 30 case-control and prospective cohort studies have reported colorectal cancer risk reduction associated to the vitamin. Similar risk reductions have also been reported for the lesion that precedes the cancer, the adenomatous polyp. However, some studies have linked folic acid intakes to an increased risk of the disease.

A review paper published in the April issue of Nutrition Reviews by Joel Mason from USDA Human Nutrition Research Center on Aging at Tufts University addressed the potential Janus effect of folate on colorectal health.

“Under most circumstances, adequate intake of folate appears to assume the role of a protective agent against cancer, most notably colorectal cancer,” wrote Dr Mason. “However, in select circumstances in which an individual who harbours a pre-cancerous or cancerous tumour consumes too much folic acid, the additional amounts of folate may instead facilitate the promotion of cancer.”

The complex links between folate and cancer have created a “global dilemma”, said Dr Mason, with regards to instituting folic acid fortification programs in other countries.

Korean data

The Korean researchers analysed data obtained from 596 men and women with colorectal cancer, and compared this to data from 509 people free of the disease. All the participants were aged between 30 and 79.

According to the EJCN report, the overall data showed that the highest levels of folate intake were linked to a 53, 58 and 52 per cent reduced risk of colorectal, colon, and rectal cancer, respectively for all the people studied.

However, when the researchers focussed on the sex of the participants, only women were found to benefit, with the highest levels of folate intake were linked to a 64, 66, and 70 per cent reduced risk of colorectal, colon, and rectal cancer, respectively.

“We found a statistically significant relationship between higher dietary folate intake and reduced risk of CRC, colon cancer and rectal cancer in women,” concluded the researchers.

Folic acid versus folate

A possible explanation for the contradictory results of studies with the vitamin and colorectal cancer may be the difference between the synthetic and natural forms of the vitamin. “The fact that folic acid, which is not a naturally occurring form of the vitamin, is used by food and pharmaceutical industries for fortification and supplementation is potentially of importance,” wrote Tufts University’s Mason in Nutrition Reviews.

On passage through the intestinal wall, folic acid is converted to 5-methyltetrahydrofolate, the naturally circulating form of folate. However, some studies have suggested that oral doses of folic acid in high doses may overwhelm this conversion pathway, leading to measurable levels of folic acid in the blood.

“There has been some concern that this oxidized, non-substituted form of folate might feasibly be detrimental because it is not a naturally occurring co-enzymatic form of the vitamin,” he added.

Source: European Journal of Clinical Nutrition
Published online ahead of print, doi:10.1038/ejcn.2009.37
“Folate intake and the risk of colorectal cancer in a Korean population”
Authors: J. Kim, D.H. Kim, B.H. Lee, S.H. Kang, H.J. Lee, S.Y. Lim, Y.K. Sun, Y.O. Ahn

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• Folic acid ‘protects baby hearts’ (news.bbc.co.uk)

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Now most expecting mothers know that folic acid is good for you.  In fact, for most prenatal vitamins it is the one constant.  The research primarly looks at the vitamin’s impact on babies born with spina bifida.  However, a was just published that shows that folic acid may be helpful in healthy heart development as well.  I have posted the entire article from NutraIngredients on the new study below to give you the full overview.

Folic acid may boost baby’s heart health: Study

By Stephen Daniells, 14-May-2009

Increased intakes of folic acid by mandatory fortification of grain products to reduce neural tube defects may also reduce a baby’s risk of severe congenital heart defects, says a new study.

The incidence of the heart problems was reduced by 6 per cent following mandatory fortification of grain products, introduced in Canada in 1998, researchers from McGill University and the University of Alberta report in the British Medical Journal.

“Our population based study shows that fortification of grain products with folic acid in Canada was followed by a significant decrease in the birth prevalence of severe congenital heart defects, supporting the hypothesis that folic acid intake in the period around conception reduces the birth prevalence of severe congenital heart defects,” wrote the researchers, led by Louise Pilote.

Folic acid and NTDs

Folate is found in foods such as green leafy vegetables, chick peas and lentils. Folic acid – the synthetic, bioavailable form of folate – is obtained from grain products in the US and Canada following introduction of mandatory fortification in 1998.

Currently, supplementation with folate and folic acid is recommended to all women of child-bearing age since most neural tube defects (NTDs), including spina bifida and anencephaly, occur within the first 22 to 28 days of pregnancy, when the mother-to-be is not aware she is even pregnant.

Folic acid supplements after this time are too late to prevent neural tube defects and therefore fail to benefit women with unplanned pregnancies – more than half of all pregnancies in the US.

Preliminary evidence indicates that the 1998 introduction of public health measures in the US and Canada has reduced the incidence of NTDs by 15 to 50 per cent. In Chile, the measure has been associated with a 40 per cent reduction in NTDs. Parallel measures in European countries, including the UK and Ireland, are still on the table.

In March, a Food Safety Authority of Ireland (FSAI) working group stated there would be no public health benefit from mandatory folic acid fortification, but a final determination would be made at the end of the year when more data would be available.

New data

The new study looked at data from infants born between 1990 and 2005 in Quebec. Out of the 1,324,440 infants born, 2,083 had a congenital heart defects. This is equivalent to an average birth prevalence of 1.57 out of every 1,000 births, said the researchers.

Analysis of the data showed no change in the prevalence of severe birth defects in the nine years before fortification, but a 6 per cent reduction in the prevalence in the seven years after fortification, wrote the researchers.

“An average 6.2 per cent reduction per year in the birth prevalence of severe congenital heart defects observed in this study might seem modest,” wrote the researchers. “However, given that severe congenital heart defects require complex surgical interventions in infancy and are associated with high infant mortality rates, even a small reduction in the overall risk will significantly reduce the costs associated with the medical care of these patients and the psychological burden on patients and their families,” they added.

Commenting on the mechanism, Pilote and her co-workers stated that the B vitamin may have a beneficial role in the early development of an embryo’s circulatory system, ensuring correct formation of the heart.

In an accompanying article from Helena Gardiner and Jean-Claude Fouron from Imperial College at Queen Charlotte’s and Chelsea and the Royal Brompton Hospitals, and CHU Sainte-Justine in Montreal, respectively, said that population-wide measures of fortification should be followed, but rather targeting of women of child bearing age.

Reaction

Commenting independently on the research, Dr Sian Astley, a scientist for the Institute of Food Research, told the BBC: “Personally, I do not think mandatory fortification is the way forward. It is like using a sledge hammer to crack a nut.

“It would reduce ill health in children but there are cautionary issues.

“An alternative would be to fortify only certain foods and clearly label them so consumers can make the choice. Co-fortification with other B vitamins would be another sensible option,” she added.

Source: British Medical Journal
2009, Volume 338:b1673, doi:10.1136/bmj.b1673
“Prevalence of severe congenital heart disease after folic acid fortification of grain products: time trend analysis in Quebec, Canada”
Authors: Raluca Ionescu-Ittu, A.J. Marelli, A.S. Mackie, L. Pilote

Editorial: British Medical Journal
2009, Volume 338: b1144, doi:10.1136/bmj.b1144
“Folic acid fortification and congenital heart disease”
Authors: H.M Gardiner, J.C. Fouron

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