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Dr. Bernard Presser D.C.
5696 Magnolia Woods Drive
Memphis, TN 38134
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In the early stages of fetal development, cells for the brain and spinal cord form a tube-like structure, the neural tube, from which the entire nervous system develops. Neural tube defects (NTDs) occur with defective closures of the neural tube, causing birth defects that can involve the brain, skull, spine, spinal cord, and meninges (covering membranes) - from relatively mild manifestations to devastating afflictions. Included are spina bifida, fetal anencephaly, lumbar meningomyelocele, and meningocele. In recent years, the intake of the vitamin folic acid (or folate) to reduce the risk of NTDs has been promoted. A decrease in the number of NTDs in the US "appears" to be related to the addition of folic acid to refined grain products (breads, flour, pastas, rice, cornmeal, and cereals ‘enriched' with synthetic vitamin isolates). So folic acid prevents NTDs, right? It's not that simple.
"Many factors are involved in the proper closure of the neural tube." The genes responsible for the process include those of the folate metabolic pathway and those involved in folate transport. But there are NUMEROUS other factors, often a combination of factors, involved. "The incidence of NTDs varies by geographic region, genetic or racial origin, and economic and educational status." Diseases (such as diabetes and epilepsy), potential problems in blood sugar control even among nondiabetic women, elevated insulin levels, obesity, smoking (by mothers OR fathers), occupational status, various medications (especially anti-epileptic drugs), and intake of "sweets" (refined sugars and flours, altered fats) have all been associated with increased risk for NTD. It is not simply a matter of obtaining sufficient folic acid.
Widespread consumption of refined, processed, and fake non-foods (including the refined grain products to which synthetic folic acid is added) contributes to the increased incidence of blood sugar and insulin disruptions. The diets of women who had NTD infants were compared with mothers who had healthy infants. Increases in NTD risk were associated with low values of iron, vitamin B6, calcium, vitamin A complex, and folate, as well as a higher percentage of calories from fats and sweets. A deficit of zinc has also been cited as a potential NTD risk. Folic acid is not "the" only nutritional indicator. Deficiencies of folic acid and other important nutrients often occur due to a lack of sufficient fresh vegetables, fruits, whole grains, legumes, and other real foods in the diet. Many people go through a day and even day after day and never eat a fresh vegetable or fruit or any other whole, real food! Heat destroys folic acid, so foods on warmers in cafeterias and many fast-food restaurants are notoriously low in folic acid and other nutrients. Birth control pills lower folic acid levels (as well as other nutrients) and it may take up to four months after stopping the pill for tissue levels to return to normal. Antibiotics destroy beneficial intestinal flora needed to convert folic acid to its useful form. People who frequently take certain types of prescription or nonprescription drugs (such as NSAIDS like Motrin or Advil, gut medications like Tagamet or Zantac, etc.) or drink too much alcohol are at high risk for folic acid deficiency. NTDs have been associated with elevated homocysteine levels, possibly indicating tissue damage. Homocysteine concentrations are moderated by various dietary factors including folic acid, vitamin B12, other B vitamins, and other nutrients, as well as by alterations in physiology (such as kidney impairment) and variation in enzymatic activity.
Environmental toxins may damage genetic material. Apartments and houses are often sprayed for insects. Many pesticides have a half-life of 30 years. A new car can out-gas gene-damaging styrene, benzene, phthalates, toluene, and other "everyday" chemicals. New carpeting, furnishings, and construction materials in homes and businesses outgas formaldehyde, trichloroethylene, acrylates, and other chemicals that can damage human genes. The influence of chemical food additives and agrochemicals has only begun to be addressed. Elevated levels of various heavy metals found in water supplies and the polluted environment provide potential risks. "Never before has one generation of man had available so many ways to damage their genetics."
NTDs are KNOWN to be multifactorial in origin, so all women who have a baby with a NTD are not lacking in folic acid. The incidence of NTDs has declined over the years, not just since the addition of the synthetic chemical folic acid to refined grain products. The reduced incidence may be related to improved intrauterine detection and subsequent elective termination of pregnancy. As to cause, "epidemiological data incriminate environmental factors" because the prevalence of NTDs has varied over time and by geographical location - epidemics have taken place at different times and in different locations worldwide. But studies in the 1980s and 1990s reported that the risk of NTD occurrence was reduced through use of folic acid supplementation prior to pregnancy. Because NTDs develop during the first few weeks after conception and the defect may arise in the unborn baby before the mother even knows she is pregnant, many professional societies and the US Public Health Service have recommended, since 1992, that all women of child-bearing age consume at least 400 micrograms of folic acid per day.
Folic acid is found especially in yeasts, green leafy vegetables, broccoli, beans, asparagus, some fruits (like oranges), whole grains, whole corn, peanuts, and animal liver. The vitamin "cannot be synthesized" in the human body and must be consumed in the diet. Since 1998, the FDA has mandated that certain grain products be ‘fortified' with 140 micrograms of folic acid per 100 grams. Yet vitamin B12 is essential to the availability to the cells of the active form of folic acid, and many other nutrients are also required as well as healthy functioning tissues and enzyme actions.
What are the possible "dangers that exist" from ingesting isolated, synthetic folic acid? Concern has been raised as to whether excessive ingestion of ‘enriched' grain products could disguise underlying B12 deficiency, "which itself has the potential to produce NTDs." Excess folate can interfere with metabolic pathways and worsen or induce B12 deficiency. Folic acid, B12, and the enzymes dependent on them are intimately involved with each other. Taking one so-called ‘vitamin' without the others can create biochemical disruptions and imbalances. Also, there is a potential interaction between zinc plasma levels and folic acid metabolism, as well as evidence suggesting a relationship between NTDs and lower levels of zinc. What other disruptions and imbalances will be discovered as the mandatory folic acid ‘fortification' continues?
It has been claimed that "natural forms of folate are less bioavailable than synthetic folic acid," that the chemical is better absorbed than food sources. Has Nature goofed again? Admittedly, natural forms of folate in foods are susceptible to destruction by cooking or processing. And the depleted soils of modern farms result in lowered food content. But the measurement of isolated folic acid in the blood does not translate into increased bioavailability. Any chemical (including drugs which synthetic vitamins resemble far more than they resemble food complexes) can be measured in the blood. Does that spell success? Does that mean the body can safely use and benefit from the ingested substance? No! Folic acid is just a portion of a vitamin complex, and never functions alone. Its use in the biochemistry of the body is far more complex than a simple blood measurement can ever tell. Besides, the body may rush the synthetic chemical through the bloodstream (showing up in blood tests) to the kidneys in order to excrete as much of it as possible as quickly as possible (a xenobiotic). Further, "there remains a concern that the potential for adverse effects" exists so a "Tolerable Upper Intake Level" has been set (not more than 1000 micrograms per day of added folic acid). Food sources do not have this risk.
Because of "a perceived failure of public health efforts" to influence women believed to be at risk for an NTD child and because the neural tube closes so early in pregnancy before many women would be aware that they are pregnant, "food fortification" rather than supplementation was deemed necessary. Not only is a synthetic chemical used to "fortify" foods, but it is administered to the entire population. Many post-fortification studies have suggested that the increased folate intake in the US population "may be about twice that originally anticipated," many people ingesting more than 1000 micrograms (the Tolerable Upper Intake Level) a day, even in the absence of folate supplements. The analyzed values of folic acid in ‘fortified' foods such as breakfast cereals were "considerably higher than labeled values." And people were often found to consume at least TWICE the labeled serving size. Despite this more than doubling of folate intake than originally intended, a debate continues about whether MORE folic acid should be added to the food supply. Some people argue that the extra folic acid would be helpful to the homocysteine levels of much of the population. Yet the "main attributable factor responsible for elevated homocysteine has switched from folate status to vitamin B12 status." Additional folic acid in the food supply "is unlikely to significantly further influence homocysteine concentrations."
The most extensive study on the effects of folic acid fortification reported a 19% drop in the rate of NTDs in the US (well short of the 50% drop expected). Does this prove the benefit of fortification? Actually, the NTD rates in the US (and worldwide) "were decreasing before fortification began," possibly due to improved nutrition or prenatal diagnosis with termination of pregnancy or simply completion of the usual historic cycle for this problem. "Thus, it is not possible to definitively attribute the decrease in the incidence of NTDs in the United States solely to fortification." Because "not all NTDs are folate responsive, it may be that the maximum benefit of fortification has already been achieved - we just do not know." The reason why folate may influence NTD rates is not known. Whether all or just a small subset of pregnant women are at risk of NTDs is not known. NTDs are significantly influenced by genetic factors and environmental factors, including nutrition. But if the possibility exists that additional fortification MAY reduce the risk of NTDs further, what is the harm? "Over the past few years, the US population has been exposed to a significant increase in folate intake for which there is essentially no data on safety. Practically no studies have been done to look directly or even indirectly for the adverse effects of elevated folate intakes." The potential masking effect of isolated folate intake on B12 deficiency is one area of concern. Isolated folic acid has not been available in megadose supplement formulations because of this concern, so the adverse effects of high intakes has not been determined. Now that folic acid is administered to the general public in foods, problematic effects may be forthcoming.
Two studies raised a concern for pregnant women given isolated synthetic folic acid. They found a 15% and 16% higher rate of spontaneous abortion (miscarriage) than in controls. Another study found no such increase. Still, the research does raise some uncomfortable questions. "Folic acid works, but we are also in the dark about how it works or whether it works properly only in tandem with a full diet and supplement programme." Without adequate data on its mechanism (the drug mentality) and with its potential risks (an inevitability of using it as a drug), women cannot really make informed and rational decisions about supplements. They and the rest of the population get no choice at the supermarket where the isolated chemical version is placed in foodstuffs.
There is no question that good nutrition generally and folic acid specifically is important in pregnancy and birth. For example, folic acid assists in reducing risk of gestational hypertension (high blood pressure associated with pregnancy) which can lead to preeclampsia, a serious condition for both mother and child. And low plasma folate levels have been associated with an increased risk of early spontaneous abortion. But in Nature, in real foods, folic acid NEVER appears by itself and never functions by itself. One important ‘partner' is vitamin B12. A low level of serum B12 (not a classical deficiency) may be "an important etiology factor in neural tube defects along with folate levels." Thus, vitamin B12 along with folate "may be warranted in the prevention of neural tube defects." Emerging discoveries demonstrate that folate status may involve a "cocktail effect" resulting from interactions among genes, nutrients, and enzymes. What effect does intake of an isolated folic acid chemical have on the other ingredients in the natural "cocktail," including the creation of imbalances which are worse than deficiencies?
Folic acid is being used as a drug. A linear, mechanistic mentality (a drug mentality) seeks a direct cause-and-effect explanation and a pharmacological (drug) solution. "Poor pregnancy outcome is the result of multiple factors and cannot be corrected by a narrow pharmaceutical shortcut." It calls for overall improvement in diet and health care. Diets of women who are pregnant or can become pregnant are never deficient in only in one micronutrient, but in a multiplicity of nutrients and other food factors, both known and unknown. "What women require is food of good nutritive value, not just a capsule of some selected synthetic nutrients." Besides the vitamin portions that are "envisaged" to be provided by the supplements, foods provide a whole range of bioactive complexes and ‘non-nutrients' (such as phytochemicals) that will no doubt be "discovered" in the future as being essential, protective, and healthful. Foods provide nutritional packages of interlocking, cooperative, potent commixtures.
Since prenatal supplements contain synthetic, isolated, or inorganic sources of various vitamins and minerals and since they are to be taken daily, "a significant proportion of pregnant women will end up with intakes that are substantially in excess of their individual requirements" with adverse effects not yet fully known. There is already plenty of evidence that synthetic vitamins or inorganic minerals (such as vitamin A and zinc) given in high does during pregnancy may be harmful to the mother or developing fetus. Will the folic acid campaign be another experiment on pregnant women and the general public that will reap disappointing or disastrous effects? Nutrient requirements are different for individuals. Real-life situations incorporate so many variables that no one can set a specific requirement for all women, especially when an isolated chemical compound is involved. The complex interactions between nutrients are affected when higher doses of one or another are taken. For example, excess copper intake comparatively depletes zinc and other trace minerals. Chronic ingestion of an isolated vitamin portion, such as ascorbic acid, will deplete other portions of the natural complex in the body including copper. The "specific nutrient-nutrient interactions" in the mixture of chemicals presented as prenatal supplements or added as ‘fortification' to refined and processed foods are unknown, especially in women deficient in many nutrients. The way to approach deficiencies "is not to resort to a fishing expedition - a hit-or-miss, blunderbuss, polypharmacy approach involving a few micronutrients that may be necessary, quite a few that may not be, and a few that may even be harmful." Also, many other nutrients and other food factors are missing. This is a precarious gamble presented to the public as a sure and safe thing. In truth, it "is unscientific, unethical, and unsustainable." MOREOVER IT IS NOT NUTRITION!! i
This website has excellent nutritional protocols for Neural Tube Defects which are available in conjunction with the Symptom Survey. Take the Symptom Survey to discover specifically what nutrition you need for your individual health problems. I want to emphasize that the whole-food nutrition I recommend CANNOT be purchased in any retail store: so-called "health food" store, drug store, super market, etc. The whole-food nutrition I recommend will help rebuild your body and help restore your health. Those other products will only give you a pharmaceutical (drug) effect. They will attempt to deal with your symptoms, which is the ONLY thing any drug can do, while leaving the state of your health unchanged.
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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.