Congenital Heart Defects Prevention with Folic Acid?

Written by Dr. Steve Chaney on . Posted in folic acid and congenital heart defects

Does Methyl Folate Work As Well?

Author: Dr. Stephen Chaney

 

congenital heart defects preventionCan folic acid aid in congenital heart defects prevention?

Every once in a while, a scientific study revolutionizes the practice of medicine and transforms how we lead our lives. The study showing that folic acid supplementation reduced the risk of neural tube defects in newborns was such a study.

First a little history: Dr. Richard Smithells and his colleague Elizabeth Hibbard first started to suspect that folic acid deficiencies were linked to neural tube defects such as spina bifida in the early 60s. By the early 70’s there was enough circumstantial evidence for this link that most doctors were recommending pregnant women start on a prenatal supplement containing folic acid once their pregnancy was confirmed by the obstetrician.

That was when Dr. Smithells convinced the Medical Research Council (MRC) of England to conduct a major, multi-center trial to definitively test his hypothesis. The MRC study (MRC Vitamin Study Research Group, Lancet 338: 131–137, 1991) was terminated in 1991 when it became clear that it was unethical to continue withholding folic acid from the placebo group. The study clearly showed:

  • Folic acid supplementation reduced the incidence of neural tube defects in newborns by 72%.
  • Supplementation with folic acid must start prior to conception for maximum efficacy. If women waited until their pregnancy was confirmed by their doctor, the benefits of folic acid supplementation were much weaker. By then, as the old saying goes: “The horse was already out of the barn”.
  • Subsequent studies have shown that folic acid supplementation is effective at reducing neural tube defects even when the mother and/or baby have MTHFR deficiencies.

As I mentioned before, this study revolutionized medicine and public health in this country.

  • The U. S. Public Health Service and CDC changed their recommendation to “All women of childbearing age should consume at least 400 micrograms of folic acid daily to prevent neural tube defects.
  • Starting in 1998, the United States and Canada mandated folic acid fortification of all flour, enriched pasta, and cornmeal.

 

What About Congenital Heart Defects Prevention?

 

folic acid congenital heart defectsWith the clear success of folic acid reducing the risk of neural tube defects, it was natural to ask whether folic acid supplementation might also help with congenital heart defects prevention. Heart defects affect 1% of all newborn babies. While they can often be treated with surgery, that is horribly expensive and not always successful.

As with neural tube defects, previous clinical studies have provided clear evidence that supplementation with at least 400 mcg/day of folic acid reduces the risk of heart defects in newborns. A meta-analysis of 18 clinical studies estimates the risk-reduction at 28% (Scientific Reports, 5: 8506, DOI: 10.1038/srep08506 ).

The authors of this study (Liu et al, Circulation 134: 647-655, 2016 ) set out to determine whether folic acid fortification had significantly reduced newborn heart defects in Canada. They utilized a database of the Canadian Institute for Health Information that covered 98% of births and stillbirths between 1990 and 2011.

Did folic acid supplementation aid in congenital heart defects prevention?

Of the 5,901,701 births and stillbirths in this database, 72,591 were diagnosed with some type of heart defect. The investigators then compared the prevalence of heart defects before and after 1998 to determine the effect of folic acid fortification on heart defects.

 

Does Folic Acid Aid in Congenital Heart Defects Prevention?

 

folic acid fortifiedThe results of the study were clear cut. Folic acid fortification of flour:

  • Reduced heart outflow abnormalities by 27%.
  • Reduced narrowing of the aorta by 23%.
  • Reduced holes in the heart wall separating the chambers by 15%.

Some types of heart defects were not significantly affected by folic acid fortification, so the overall reduction in newborns with heart defects was 11%.

The paper concluded “Although food fortification with folic acid was aimed primarily at reducing neural tube defects, this population based intervention may also have had a beneficial effect on specific types of [heart defects], which in aggregate are more common.”

Overall, folic acid fortification (providing an extra 100 mcg/day folic acid) did not appear to be as effective as supplementation with 400 mcg/day folic acid at reducing total heart defects in newborns. Perhaps because of that, the senior investigator in the study was quoted as saying “Women who are likely to get pregnant should start taking folic acid supplements before getting pregnant as they may not necessarily receive adequate folate from diet alone.”

 

Does Methyl Folate Aid in Congenital Heart Defects Prevention as Well?

methyl folate mythMethyl folate is being widely promoted as safer, more natural, better absorbed, and more effective than folic acid. I have thoroughly debunked the first three claims in my video “The Truth About Methyl Folate.

What about the claim that methyl folate is more effective than folic acid?

The fact is we don’t even know whether methyl folate is even as effective as folic acid. The studies on neural tube defects and heart defects were done with folic acid, not methyl folate. There are literally thousands of studies on the health benefits of folic acid. Almost all of them were done with folic acid, not methyl folate. It is reasonable to assume that methyl folate might be as beneficial as folic acid, but without clinical studies we simply don’t know.

The few clinical studies that have used methyl folate have not included patients that were given folic acid instead of methyl folate. Without that kind of direct comparison, it is impossible to know whether methyl folate is less effective, the same, or more effective than folic acid.

Finally, there is the claim that methyl folate is more effective than folic acid in people with MTHFR deficiencies. Until we start seeing clinical studies directly comparing the effect of methyl folate and folic acid supplementation on health outcomes in people with MTHFR deficiencies, it is impossible to verify that claim. Once again, methyl folate might be less effective, the same, or more effective than folic acid. We simply don’t know.

Folic Acid does aid in congenital heart defects prevention and methyl folate may.

 

The Bottom Line

 

  • It has been clearly established that folic acid supplementation reduces the risk of neural tube defects in newborns, and that food fortification with folic acid has also helped reduce the incidence of neural tube defects.
  • Previous studies have also shown that folic acid supplementation reduces the risk of heart defects in newborns.
  • A recent study has shown that food fortification with folic acid also contributes to a reduction in the risk of giving birth to babies with heart defects.
  • The U. S. Public Health Service and CDC recommend “All women of childbearing age should consume at least 400 micrograms of folic acid daily to prevent neural tube defects.” Based on the latest studies, folic acid aids in congenital heart defects prevention as well.
  • The studies on neural tube defects and heart defects were done with folic acid, not methyl folate. It is reasonable to assume that methyl folate might be as beneficial as folic acid, but without clinical studies we simply don’t know whether it is even as effective as folic acid.
  • As for other claims about methyl folate, there are no clinical studies I am aware of directly comparing methyl folate and folic acid. Without that kind of study, it is impossible to know whether methyl folate is less effective, the same, or more effective than folic acid.

 

For details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (4)

  • Robin

    |

    No mention here of the 4 possible MTHFR mutations that I understand is present in 30 – 40% of the population. People with this mutation do not adequately process folic acid into methyl folate. For the most affected taking folic acid can be harmful. This can contribute to heart disease and play a role addiction behaviors and heart disease and bipolar disease.

    Reply

    • Dr. Steve Chaney

      |

      Dear Robin,

      Unfortunately, there is no evidence to back up your statements. I have addressed this in detail in my video “The Truth About Methyl Folate”
      (https://www.youtube.com/watch?v=MzT-iU8UIwo)

      Dr. Chaney

      Reply

  • Jeanne

    |

    Dr. Chaney,
    I like what you have to say. You are very sincere and scientific and do not prey on the ignorance of most people. I like the fact that your articles are short, not too technical, and not full of promises. I also like the summary at the end of each article.
    Can you address the issue of clean water and whether or not to add minerals to distilled or purified water? If you have already addressed this issue please send me a link.
    Thank you and God bless your work,
    Jeanne Dart

    Reply

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Latest Article

Does Protein Supplement Timing Matter?

Posted May 15, 2018 by Dr. Steve Chaney

How Do You Gain Muscle Mass & Lose Fat Mass?

Author: Dr. Stephen Chaney

 

protein supplement timingMost of what you read about protein supplements on the internet is wrong. That is because most published studies on protein supplements:

  • Are very small
  • Are not double blinded.
    • Both the subjects and the investigators knew who got the protein supplement.
  • Are done by individual companies with their product.
    • You have no idea which ingredients are in their product are responsible for the effects they report.
    • You have no idea how their product compares with other protein products.
    • There is no standardization with respect to the amount or type of protein or the addition of non-protein ingredients.

Because of these limitations there is a lot of misleading information on the benefits of protein supplements timing and maximal benefit. Let’s start by looking at why people use protein supplements. Let’s also look at what is generally accepted as true with respect to the best supplement timing.

There are 4 major reasons people consume protein supplements:

  • Enhance the muscle gain associated with resistance training: In this case, protein supplements are customarily consumed concurrently with the workout.
  • Preserve muscle and accelerate fat loss while on a weight loss diet: In this case, protein supplements are customarily consumed with meals or as meal replacements.
  • Provide a healthier protein source. In this case, protein supplements are customarily consumed with meals in place of meat protein.
  • Prevent muscle loss associated with aging or illness. There is no customary pattern associated with this use of protein supplements.

How good are the data supporting the customary timing of protein supplementation? The answer is: Not very good. The timing is based on a collection of weak studies which do not always agree with each other.

The current study  (J.L. Hudson et al, Nutrition Reviews, 76: 461-468, 2018 ) was designed to fill this void in our knowledge. It is a meta-analysis that compares all reasonably good studies that have looked at the effect of protein supplement timing on weight gain or loss, lean muscle mass gain, fat loss, and the ratio of lean muscle mass to fat mass.

How Was The Study Done?

The authors started by doing a literature search of all studies that met the following criteria:

  • The study was a randomized control trial with parallel design. This means that study contained a control group. It does not mean that the investigators or subjects were blinded with respect to which subjects used a protein supplement and which did not.
  • The subjects were engaged in resistance training.
  • The study lasted 6 weeks or longer.
  • Reliable methods were used to measure body composition (lean muscle mass and fat mass).
  • The subjects were healthy and at least 19 years old.
  • There was no restriction on the food the subjects consumed.

The authors started with 2074 published studies and ended up with 34 that met all their criteria. They then separated the studies into two groups – those in which the protein supplements were used with meals and those in which the protein supplements were used between meals.

Both groups were diverse.

  • Group 1 included subjects who consumed their protein supplement with their meal and those who consumed their protein supplement as a meal replacement.
  • Group 2 included subjects who consumed their protein supplement concurrent with exercise (usually immediately after exercise) and those who consumed their protein supplement at a fixed time of day not associated with exercise.

Does Protein Supplement Timing Matter?

 

protein supplement timing workoutsBecause the individual studies were very diverse in the way they were designed, the authors could not calculate a reliable estimate of how much lean muscle mass was increased or fat mass was decreased. Instead, they calculated the percentage of studies showing an increase in lean muscle mass or a decrease in fat mass.

When the authors compared protein supplements consumed with meals versus protein supplements consumed between meals:

  • Weight gain was observed in 56% of the studies of protein supplementation with meals compared to 72% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • An increase in lean muscle mass was observed in 94% of the studies of protein supplementation with meals compared to 90% of the studies of protein supplementation between meals. In other words, timing of protein supplementation did not matter with respect to increase in muscle mass.
  • A loss of fat mass was observed in 87% of the studies of protein supplementation with meals compared to 59% of the studies of protein supplementation between meals. In other words, protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • An increase in the ratio of lean muscle mass to fat mass was observed in 100% of the studies of protein supplementation with meals compared to 87% of the studies of protein supplementation between meals. In short, protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean muscle mass to fat mass.

The following seem to suggest protein supplement timing matters:

The authors pointed out that their findings were consistent with previous studies showing that when protein supplements are consumed with a meal they displace some of the calories that otherwise would have been consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors stated that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

The others concluded: “Concurrently with resistance training, consuming protein supplements with meals, rather than between meals, may more effectively promote weight control and reduce fat mass without influencing improvements in lean [muscle] mass.”

What Are The Limitations Of The Study?

Meta-analyses such as this one, are only as good as the studies included in the meta-analysis. Unfortunately, most sports nutrition studies are very weak studies. Thus, this meta-analysis is a perfect example of the “Garbage In: Garbage Out (GI:GO)” phenomenon.

For example, let’s start by looking at what the term “protein supplement” meant.

  • Because the studies were done by individual companies with their product, the protein supplements in this meta-analysis:
    • Included whey, casein, soy, bovine colostrum, rice or combinations of protein sources.
    • Were isolates, concentrates, or hydrolysates.
    • Contained various additions like creatine, amino acids, and carbohydrate.
  • As I discuss in my book, Slaying the Food Myths, previous studies have shown that optimal protein and leucine levels are needed to maximize the increase in muscle mass and decrease in fat mass associated with resistance exercise. However, neither protein nor leucine levels were standardized in the protein supplements included in this meta-analysis.
  • Previous studies have shown that protein supplements that have little effect on blood sugar levels (have a low glycemic index) are more likely to curb appetite. However, glycemic index was not standardized for the protein supplements included in this meta-analysis.

protein supplement timing workout peopleIn short, the conclusions of this study might be true for some protein supplements, but not for others. We have no way of knowing.

We also need to consider the composition of the two groups.

  • Protein supplements used as meal replacements are more likely to decrease weight and fat mass than protein supplements consumed with meals. Yet, both were included in group 1.
  • Some studies suggest that protein supplements consumed concurrent with resistance exercise are more likely to increase muscle mass than protein supplements consumed another time of day. Yet, both are included in group 2. We also have no idea whether the meals with protein supplements in group 1 were consumed shortly after exercise or at an entirely different time of day.

This was the most glaring weakness of the study because it was completely avoidable. The authors could have grouped the studies into categories that made more sense.

In other words, there are multiple weaknesses that limit the predictive power of this study.

What Can We Learn From This Study?

Despite its many limitations, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, most of us are using protein supplements to lose weight or to increase our lean mass to fat mass ratio. Simply put, we are either trying to lean out (shape up) or lose weight. And, we want to lose that weight primarily by getting rid of excess fat. For us, calories do matter. With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

 

The Bottom Line:

 

A recent study looked at the optimal timing of protein supplements consumed by subjects who were engaged in resistance exercise. Specifically, the study compared protein supplements consumed with meals versus protein supplements consumed between meals on weight, lean muscle mass, fat mass, and the ratio of lean muscle mass to fat mass. The study reported:

  • Protein supplements consumed with meals were less likely to lead to weight gain than protein supplements consumed between meals.
  • Timing of protein supplementation did not matter with respect to increase in muscle mass.
  • Protein supplements consumed with meals were more likely to lead to loss of fat mass.
  • Protein supplements consumed with meals were slightly more likely to lead to an increase in the ratio of lean mass to fat mass.

The authors pointed out that their findings were consistent with previous studies showing that when a protein supplement was consumed with a meal it displaces some of the calories that would have been otherwise consumed. Simply put, people naturally compensate by eating less of other foods.

In contrast, the authors said that previous studies have shown that when foods, especially liquid foods, are consumed as snacks (between meals), people are less likely to compensate by reducing the calories consumed in the next meal.

As discussed in the article above, the study has major weaknesses. However, despite its many weaknesses, this study does remind us that protein supplements do have calories. This is of relatively little importance for people whose primary goal is to increase lean muscle mass.

However, for those of us who are using protein supplements to lose weight or to increase our lean mass to fat mass ratio, calories do matter.  With that in mind:

  • If we are consuming a protein supplement immediately after exercise or between meals we probably should make a conscious effort to reduce our daily caloric intake elsewhere in our diet.
  • Alternatively, we could consume the protein supplement with a meal, but time the meal so it occurs shortly after exercise.

For more details, read the article above:

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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