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

What Is The Planetary Diet?

Posted May 21, 2019 by Dr. Steve Chaney

Is Your Diet Destroying The Planet?

Author: Dr. Stephen Chaney

 

Earth Day has come and gone, but you are still committed to saving the planet. You save energy. You recycle. You drive an electric car. But is your diet destroying the planet?

This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) serves as a dire warning of what will happen if we don’t change our ways. I touched on this report briefly in a previous issue of “Health Tips From The Professor,” What Is The Flexitarian Diet , but this topic is important enough that it deserves an issue all its own.

The commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The commission described the typical American diet as a “lose-lose diet.” It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

How Was The Study Done?

The study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission included world class experts on healthy diets, agricultural methods, climate change, and earth sciences. The Commission reviewed 356 published studies in preparing their report.

 

Is Your Diet Destroying The Planet?

When they looked at the effect of food production on the environment, the Commission concluded:

  • “Strong evidence indicates that food production is among the largest drivers of global environmental change.” Specifically, the commission reported:
  • Agriculture occupies 40% of global land (58% of that is for pasture use).
  • Food production is responsible for 30% of global greenhouse gas emissions and 70% of freshwater use.
  • Conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction. Specifically, 80% of extinction threats to mammals and bird species are due to agricultural practices.
  • Overuse and misuse of nitrogen and phosphorous in fertilizers causes eutrophication. In case you are wondering, eutrophication is defined as the process by which a body of water becomes enriched in dissolved nutrients (such as phosphates from commercial fertilizer) that stimulate the growth of algae and other aquatic plant life, usually resulting in the depletion of dissolved oxygen. This creates dead zones in lakes and coastal regions where fish and other marine organisms cannot survive.
  • About 60% of world fish stocks are fully fished and more than 30% are overfished. Because of this, catch by global marine fisheries has been declining since 1996.
  • “Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
  • The world’s population is expected to increase to 10 billion by 2050. The current system of food production is unsustainable.

When they looked at the effect of the foods we eat on the environment, the Commission concluded:

  • Beef and lamb are the biggest contributors to greenhouse gas emissions and land use.
  • The concern about land use is obvious because of the large amount of pasture land required to raise cattle and sheep.
  • The concern about greenhouse gas emissions is because cattle and sheep are ruminants. They not only breathe out CO2, but they also release methane into the atmosphere from fermentation in their rumens of the food they eat. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO2. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb. [Note: grass fed cattle produce more greenhouse gas emissions than cattle raised on corn because they require 3 years to bring to market rather than 2 years.]
  • In terms of energy use beef, lamb, pork, chicken, dairy and eggs all require much more energy to produce than any of the plant foods.
  • In terms of eutrophication, beef, lamb, and pork, all cause much more eutrophication than any plant food. Dairy and eggs cause more eutrophication than any plant food except fruits.
  • In contrast, plant crops reduce greenhouse gas emissions by removing CO2 from the atmosphere.

 

What Is The Planetary Diet?

In the words of the Commission: “[The Planetary Diet] largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils. It includes a low to moderate amount of seafood, poultry, and eggs. It includes no or a very low amount of red meat, processed meat, sugar, refined grains, and starchy vegetables.”

When described in that fashion it sounds very much like other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable. Here is a more detailed description of the diet:

  • It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
  • It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).
  • It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
  • It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

This is obviously very different from the way most Americans currently eat. According to the Commission:

  • “This would require greater than 50% reduction in consumption of unhealthy foods, such as red meat and sugar, and greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes.”
  • “In addition to the benefits for the environment, “dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10.8-11.6 million deaths per year globally.”

What Else Did The Commission Recommend?

In addition to changes in our diets, the Commission also recommended several changes in the way food is produced. Here are a few of them.

  • Reduce greenhouse gas emissions from the fuel used to transport food to market.
  • Reduce food losses and waste by at least 50%.
  • Make radical improvements in the efficiency of fertilizer and water use. In terms of fertilizer, the change would be two-fold:
    • In developed countries, reduce fertilizer use and put in place systems to capture runoff and recycle the phosphorous.
    • In third world countries, make fertilizer more available so that crop yields can be increased, something the Commission refer to as eliminating the “yield gap” between third world and developed countries.
  • Stop the expansion of new agricultural land use into natural ecosystems and put in place policies aimed at restoring and re-foresting degraded land.
  • Manage the world’s oceans effectively to ensure that fish stocks are used responsibly and global aquaculture (fish farm) production is expanded sustainability.

What we can do: While most of these are government level policies, we can contribute to the first three by reducing personal food waste and purchasing organic produce locally whenever possible.

What Does This Mean For You?

If you are a vegan, you are probably asking why the Commission did not recommend a completely plant-based diet. The answer is that a vegan diet is perfect for the health of our planet. However, the Commission wanted to make a diet that was as consumer-friendly as possible and still meet their goals of a healthy, environmentally friendly, and sustainable diet.

If you are eating a typical American diet or one of the fad diets that encourage meat consumption, you are probably wondering how you can ever make such drastic changes to your diet. The answer is “one step at a time.”  If you have read my books “Slaying The Food Myths” or “Slaying the Supplement Myths,”  you know that my wife and I did not change our diet overnight. Our diet evolved to something very close to the Planetary Diet over a period of years.

The Commission also purposely designed the Planetary Diet so that you “never have to say never” to your favorite foods. Three ounces of red meat a week does not sound like much, but it allows you a juicy steak once a month.

Sometimes you just need to develop a new mindset. As I shared in my books, my father prided himself on grilling the perfect steak. I love steaks, but I decided to set a few parameters. I don’t waste my red meat calories on anything besides filet mignon at a fine restaurant. It must be a special occasion, and someone else must be buying. That limits it to 2-3 times a year. I still get to enjoy good steak, and I stay well within the parameters of the Planetary diet.

Develop your strategy for enjoying some of your favorite foods within the parameters of the Planetary Diet and have fun with it.

The Bottom Line

 

Is your diet destroying the planet? This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report serves as a dire warning of what will happen to us and our planet if we don’t change our ways.

The Commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The Commission described the typical American diet as a “lose-lose diet.”  It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

The Planetary Diet is similar to other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable (for details, read the article above).

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

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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