Could prenatal vitamins be related to the rise in allergies, autism, autoimmune diseases, and diabetes?
What if supplemental folic acid is making us sick?
What if prenatal vitamins aren’t really building healthier babies like we’d like to believe?
What if foods enriched and fortified with folic acid are partially responsible for the increase in autoimmune disease, diabetes, and autism of the past 10 years?
I’m not a doctor. I’m not a nutritionist. But I am a mom concerned about my health, my family’s health, and the health of the children I hope to have in the future. And after you review the research I’ve found on folic acid, the synthetic version of folate, added to vitamins and foods worldwide, you might being to wonder if trading your folic acid containing supplements in for food is the only safe, and truly healthy way, to assure the optimal outcome for you and your offspring. Like most expectant moms, I took prenatal vitamins before and during my pregnancy, but after what I’ve learned, I’m beginning to rethink whether they’re as necessary as we’ve been lead to believe.
Let’s look at the facts.
Since 1998, when folic acid fortification of white flour became mandatory in the United States, autism and diabetes rates have skyrocketed. In that time period, the diabetes rate in the U.S. jumped from 7.63 million to 10.48 million. This is significant because the jump seems to correspond with the US Food and Drug Administration’s authorization of the addition of folic acid to enriched grain products in March 1996, with compliance mandatory by January 1998 . As for autism, rates rose from 1 child with autism out of 500 in 1995 to 1 in 250 by 2001, a 50% increase in five years, with new cases continuing to rise each year.
Simultaneously, the supplement industry’s growth exploded. In 1998, sales of over the counter supplements reached 13.66 billion. According to Forbes, in 2012 the supplement industry produced about $32 billion in revenue, and by 2021 that figure is expected to grow to approximately $60 billion. High revenues indicate that more Americans are buying into the idea that over the counter vitamins, herbs, and other supplemental concoctions will make them healthier, though the data for things like diabetes and autism suggests just the opposite.
Now, you might think I’m crazy for even suggesting I know what could be contributing to rising autism and diabetes rates, and that I’m begging for an online beating, but I’m simply asking “what if?”
What if supplementation with vitamins, specifically folic acid and too much of it, is actually making us and our offspring sick?
Science has certainly been thinking about this possibility, but why aren’t we?
So what exactly are the researchers saying about how folic acid might be affecting insulin resistance in kids? Or brain changes in rats? Or even rising allergy rates?
Much of the data I’ll present to you below was found in the August 2014 research paper entitled Maternal methyl supplemented diets and effects on offspring health. This is the most comprehensive and most recent review I could find on how supplementation with folic acid might be impacting the human species.
Folic Acid & Methylation: what is it?
To understand how folic acid interacts with our bodies, it’s important to understand a little bit about methylation.
The authors of the 2014 paper cited above explain that, “Methylation… is a potent regulator of gene expression, and this process is affected by various external, including dietary, factors. There has been growing interest in the potential protective [and deleterious] effects that dietary supplements might exert on [our genes]. Such nutraceuticals include…pyridoxine (vitamin B6), folate (vitamin B9), betaine (trimethylglycine), choline, Vitamin B12, and zinc.”
So why is supplementation with folic acid, and other methyl vitamins, so scary?
Despite what we’d like to believe, there is no way to “target” specific genes and pathways with supplementation, the authors further explain. We can’t pick and choose how what we take affects us, unfortunately, which is what makes supplementation, especially during pregnancy, so dangerous. Bombard your body with synthetic supplemental B vitamins like folic acid and hope that maybe you’ll decrease your chance of having a child with a neural tube defect, or that you’ll protect your child’s brain development and garner some insurance against a poor diet, but as the scientists explain, it’s not so simple:
“tinkering with methylation status on the global level, as likely occurs with consumption of…supplements, can affect both “beneficial” and “harmful” genes. The scale of disease promotion or prevention is likely tipped one way or another depending on the combined genes that are affected.”
So by taking supplements at all, at any stage in life, we could be tipping the nutritional scales in our bodies to the bad side. Throw in the precarious events of pregnancy, and we may be tipping the scales so far, in fact, that we’re actually reprogramming the DNA of our children, and not for the better, without even realizing it.
Folic Acid & Rats
Studies on humans are limited, though there are some, but a fairly robust amount of research exists for how rats supplemented with methyl vitamins, like folic acid, fair.
But rats aren’t humans, so do tests on them really matter when we attempt to translate the results to human health? According to LiveScience.com, Rodents are used as models in medical testing because “their genetic, biological and behavior characteristics closely resemble those of humans, and many symptoms of human conditions can be replicated in mice and rats.”
Regarding rats and colitis, pregnant rodents fed a diet supplemented with folic acid, and other methyl vitamins, had the following characteristics: Harmful and persistent changes in the offspring gut microbiota; strange changes in gut DNA; and an increased incidence of colitis in exposed compared to control offspring. Could the increasing incidence of ulcertative colitis disease in children have something to do with the vitamins their parents took or the fortified and enriched foods popular in early childhood?
Then, when it comes to allergies, pregnant rats supplemented with methyl compounds, like folic acid, had an increased incidence of allergic airway disease in their offspring with corresponding hypermethylation of “a gene that has previously been shown to suppress [this] disease.”
Finally, in terms of brain development, rats fed higher amounts of folic acid had the following: “Disruptive gene and protein expression changes in the cerebral hemispheres of newborn pups; [and] behavioral abnormalities in neonatal pups, including increased ultrasonic vocalizations, anxiety-like, and hyperactive behaviors.”
Want to review the table of rat research yourself? Check it out here.
Humans, Folic Acid, & Available Research
Here’s what the recent research says about folic acid supplementation and pregnant women, in summary:
“Consumption of folic acid supplements by pregnant women after 12 weeks of gestation has been linked to epigenetic changes in fetal cord blood… These results thus suggest that a maternal MS diet can influence expression of both repeat elements and imprinted genes in offspring. The long term phenotypic effects of such changes, however, remain unknown.”
Furthermore, while maternal folic acid supplementation has been linked to decreased incidence of preeclampsia and small for gestational age births, on the other hand, “maternal supplementation of folic acid beginning at the first trimester increased the likelihood of infant bronchiolitis”.
Then, a recent study of Gambian women and their children demonstrated that consumption of a folic acid and other vitamin enriched diet during pregnancy strongly correlated with persistent and systemic epigenetic changes in several genes thought to be particularly vulnerable to environmental influences. The authors explain:
“This relatively large (24 villages, 166 women), 2 years study suggests a strong association between maternal methyl donor consumption and DNA patterns in the genomes of offspring, which may ultimately result in adverse…outcomes.”
Folic acid and Diabetes
A 2008 study of 700 Indian women found that those with higher concentrations of folate in their blood went on to have children with higher body fat composition and insulin resistance. What does insulin resistance lead to? You guessed it, diabetes.
Then we turn to our friends the rats yet again, for a 2014 study which suggests that high folic acid consumption by mothers exacerbates a detrimental effect on glucose intolerance and insulin resistance in male offspring, “implying that high folic acid supplementation during pregnancy should be adopted cautiously in the general population of pregnant women to avoid potential deleterious effect on the metabolic diseases in their offspring.” This is interesting because some research suggests that diabetes rates in boys are slightly higher than girls.
The developing brain, folic acid, and Autism
Now I have to emphasis once again that I’m not a doctor or a scientist. I’m simply a mom and nutrition geek on the quest for answers, for a better, healthier future for my children and yours. Well, the current rate of autism in this country, approximately 1 child out of 68, is unacceptable in my opinion. As the family member of a person with a brain disorder, I know just how devastating, and how complicated, life with a neurologically challenged loved one can be.
Rat studies, which show how methyl vitamins can disturb brain development, aside, here’s what I found about autism, humans, and prenatal vitamins:
One alarming study referenced in the 2014 paper is from the Rochester Epidemiological Project in Rochester, MN, which spanned decades from 1976–1997, that’s 20 years of research. This study suggested a strong correlation (0.87) for maternal consumption of prescription prenatal vitamins (containing > 1 mg of folic acid) and ASD incidence in offspring. “Consequently, the investigators concluded that too much folic acid might disrupt brain development and thus increase the risk for ASD, a hypothesis promoted in previous studies,” the paper reports.
Note that this study concluded right when fortification of flour with folic acid became mandatory in the US and right around when autism rates began to soar. If you look at the supplement industry sales data from the last several years, you’ll see that the market for prenatal vitamins increased exponentially from 2008 to 2013, while autism rates have also increased during that same period.
If prenatal vitamins containing folic acid are supposed to build better babies and healthier brains, and if more people are taking them as evidenced by growth of the industry, then why are autism rates continuing to rise? Even if the answer is not at the bottom of a vitamin bottle, one thing is for sure, prenatal vitamins, and the folic acid that come with them, don’t appear to be helping.
So how much folic acid is too much?
Unfortunately, upper limits during pregnancy have not been established, despite aisles and aisles of foods stocked with fortified and enriched foods at the grocery store, and shelves full of over the counter prenatal vitamins. It’s easier than you think to over dose on folic acid and other vitamins without realizing it. While the current recommendations state that those wishing to become pregnant should consume up to 600 units of folic acid or folate from food sources or supplements a day, what happens if you consume a prenatal on top of a diet already rich in folate containing foods? Are the benefits of the foods distinguished by the supplement use? Does the supplement interfere with the body’s ability to metabolize that natural folate? Especially in individuals who have no problem metabolizing folate in the first place.
There are no clear answers here.
In my opinion, one that is shared with many in the scientific community, the current one sized all approached to prenatal and gestational supplementation, along with unchecked food fortification and enrichment in the United States, is alarming, and potentially irresponsible. Especially when the research we do have is so mixed. I’ve presented mostly negative research here, but there are good studies too, it’s upon these contradictions that entire supplement marketing campaigns thrive. One researcher will say that prenatal vitamins improve pregnancy outcomes, while another will link them to reduced fetal size, autism, and even death.
In fact, the authors of the 2014 paper say that while folic acid supplementation, especially methylated folate, may have a protective effect for those with the MTHFR gene mutation, an adverse one may result for those who metabolize folic acid normally, but supplement with folic acid anyway. This was interesting to me because while immersing myself in infertility blogs in trying to conceive my daughter, I noticed a “more is more” trend regarding supplemental folic acid use. The idea was that since testing for the MTHFR gene mutation was a last resort, after several pregnancy losses, adding additional folic acid above and beyond a prenatal vitamin could have protective effects. In some cases the bloggers would mention that they’d even gotten the green light from their doctors to dose themselves with extra folic acid. This highlights what’s scary about the supplement industry: you can get these seemingly innocuous pills over the counter and even your own doctor can’t tell you what they’ll do to you or your children. The long-term research just isn’t there, and the medical community is too busy treating patients in many cases to be scouring recent developments, nor is there enough research money to go around.
Neural Tube Defects Floor Effect
What about neural tube defects (NTDs), the very thing that mandatory folic acid fortification, and pre conception supplementation is meant to prevent?
It’s been demonstrated that a floor effect for folic acid exists, meaning that the decline in NTDs was independent of the amount of folic acid administered. This researchers explain, “clearly shows that not all cases of NTD are preventable by increasing the folate intake. The relative decline depends on the initial NTD rate. Countries with NTD prevalence close to the observed floor may have much smaller reductions in NTD rates with folic acid fortification. Additionally, potential adverse effects of fortification on other vulnerable population groups have to be seriously considered.”
We know that there are likely adverse effects that result from over supplementation, so should fortified foods, and vitamins, contain a warning label beyond the statement that the claims presented on the bottle haven’t been evaluated by the FDA? I have a feeling that the more we research how nutraceuticals effect the developing brain and body, the more necessary this will become.
Folic Acid & You
Brain changes in rats, potential links to autism, insulin resistance in 6-year olds, if I haven’t convinced you to think twice about swallowing a prenatal vitamin or folic acid tablet, but especially about taking more than the recommended dose, then I don’t know what will. I encourage you to ask your doctor about this research and to consider demanding a test for the MTHFR gene mutation, to see if you’re one of the people who actually benefit from supplementation with specially formulated folic acid. Because what if encouraging all women of child bearing age to take prenatal vitamins, and dosing the rest of the population with folic acid via fortified foods, is doing more harm than good?
While science is figuring out, there is something we can do for our bodies and our babies. We can pay attention to where our nutrients are coming from, we can eat better food. With produce delivery services like Farm Fresh To You, it’s easier than ever to get nutritionally dense produce, and even eggs, delivered right to your door. And it’s easier than you think to get all the folate you need from your meals.
Here’s an example of a typical menu for a folate rich day:
1 cup of spinach 2-egg omelet with ½ an avocado
1 green pineapple smoothie (recipe below)
Taco salad with 2 cups romaine lettuce and 1 cup black beans
1 cup steamed broccoli, tuna steak, and brown rice
1 cup spinach salad, with mandarin oranges, almond shavings, and vinaigrette
Not that hard right? Incorporate greens at every meal, a serving of beans and avocado throughout the day, and you’re there. In fact, this particular menu has 155% of your required folate for the day if you are a pregnant or nursing mother! No weird supplement concoction required and the body knows how to safely utilize or excrete anything extra.
The current attitude in the medical community seems to be, “take a prenatal vitamin. It can’t hurt.” But based on what I’ve presented above, maybe it can. If you are alarmed by this research like I am, talk to your doctor, and send them this blog. I’ll certainly be presenting this research to my own doctor at my next appointment. In the meantime, if you do continue taking a prenatal vitamin pay attention to how much synthetic folic acid you’re getting from other sources. You may even consider skipping your prenatal on days you eat well. Because in most cases, folate from good food, and all the other awesome nutritional benefits that come with it, really is all you need. In a perfect world, we’d be able to get a prescription for produce delivery from a service like Farm Fresh to You, just as easy as we’re able to obtain one for prenatal vitamins. But since we’re far from that utopia, it’s up to us to make better and more informed choices about what we put into our bodies, folic acid containing supplements included, before, during, and after pregnancy.