Tuesday, May 17, 2016

Folic Acid in Prenatal Vitamins are only for 1st Trimester

Folic Acid in Prenatal Vitamins are only for 1st Trimester


May 13, 2016 - Posted by: Albert Mensah, MD

Folic acid supplementation is not one size fits all for pregnant women. In addition, women should not presume that while you are preparing to get pregnant that you should eat lots of green leafy vegetables. They may or may not be beneficial to you or your child. Even worse, they may be a benefit to you and not your child.

A new study out of Johns Hopkins University’s school of public health shows that medicine’s decade long promotion of folic acid supplementation for pregnant women can be very detrimental for certain patients and their unborn babies, possibly contributing to the rise in autism over the last decade.

We have been telling patients for many years that women should take the standard dose of folic acid only during the first trimester of pregnancy, and not go beyond that time period. Folate is a necessary nutrient for the prevention of neural tube defects but it can have very detrimental side effects for both mother and baby if one or both are undermethylated. It is only needed during the first trimester of pregnancy. After which the brain is fully formed.

The John Hopkins study supports what we’ve been saying for almost a decade. Folic acid in excess may not be good. Quite frankly, sometimes too much or too little of any good thing can be problematic. And this is true for folic acid.

We’ve seen the trend in medicine over the last decade move from recommending folic acid for the first three months, to six months, to a year, and then to giving it to nursing mothers as well. It seemed like the general consensus was, if something is good then more is better.  We have been cautioning our patients for years to only use folic acid for the first three months of pregnancy, after which the folic acid should be discontinued. Bottom line: continued use of folic acid while pregnant may potentially offer more dangers than it does benefits.

Why Folic Acid Should be Discontinued after the First Trimester

The John Hopkins article specifically refers to the risk of autism due to excessive use of folate during gestation. For us the underlying factor involved here is methylation status. Many of our patients are familiar with the methylation cycle, which is a series of interdependent biochemical pathways that all our bodies use to function. The methylation cycle influences critical biological processes such as DNA maintenance, energy production, detoxification, and our immune systems.

When the methylation cycle is out of balance mental health conditions will surface because an imbalance negatively effects neurotransmitter activity and development. If you have an imbalance you can be either undermethylated or overmethylated. Folate, while very beneficial for overmethylated folks, is extremely detrimental for undermethylated people.

Children with autism are mostly undermethylated and undermethylation is also a factor in various other conditions we treat that may be affected by excess folate from supplementation in utero.

This imbalance may also be producing future anxiety, future depression, and future ADHD in undermethylated babies fed too much folic acid in utero.  Statistics show that in addition to autism, ADHD has also risen in the past decade.  Is excess folate supplementation in utero also creating Aspergers syndrome? Future OCD? All of these conditions may be related to excess folic acid. This is also why we don’t recommend methylated folate for our patients diagnosed with autism.

Folic acid is not a friend for these undermethylated folks.

Folic Acid Supplementation for Overmethylated Pregnant Women

But what if you are overmethylated? You might be an overmethylated mommy who needs folic acid. But you don’t know if your child is an undermethylated fetus. Two lineages (maternal and paternal) can influence the methylation status of the unborn child. If you do any form of folate such as folinic acid, methylated folate, or folic acid, we recommend that you discontinue dosing after the first trimester when brain development of the fetus is fully formed. Your continued use of folic acid at 6 months, a year, and while nursing may contribute to a biochemical imbalance in your child if he or she is potentially undermethylated. Once you have delivered the baby, if you are not breast feeding, YOU should get back on your supplements if you are on a nutrient program.

What’s the Bottom Line?

Eat a balanced diet if you are thinking about becoming pregnant or if you are pregnant. Keep away from the extreme diets. Carnivores, you typically don’t get enough folic acid in your diet.  Sorry, veggievors. You typically get too much folic acid in your diet. Please note, folic acid is important. But too little folic acid and too much folic acid can be detrimental to patients.

Now we have seen that traditional medicine has likely been advocating too much folic acid supplementation. Now the medical world has begun to re-evaluate previous recommendations for folic acid usage and are beginning to understand the potential dangers and beyond.

Let’s talk about hidden food sources of folic acid. The average diet in the U.S. is full of hidden folates. Enriched or fortified has 200 to 400 mcg of folic acid. This includes bread, orange juice, cereal, and of course over the counter multivitamins. Plain and simple, now is the time we need to be cautious. Please read labels.