Does Methyl Folate Work As Well?
Author: Dr. Stephen Chaney
Can 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.
- Even though food fortification only increased folic acid intake by 100 mcg/day, two subsequent studies found that neural tube defects have decreased by an average of 26% since folic acid fortification started (Williams et al, Teratology66: 33–39, 2002; Honein et al, J Am Med Assoc 285: 2981–2986, 2001 ).
What About Congenital Heart Defects Prevention?
With 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?
The 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 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.