Folic acid Awareness
National Folic Acid Awareness Week was observed from January 3rd – January 6th. I propose “folate” awareness and you’ll see why as you read on. Of the many micronutrients that we know about, folic acid is the only one that claims any space on the National Health Observances calendar. It’s with good reason we find folic acid on the calendar. Without adequate maternal consumption of folic acid, portions of the neural tube may fail to fuse during embryonic development. This can happen anywhere from the brain to the bottom of the spinal cord. You can think of the neural tube as the bony and soft tissue structures that surround and protect the delicate spinal cord. These neural tube defects (NTDs), with spina bifida being the most prevalent, are felt to be reduced by 50 percent with adequate folic acid intake.1 The US Public Health Service recommends that all women, capable of pregnancy take 400mcg of folic acid each day.1 The Institute of Medicine (IOM) Food and Nutrition Board’s recommended dietary allowance (RDA) for pregnant women is 600mcg.2 But the importance of proper folate status goes beyond preventing congenital anomalies such as NTDs. Folate is crucial for proper cell replication and division, prevention of a form of anemia called megaloblastic anemia, which is associated with oversized and fewer red blood cells, fatigue and shortness of breath if left untreated. My focus here is folate’s valuable role in cardiovascular health.
Cardiovascular Health and Folate
Low dietary folate intake is a known risk factor for vascular disease.3 Diets rich in folate have been linked to decreased rates of heart attacks, stroke and coronary artery disease.3 Further, a ten-year study following nearly 2,000 men found that those consuming the most dietary folate had a 55 percent reduced rate of heart attacks compared to those who consumed the least amount of folate.4 Folic acid research has shown it improves specific measurable end points. One being the thickness of the innermost lining of the vascular system. Ultrasound measurement of the carotid intima-media thickness (CIMT) is a predictor of early cardiovascular disease and cardiac events. The effect of folic acid was analyzed from ten randomized trials showing a reduction in CIMT.5 Another endpoint found improved with folic acid is endothelial function. The endothelium can be described as cells which line the vascular system. Under healthy conditions these cells are flexible enough to promote arterial dilation, proper immune regulation, and balance electrolytes within the vascular space. In the diseased state the endothelium becomes stiff and less able to dilate, is inflamed, and unable to properly control electrolytes. Not only is endothelial dysfunction characteristic of cardiovascular disease but, as so has contributed to some of the earliest changes that occur in cardiovascular disease. Folic acid in higher doses has been associated with improvements in endothelia functioning in individuals with and without cardiovascular disease.6
Forms of folate and Genetics
Folate is the umbrella term for a group of compounds having the properties of folic acid. Folic acid is the synthetic derivation used to fortify processed foods and in standard supplements. Other synthetic forms include folinic acid and levomefolic acid. The synthetic forms have no biological activity until they are converted into folates in the body. Folate is the active form that naturally occurs in foods. Folate’s synthetic counterpart is more absorbable than dietary folates but requires a two-step activation process in the body. Up to 32 percent of people in some populations have inherited a double mutation in the gene for the five, ten-methylenetetrahydrofolate reductase (MTHFR) enzyme. MTHFR is the enzyme that allows an important step in activation possible. This enzyme encourages the conversion of one biologically active form of folate to another. Both forms are critical but the second is associated with the cardiovascular benefits associated with folate. Individuals with double mutations in the MTHFR gene can have as much as a 65 percent reduction in functioning of the MTHFR enzyme. This common mutation is associated with reduced red blood cell folate levels. It is also associated with increased levels of homocysteine, the cardiovascular toxic metabolite of inappropriate metabolism of the amino acid methionine. Folate supplementation is known to reduce homocysteine in individuals with and without MTHFR mutations.8 Here is where you’ll find folate.
Green leafy vegetables, salad greens, and spinach are excellent sources of folate. However, vegetables stored at room temperature lose much of their folate. Cooking them drastically lowers the amount of available folate also. Of all foods, chicken liver tops the list. Other dietary sources are brewer’s yeast, lentils, black-eyed peas, chickpeas, and citrus. Fortified grains and cereals contain variable amounts of synthetic folic acid.
Supplementing with Folate
The typical form of folate found in single nutrient and vitamin compounds is folic acid. Currently the adult RDA for folic acid is 200mcg a day. For pregnancy, or women capable of becoming pregnant, it’s 400mcg. There is concern that the RDA may not meet the daily folate requirements of individuals with MTHFR mutations. Fortunately, the active folate is increasingly found in supplement products and may serve to compensate individuals with the not-uncommon MTHFR mutation. Individuals with MTHFR mutations are ideal candidates for active folate supplementation but side effects such as anxiety, insomnia, and nausea may occur with improper dosing. Since most persons carrying the MTHFR mutation do so unwittingly, anyone who begins a folate regimen should dose low, go slow, and take it in combination with other B-vitamins to minimize side effects.
- Pediatrics Folic Acid for the Prevention of Neural Tube Defects: August 1999, Volume 104 / issue 2
- Institute of Medicine. Dietary reference intakes: folate, other B vitamins, and choline. In: Dietary Reference Intakes for Thiamin, Riboflavin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998:(8)32
- McNeil CJ, Beattie JH, Gordon MJ, Pirie LP, Duthie SJ. Nutritional B vitamin deficiency disrupts lipid metabolism causing accumulation of proatherogenic lipoproteins in the aorta adventitia of ApoE null mice. Mol Nutr Food Res. 2012;56(7):1122-1130. (PubMed)
- Voutilainen S, Rissanen TH, Virtanen J, Lakka TA, Salonen JT. Low dietary folate intake is associated with an excess incidence of acute coronary events: The Kuopio Ischemic Heart Disease Risk Factor Study. Circulation. 2001;103(22):2674-2680. (PubMed)
- Qin X, Xu M, Zhang Y, et al. Effect of folic acid supplementation on the progression of carotid intima-media thickness: a meta-analysis of randomized controlled trials. Atherosclerosis. 2012;222(2):307-313. (PubMed)
- de Bree A, van Mierlo LA, Draijer R. Folic acid improves vascular reactivity in humans: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2007;86(3):610-617. (PubMed)
- Higdon, Jane et al. Linus Pauling Institute Micronutrient Information Center; Oregon State University, 2014 http://lpi.oregonstate.edu/mic/vitamins/folate. Dec. 23, 2016
- Homocysteine Lowering Trialists’ Collaboration. Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. Am J Clin Nutr. 2005;82(4):806-812. (PubMed)
Wiki ya Kitaifa ya Uhamasishaji wa Asidi ya Foliki (National Folic Acid Awareness Week) ilianzishwa mnamo Januari 3, 2016 na inaadhimishwa kila mwaka. Mimi kupendekeza <unk>folate<unk> ufahamu na utaona kwa nini kama wewe kusoma juu. Kati ya micronutrients nyingi ambazo zinajulikana, asidi ya foliki ni moja tu ambayo inadai nafasi yoyote kwenye kalenda ya Ufuatiliaji wa Afya ya Kitaifa. Ni kwa sababu nzuri tunapata asidi ya foliki kwenye kalenda. Bila matumizi ya kutosha ya asidi ya foliki ya mama, sehemu za bomba la neva zinaweza kushindwa kuunganishwa wakati wa ukuzi wa kiinitete. Hii inaweza kutokea mahali popote kutoka ubongo hadi chini ya uti wa mgongo. Tubu ya neva ni sehemu ya mifupa na tishu laini inayozunguka na kulinda uti wa mgongo. Ugonjwa wa spina bifida (NTD) ni ugonjwa wa kawaida wa utumbo ambao unashuka kwa asilimia 50 kwa kutumia asidi ya foliki, na kwa wanawake wenye uwezo wa kupata mimba, inashauriwa kuchukua asidi ya foliki kwa kila siku kwa kiasi cha 400mg kwa siku. Foliate ni muhimu kwa ajili ya replication sahihi ya seli na mgawanyiko, kuzuia aina ya anemia aitwaye megaloblastic anemia, ambayo ni kuhusishwa na kubwa na chache nyekundu seli za damu, uchovu na upungufu wa pumzi kama kushoto untreated. Mtazamo wangu hapa ni folate's thamani ya jukumu katika afya ya moyo na mishipa ya damu. Kwa sababu ya matumizi ya folate katika chakula, watu wengi hupata matatizo ya moyo, ugonjwa wa moyo, na ugonjwa wa mishipa ya damu, na utafiti uliofanywa kwa miaka kumi uliofuata wanaume 2,000 uligundua kwamba wale wanaotumia folate zaidi walikuwa na kiwango cha chini cha 55 cha mshtuko wa moyo ikilinganishwa na wale wanaotumia folate kidogo. Moja ni unene wa utando wa ndani zaidi wa mfumo wa mishipa ya damu. Ultrasound ya intima-media carotene (CIMT) ni dalili ya ugonjwa wa moyo na mishipa ya damu. Matokeo ya asidi ya foliki yaligunduliwa kutoka kwa majaribio kumi ya nasibu, na kuonesha kupunguzwa kwa CIMT, na matokeo mengine yaligunduliwa kuwa yaliboreshwa na asidi ya foliki: kazi ya endothelial. Endothelium inaweza kuelezwa kama seli ambazo line mfumo wa mishipa. Chini ya hali nzuri chembe hizi ni rahisi kutosha kukuza upanuzi wa mishipa ya damu, udhibiti sahihi wa kinga, na usawa wa electrolytes ndani ya nafasi ya mishipa ya damu. Katika hali ya ugonjwa endothelium inakuwa ngumu na haiwezi kupanuka, ni mchochota, na haiwezi kudhibiti vizuri electrolytes. Endothelial dysfunction ni moja ya dalili za ugonjwa wa moyo na mishipa ya damu, na pia ni moja ya sababu za kuibuka kwa ugonjwa wa moyo na mishipa ya damu. Asidi ya foliki katika kipimo cha juu imehusishwa na uboreshaji wa utendaji wa endothelium katika watu walio na na bila ugonjwa wa moyo na mishipa. Asidi ya foliki ni derivative synthetic kutumika kuimarisha vyakula kusindika na katika virutubisho kawaida. Aina nyingine za synthetic ni pamoja na asidi folinic na asidi levomefolic. Aina hizo za synthetic hazina utendaji wa kibiolojia mpaka zitakapobadilishwa kuwa folati mwilini. Foliati ni aina yenye nguvu inayopatikana kwa asili katika vyakula. Folate's synthetic counterpart is more absorbable than dietary folates but requires a two-step activation process in the body. Folate's synthetic counterpart is more absorbable than dietary folates but requires a two-step activation process in the body. Kwa mfano, asilimia 32 ya watu katika baadhi ya jamii za watu wana mutation mbili katika jeni ya enzyme ya methylenetetrahydrofolate reductase (MTHFR). MTHFR ni enzyme ambayo inawezesha hatua muhimu katika uanzishaji. Enzyme hii huchochea kubadilishwa kwa aina moja ya folati yenye utendaji wa kibiolojia kuwa nyingine. Aina zote mbili ni muhimu lakini ya pili inahusishwa na faida za moyo na mishipa inayohusiana na folati. Watu walio na mabadiliko mawili katika jeni la MTHFR wanaweza kuwa na upungufu wa asilimia 65 katika utendaji wa enzyme ya MTHFR. Mabadiliko haya ya kawaida huhusianishwa na kupunguzwa kwa viwango vya folati katika chembe nyekundu za damu. Pia inahusishwa na kuongezeka kwa viwango vya homocysteine, metabolite ya sumu ya moyo wa damu ya kimetaboliki isiyofaa ya amino asidi methionine. Foliate supplementation ni inayojulikana kupunguza homocysteine katika watu na bila MTHFR mutations.8 Hapa ni ambapo utapata folate. Mboga zenye majani ya kijani kibichi, mboga za saladi, na mchuzi ni vyanzo bora vya folati. Hata hivyo, mboga zilizohifadhiwa katika joto la chumba hupoteza folati nyingi. Kupika kwa mchuzi huo hupunguza sana kiasi cha folati inayopatikana. Kati ya vyakula vyote, ini la kuku ndilo la kwanza kwenye orodha hiyo. Vyanzo vingine vya chakula ni chachu ya bia, lentils, black-eyed peas, chickpeas, na machungwa. Mbegu na nafaka zilizotengenezwa kwa nguvu zina kiasi tofauti cha asidi ya foliki ya synthetic. Fomu ya kawaida ya folate inayopatikana katika virutubisho vya virutubisho na vitamini ni asidi foliki. Kwa sasa, RDA ya watu wazima kwa asidi ya foliki ni 200mg kwa siku. Kwa wanawake wajawazito au wanawake wanaoweza kupata mimba, ni 400mcg. Kuna wasiwasi kwamba RDA inaweza kukidhi mahitaji ya folate ya kila siku ya watu wenye mabadiliko ya MTHFR. Kwa bahati nzuri, folate hai hupatikana zaidi katika bidhaa za ziada na inaweza kutumika kulipia watu wenye mabadiliko ya kawaida ya MTHFR. Watu wenye mabadiliko ya MTHFR ni wagombea bora kwa ajili ya ziada ya folate hai lakini athari za upande kama vile wasiwasi, insomnia, na kichefuchefu inaweza kutokea na dosing sahihi. Kwa kuwa watu wengi wanaobeba mabadiliko ya MTHFR hufanya hivyo bila kujua, mtu yeyote anayeanza kutumia folate anapaswa kuchukua kiasi kidogo, polepole, na kuichukua pamoja na vitamini vingine vya B ili kupunguza athari za upande. "Pediatrics: Folic Acid for the Prevention of Neural Tube Defects: August 1999, Volume 104 Issue 2 - Institute of Medicine, ""Uchunguzi wa Matibabu ya Watoto: Matokeo ya Matibabu ya Watoto""" Vyakula vinavyopendekezwa: folati, vitamini vingine vya kikundi cha B, na kolini. Kwa mfano, kwa ajili ya chakula cha kawaida, inapaswa kuwa na kiasi cha kiasi cha thiamine, riboflavin, vitamini B6, folate, vitamini B12, asidi ya pantothenic, biotin, na choline. "Mwaka wa 1998: ""Maktaba ya Kimataifa ya Kimataifa"" (Maktaba ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa ya Kimataifa)." Upungufu wa vitamini B katika lishe huzuia kimetaboliki ya lipidi na kusababisha mkusanyiko wa lipoproteini za proatherogenic katika aorta adventitia ya panya wa ApoE null. Molr Chakula Res. 2012;56(7):1122-1130. (PubMed) - Voutilainen S, Rissanen TH, Virtanen J, Lakka TA, Salonen JT. Utoaji wa folati ya chini ya lishe unahusishwa na matukio ya ziada ya matukio ya moyo mkali: Utafiti wa Kuopio Ischemic Heart Disease Risk Factor. Mzunguko wa damu. 2001;103(22):2674-2680. (PubMed) - Qin X, Xu M, Zhang Y, et al. Athari ya kuongeza asidi ya foliki juu ya maendeleo ya carotidi intima-media unene: meta-uchambuzi wa majaribio randomized kudhibitiwa. Ugonjwa wa atherosclerosis. 2012;222(2):307-313. De Bree, Van Mierlo, Dreyer, R. Asidi ya foliki inaboresha athari za mishipa ya damu kwa wanadamu: uchambuzi wa meta wa majaribio ya kudhibitiwa ya nasibu. Mimi ni J Clin Nutr. 2007;86 (3):610-617. (PubMed) - Higdon, Jane et al. Linus Pauling Institute Micronutrient Information Center, Chuo Kikuu cha Jimbo la Oregon, 2014 "Kama ilivyoelezwa hapo juu, ""Homocysteine Lowering Trialists"" ni utafiti wa kwanza uliofanywa na utafiti wa utafiti wa homocysteine." Athari za kutegemea kipimo cha asidi ya foliki kwenye viwango vya damu vya homocysteine: uchambuzi wa meta wa majaribio ya nasibu. Mimi ni J Clin Nutr. 2005;82 (4):806-812. (PubMed)