Cdc: Mthfr Carriers Should Take Folic Acid When Pregnant
The most common mutation in the MTHFR gene is a C< T allele switch from the wild-type 677CC. MTHFR C677T is a very common variant, with 30% of the population carrying at least one copy.
Those with the wild-type of the MTHFR gene have uninhibited MTHFR enzyme activity, so they are likely to process folic acid into 5-MTHF very efficiently. If you carry two abnormal copies of this gene , MTHFR enzyme activity is decreased by around 65%. For heterozygous 677CT individuals, theres a loss of activity estimated at 30%. Another variant , may reduce MTHFR activity by about 32% compared to the wild-type of the gene.6789
Fortunately, there are some good ways to support adequate folate status even if you have an MTHFR mutation. These include:
- Increasing your intake of folate-rich foods
- Reducing inhibitors of folate status, such as alcohol consumption.
Interestingly, results from short-term studies found that people with MTHFR mutations have a detectable and significant increase in levels of circulating un-metabolized folic acid when taking a folic acid supplement. 101112
However, longer studies show that levels of un-metabolized folic acid start to drop with time, so this may not be a concern.13 This suggests that the body may increase folic acid metabolism and decrease levels of circulating un-metabolized folic acid. This is food for thought for anyone beginning a high dose of folic acid just prior to conception.
More from the CDC on this issue:
What Does A Diet Rich In Food Folate Look Like
When I created the meal plans in Real Food for Pregnancy, providing ample folate was one of the top considerations. The nice thing about a real food diet is that its not very hard to meet folate needs from food. All of my meal plans exceed the recommended dietary allowance for pregnancy of 600 mcg per day they even outperform the conventional prenatal meal plans that rely on fortified foods. You can see a sample meal plan alongside a nutritional breakdown in the first chapter, which I give away free here on my site .
A few examples of food folate-rich meals and snacks:
- Snap peas or broccoli with hummus
- Eggs and sauteed spinach
- Split pea soup
I could go on and on
Vegetarian Vegan And Special Diets In Pregnancy
A varied and balanced vegetarian diet should provide enough nutrients for you and your baby during pregnancy.
But you might find it more difficult to get enough iron and vitamin B12.
Talk to a midwife or doctor about how to make sure you’re getting enough of these important nutrients.
If you’re vegan or you follow a restricted diet because of a food intolerance or for religious reasons, talk to a midwife or GP.
Ask to be referred to a dietitian for advice on how to make sure you’re getting all the nutrients you need for you and your baby.
Find out more about healthy eating if you’re pregnant and vegetarian or vegan.
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What Foods Contain Folic Acid
Folic acid is added to foods that are refined or processed :
- Breakfast cereals
- Breads and pasta
- White rice
Since 1998, the Food and Drug Administration has required food manufacturers to add folic acid to processed breads, cereals, flours, cornmeal, pastas, rice, and other grains.9 For other foods, check the Nutrition Facts label on the package to see if it has folic acid. The label will also tell you how much folic acid is in each serving. Sometimes, the label will say “folate” instead of folic acid.
Can We Increase Folate Intake
Folate is found naturally in green leafy vegetables , citrus fruits and juices, wholemeal bread and legumes. Animal liver is also a rich source of folate. However, it is difficult to get enough folate from natural sources to reduce the risk of a NTD affected pregnancy.
For example, if women relied on green leafy vegetables and fruit to increase their folate intake, they would have to eat the equivalent of 500 g of raw spinach or 900 g of boiled spinach or raw broccoli daily to get the amount needed to reduce the risk of having a baby with a neural tube defect.
Further information on eating well for pregnancy can be found the Health Education resource Eating for Healthy Pregnant Women or your local public health unit.
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Why Do Mthfr Variations Matter
Estimates are that 40-60% of the population has at least one MTHFR polymorphism, which means that roughly HALF the population has an impaired ability to use synthetic folic acid.
This creates a major problem if were relying on fortified foods or supplements that have high levels of folic acid, particularly if the rest of our diet is low in food folate.
Thanks in large part to the work of Dr. Ben Lynch, more people are aware of this issue and are actively steering away from the cheap folic acid that dominates the multivitamin/prenatal vitamin world .
Instead, they are using more metabolically active forms of folate, such as methylfolate and folinic acid when supplementing. More people are also emphasizing real food folate.
To be clear: Those of us with MTHFR variations need metabolically active versions of folate. Our bodies have trouble processing synthetic folic acid.
Is 1000 Mcg Of Folic Acid Too Much
Women are unlikely to suffer from excessive folic acid intake. We dont know of a dangerous amount. Still, it makes no sense for most women to consume more than 1,000 mcg of folic acid per day. Unless their doctor advises them to take more, most women should limit the amount they take to 1,000 mcg per day.
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Recommended Folate Intakes For Women Of Childbearing Age
Folate requirements have been set mainly based on the amount of dietary folate equivalents Footnote 2 needed to maintain normal red blood cell concentrations . The Recommended Dietary Allowance Footnote 3 for women of childbearing age is 400 mcg DFEs . In addition to dietary folate intake from a varied diet, all women who can become pregnant should take a multivitaminFootnote 4 containing 400 mcg of folic acid every day. This reduces the risk of neural tube defects .
Does Folate Help With Ivf
If a woman is undergoing IVF, I recommend that she take over 800 mcg of supplemental folate. This is based off of a study suggesting a relationship between supplementation of certain micronutrients and higher chance of IVF success. One of these micronutrients is folic acid and taking in at least 833 mcg appears to offer some benefit. In addition, there is evidence demonstrating that high folate supplementation might protect against the adverse reproductive consequences of traffic-related air pollution.
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Are Some Women At Risk For Not Getting Enough Folic Acid
Yes, certain groups of women do not get enough folic acid each day.4
- Women who can get pregnant need more folic acid .2
- Nearly one in three African-American women does not get enough folic acid each day.
- Spanish-speaking Mexican-American women often do not get enough folic acid. However, Mexican-Americans who speak English usually get enough folic acid.5
What Are The Benefits Of Folic Acid
Without enough folic acid in your body, your baby’s neural tube may not close correctly and they could develop health problems called neural tube defects. These include:
- Spina bifida: incomplete development of the spinal cord or the vertebrae
- Anencephaly: incomplete development of major parts of the brain
Babies with anencephaly usually do not live long, and those with spina bifida may be permanently disabled. These are scary problems, to say the least. But the good news is that getting enough folic acid may protect your baby from neural tube defects by at least 50%. According to the CDC, if you’ve already had a baby with a neural tube defect, getting enough folic acid may reduce your risk of having another child with a neural tube defect by as much as 70%. If you have had a previous child with a neural tube defect, tit is recommended that you increase your daily amount of folic acid to 4000 mcg each day. Check with your doctor about how much you should take.
When taken before and during pregnancy, folic acid may also protect your baby against:
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Foods In Australia That Are Fortified With Folic Acid
Folic acid is the man-made form of folate that is added to lots of other foods that dont have any folate. Since October 2009, all wheat flour used for bread making in Australia must contain folic acid. This means that most bread sold in Australia is fortified with folic acid. This is in line with the Food Standards Australia New Zealand mandatory folic acid fortification standard. This standard was introduced to help reduce the number of neural tube defects.Breakfast cereals and fruit juices for sale in Australia may also have added folic acid.
What Are The Health Benefits Of Taking Folic Acid During Pregnancy
Approximately 3,000 babies are born with neural tube defects in the United States each year. Normally, the neural tube develops into the spinal cord and brain by 28 days after conception.
If the neural tube doesnt close properly, neural tube defects occur. Anencephaly is a condition in which the brain doesnt develop properly. Babies born with anencephaly cannot survive.
Babies born with spina bifida or encephalocele may face multiple surgeries, paralysis, and long-term disability.
According to a
Research also shows folic acid supplementation in early pregnancy may help prevent cleft lip and cleft palate.
These birth defects occur if parts of the mouth and lip do not merge together properly during the first 6 to 10 weeks of pregnancy. One or more surgeries are usually needed to correct the condition.
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What Do Other Countries Do
Mandatory fortification with folic acid
- USA has had mandatory fortification of all cereal/grain flours with folic acid since 1998.
- Canada white flour and pasta has been mandatorily fortified since 1998.
- Chile introduced mandatory fortification of flour in 2000.
- Australia introduced mandatory fortification of non-organic bread-making wheat flour in late 2009.
Food Standards Australia New Zealand develops food standards for both New Zealand and Australia.
Voluntary fortification with folic acid
- European countries to date, none have introduced mandatory fortification with folic acid.
- UK and Ireland continue to permit voluntary fortification of certain foods with folic acid.
Recommendations for women planning a pregnancy
USA, Canada, Australia, UK and Ireland recommend women planning a pregnancy take a folic acid tablet in the range of 400500 µg for women at low risk of a NTD affected pregnancy.
How Folate Helps Prevent Neural Tube Defects
Neural tube defects Footnote 6 include spina bifida and anencephaly. They occur when the neural tube fails to close properly during the third and fourth week of pregnancy. Often a woman doesn’t yet know that she is pregnant during this critical time. A decreased risk of NTD is associated with both increased folate intake and higher red blood cell folate concentrations though the experimental evidence is stronger for increased folate intake and NTD risk reduction .
The risk is reduced when women start taking a daily multivitamin containing folic acid three months before the beginning of pregnancy and continuing in early pregnancy while the neural tube is closing Footnote 7 . The reduced risk has been observed in women who took a supplement containing 360 to 800 mcg of folic acid per day, in addition to an intake of 200 to 300 mcg per day of natural folate .
Many studies also show that multivitamins containing folic acid taken in the early weeks of pregnancy are associated with a decreased risk of oral cleft and cardiovascular anomalies . Some evidence also suggests an association with reduced risk of preeclampsia . This is an area of active and on-going research.
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Folate Vs Folic Acid Whats The Difference
Folic acid and folate are not interchangeable terms. Folate is an umbrella term that encompasses several related compounds in the vitamin B group that share a similar structure.
Folic acid is a synthetic form of folate. Folic acid became popular because it is stable in supplement form and can be used to fortify foods. The folate found naturally in food is not stable enough to be used in supplements or for fortification. And, the amount of folate can vary considerably in the diet, making supplements a convenient way to ingest a minimum amount of folate each day.
Can Too Much Folic Acid Hurt My Baby
But even though folic acid is important, taking too much could be problematic. Research is pointing to some possible negative effects of consuming too much folic acid, such as impaired fetal growth, increased risks of childhood diseases like asthma and autism, and promoting the growth of some cancer cells.
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What About The Safety Of Folic Acid During Pregnancy
When it comes to pregnancy, research has shown that prescribing high doses of folic acid to pregnant women results in maternal and cord blood levels of unmetabolized folic acid 5x greater than normal. Many studies have also documented high levels of unmetabolized folic acid in newborn infants, even in areas without mandatory food fortification programs.
Unmetabolized folic acid is a bigger problem in countries who fortify their food supply with folic acid . In one Canadian study, 93% of newborns had detectable unmetabolized folic acid present in their blood .
The high dosage of folic acid supplementation often given in pregnancy is worrisome because it doesnt take much to negatively affect folate metabolism in the body.
Consider this from a 2015 study:
Folic acid intake as little as 280 mcg saturates the capacity of dihydrofolate reductase, which is a critical step in folic acid metabolism and results in its appearance unaltered in the circulation.
The phrase unaltered in the circulation is another way of saying that some of this folic acid does not get utilized by the body, meaning you have unmetabolized folic acid present in your blood.
If you think what Im sharing here is shocking, consider this from a 2015 research paper in the esteemed American Journal of Clinical Nutrition looking at unmetabolized folic acid in cord blood:
What Is Methylfolate
Methylfolate is the form of folate that is active in the body for use. This methylated form of folate is what is required for the body to benefit from folate. Unfortunately, up to 60% of the population carry a gene mutation that does not allow for proper conversion of folic acid to this active form of methylfolate which can lead to folate deficiencies.
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When To Take Folate
Recommendations differ for folate in pregnancy, and its good to start taking folate supplements well before TTC.
If you can, begin taking a good quality prenatal vitamin or folic acid supplement at least a year prior to conception. Research shows that this could reduce your risk of spontaneous pre-term birth by up to 78%.5 For some people, 800 mcg of folic acid per day from fortified foods and supplements is typically sufficient to maintain adequate active folate.
If youre TTC and have no known health risks:
- Eat a diet rich in folate
- Take a folate supplement providing 400-1000 mcg per day for at least 2-3 months prior to becoming pregnant
- Continue this dose throughout pregnancy and while nursing your infant.
If you have a family or personal history of neural tube defects or other high-risk factors:
- Eat folate-rich foods and supplement with 5 mg of folate daily
- Begin taking folate supplements at least 3 months prior to conception
- Continue until 10-12 weeks post-conception
- After the 12th week of pregnancy, take 400 mcg to 1000 mcg daily
- Continue taking 400-1000 mcg while nursing.
How To Take Folic Acid
- If you have bought folic acid tablets because you are planning to have a baby, read the manufacturers printed information on the pack before you start taking the tablets. Make sure you are clear about what dose to take the recommended dose is 400 micrograms once daily. The 5 mg tablet has more than ten times as much folic acid as this. If you have any questions, ask a pharmacist to advise you.
- If you have been prescribed 5 mg folic acid tablets by a doctor, take them exactly as you are told to. Depending upon the reason for which you are taking folic acid, you may be asked to take one tablet every day, or one tablet only on certain days of the week. Try to take your doses at the same time of day each day that you take them, as this will help you to remember to take the tablets regularly. There will be more information about folic acid on the manufacturers printed information leaflet from inside your pack.
- It is not important whether you take folic acid before or after meals.
- If you forget to take a tablet, take it as soon as you remember. If you do not remember until the following day, skip the forgotten dose. Do not take two doses at the same time to make up for a missed dose.
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If You Have An Mthfr Variant Can Taking Folic Acid Help Prevent Ntds In Your Baby
Yes. If you have an MTHFR variant, taking 400 mcg of folic acid every day before and during early pregnancy can help prevent NTDS in your baby.
MTHFR stands for methylenetetrahydrofolate reductase. Its an enzyme that helps your body break down and use folate. One MTHFR variant is a change in your bodys MTHFR gene that makes you use folate more slowly than usual. Genes are parts of your bodys cells that store instructions for how your body grows and works. They are inherited . MTHFR variants are inherited. If you know you have an MTHFR variant or you think it runs in your family, talk to your provider.
Your provider may want to test you for an MTHFR variant if you have high levels of a substance in your blood called homocysteine. Too much homocysteine in your blood can cause heart conditions, blood clots and stroke. You can find out your homocysteine levels with a blood test. If your level is high, you can have a genetic test to see if you have an MTHFR variant. A genetic test looks for changes in genes that can cause birth defects or other medical conditions.
You may have heard not to take folic acid if you have an MTHFR variant because it can increase your risk of pregnancy complications and your baby having health problems. The Centers for Disease Control and Prevention recommends that all women take 400 mcg of folic acid every day before and during early pregnancy. If you have an MTHFR variant, talk to your provider.