Folic Acid: The Janus-Vitamin

31. July 2009

People not eating enough vegetables easily can get their vitamin B9, better known as folic acid, as a pill or directly as a food additive. It then reliably reduces the risk of birth defects. But it also increases the number of cancer cells.

Actually everything seemed to amount to one of those wonderful success stories. Just like fluor in the toothpaste saves the teeth, folic acid in flour, noodles and salt became the guardian angel of all pregnant women. In a society more and more preferring chili in a can and a curry wurst at the little place on the corner from an elaborate vegetable cuisine, the vitamin B fortification of food helps prevent from birth defects. After about ten years of experience in enriching food in Canada, the New England Journal of Medicine 2007 declared a drop in neural-tube defects by about 5 percent. A Hungarian study even musters 90 percent with multivitamin pills. This data has convinced 67 states so far to add folic acid to their staple foods.

But all of a sudden bad news becloud the sun over this radiant showpiece of governmental healthcare. A few years ago epidemiologists noticed that in those countries where a fortification was made mandatory, the cancer rate increased as well. Not long ago in the Eighties, the opposite appeared to be true. Back then scientists were convinced that the “wonder-vitamin” prevented cancer.

Leafy vegetables such as spinach, field salad or also broccoli contain larger quantities of the vitamin. German dieticians recommend 0.4 milligrams per day, pregnant women are welcome to take a double especially during the first couple of weeks of pregnancy. But whoever takes a look at the nutritional balance of the average German finds less than 300 micrograms there. That is not enough for the first few weeks of a pregnancy. The consequence: An increased risk for spina bifida, anencephaly or heart defect for the baby.

Higher cancer rate instead of prevention

In June 2007, the Journal of the American Medical Association (JAMA) published an article by Bernard Cole and his colleagues of the Polyp Prevention Study Group reporting that the administration of one milligram folic acid per day increased the risk of a colorectal adenoma by about 10 percent, the one for an according lesion even by 30 to 60 percent depending on the follow-up. The results startled all those who thought up to now that taking additional vitamins as a food supplement cannot do any harm.

And it got even worse: This spring, Jane Figueiredo of the Los Angeles University published an analysis of an earlier study on folic acid supplements. “Relative Risk = 1.63″ is the prognosis for a prostate carcinoma in men taking additional folic acid. For the last 20 years, I’ve been publishing papers and doing research that demonstrates that if you don’t get enough folate, you have a higher risk for several types of cancer,” said Joel B. Mason, professor of nutrition science and policy at Tufts University in Boston. “More recently, what has emerged is that it’s not as simple of a relationship as we thought.” Because the rate of colon cancer significantly increased since the folic acid fortification in Chile as well.

Key to the tumor cell

As far back as the 1940s, folic acid supplements were found to accelerate leukemia in children. A report by a working group in Freiburg/Germany in the Anticancer Research shows that folate receptors are overexpressed in human ovarian carcinoma tissue. And finally folic acid might serve as a key for active ingredients to channel them into tumor cells – Freiburg scientists are working on that as well. The vitamin plays an indispensable role in the body regarding DNA synthesis and methylation reactions of DNA and amino acids. If the metabolism lacks folate it installs uracil instead of thymine in the DNA. Natural folate taken with regular food consists of a mixture of mono- and polyglutamate forms while the synthetic product has only one remain of glutamine acid. Test persons getting a lot of folate with their food even have a decreased risk for colon- and prostate cancer according to studies. So it might be the unmetabolized monoglutamates circling in the blood and perhaps causing damage as Joel Mason and John Mathers at the Newcastle University speculate.

But despite all worries about cancer risks, we should not forget the benefits of an extra portion of folic acid for pregnant women. A large study just recently confirmed that the number of congenital heart defects in Canada has declined considerably – by about six percent each year. Even intensive campaigns against a lack of folate reached only a third of all women wanting a child before. As DocCheck learned during an interview with Anke Weißenborn of the Bundesinstitut für Risikobewertung (Federal Institute for Risk Assessment), the causal correlation between cancer rate and folic acid fortification has not been all cleared yet. But for now an obligatory fortification of food without a quantity control of synthetic folate which ends up on the table of the consumer might be arguable.

Folic acid seems to take a similar way like the betacarotine. Because here two studies showed that a high-dose therapy with the provitamin A does not lead to less cancer cases but on the contrary causes an increase of the rate. On the websites of the Arbeitskreis Folsäure (working group folic acid) you will find information about the folic acid contents of many kinds of food. If you want to keep out of harm’s way – threatening your body with just a little over one milligram of additional folic acid – just eat more spinach, fennel or peas instead of multivitamin pills.

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