In the last several months, I’ve devoted considerable column space and radio air time to publicizing the need for expectant mothers—indeed, for all married women of child-bearing age as well as soon-to-be married women—to adopt lifestyle behaviors that increase their chances of having a healthy baby. Eating a balanced diet rich in nutrients that have been clinically proven to promote optimal fetal development is at the top of that list. Because most women don’t get enough of these vitamins, minerals and essential fatty acids through the foods they consume, supplementation is generally appropriate and necessary.
Folic acid and B12 in particular have received a lot of attention from the scientific community in recent years.
Folic Acid: What, Why, and When
Folic acid is the synthetic form of the B-group vitamin folate, which is vital for a wide range of enzymatic reactions that promote normal fetal growth and development. Important studies have shown that folic acid significantly reduces the risk of a baby being born with neural tube (brain and spinal cord) defects (NTDs), such as spina bifida and anencephaly. Preliminary studies also suggest that folic acid may decrease the risk of other birth defects, including congenital heart defects and cleft lip/ cleft palate, and lower the risk of pre-term delivery.
Since NTDs and certain other defects usually occur during the first month of gestation, experts believe it is crucial for women to begin a folic acid regimen even before they are expecting. Along these lines, the Mayo Clinic and others recommend that women start taking folic acid at least one month before pregnancy, while the Hospital for Sick Children recommends three months. To decrease the risk of pre-term delivery, some experts recommend starting a year before.
In my own practice, I recommend that young women begin taking 800 mcg of folic acid in an iron-free multivitamin when they start seminary and continue the regimen throughout their childbearing years. (Since most multi-vitamins contain iron –which should be avoided, except in cases of anemia—Nutri-Supreme has formulated a special iron-free multi-vitamin with 800 mcg of folic acid and 200 mcg of B12. According to a National Institute of Health-sponsored study, children born to women with low B12 have a two to three times greater risk of NTDs.)
Women who have already had a baby with an NTD, are usually advised to take more than the generally recommended 600 to 800 mcg of folic acid. But since not all women metabolize folic acid in the same way, it is important to be aware of other exceptions to the general dosage recommendations.
A GPS for the Road to Fetal Health
Scientific research is now beginning to reveal that gene mutations in the folate metabolism pathway (a series of genes that regulates folic acid metabolism) can affect how well the body processes folic acid. If that biologic process is not coordinated properly in the early weeks of gestation, a possible neural tube defect may result in the embryo.
I like to use the example of a GPS to explain this breakdown in the metabolism process: If there is a blockage along the road to a destination, even the best GPS instructions won’t help us get there. Similarly, if the folate pathway is compromised, the folic acid can’t get to where it needs to be in order to do its job properly.
A common genetic variation that’s been shown to interfere with folic acid metabolism is known as MTHFR C677T. (The C677T designation means that the MTHFR gene mutation was passed down by both parents.). This mutation, which researchers estimate affects approximately 25 to 50 percent of the population, is also associated with increased miscarriage risk.
People with MTHFR gene mutations are more likely to have high-homocysteine levels—though not everyone with high homocysteine levels has the MTHFR gene variant. High homocysteine, which can result from a folic acid or B12 deficiency, has itself been correlated with an increased risk of birth defects and miscarriage.
For women who fall into the high homocysteine and/or MTHFR categories, simply upping the folic acid dosage is generally not the answer. (Indeed many doctors feel that taking more than 1000 mcg of folic acid is an inadvisable and even potentially risky practice.) Rather, they should take a different form of folic acid known as L-methyl folate. (Nutri-Supreme’s Methyl Folate and Methyl Folate with B12 and B6 are the only standalone Methyl Folate supplements on the heimishe kosher market.)
Every day, science reveals new ways to help ensure healthy pregnancies and lower the risk of birth defects. But given all the studies already linking folic acid and B12 deficiencies with NTDs and other birth defects, is there anything we can do right now to further that goal?
In my view, there is a lot to gain—and much potential heartbreak to avoid—by making simple blood screenings for homocysteine, folic acid, B12 and glutathione “standard procedure” for any young woman beginning the pre-pregnancy vitamin regimen, especially those with a family history of birth defects. (Note: Low glutathione levels can be a marker for oxidative stress, which can play a role in increasing the risk of miscarriage and birth defects.)
I am hardly alone in this opinion: In a conversation I had with Dr. Jill James, a well-known researcher for the Arkansas Center for Birth Defects and Prevention, she commented that with homocysteine testing so readily available, there’s no reason women should not be making it part of their pre-natal regimens today.
Eliezer Gruber, Certified Nutritionist, is the founder of Nutri-Supreme Research. His radio show Healthy Living can be heard live on 97.5 FM JRoute Radio or by calling 712.432.4217 each Thursday at 12:00 p.m. He can be reached at 888.68-Nutri.
By Eliezer Gruber