At the urging of groups like the March of Dimes, who seek to reduce the incidence of birth defects in the United States, the FDA last month issued approval for manufacturers to enrich corn masa flour with folic acid. (After much discussion and contention, the FDA mandated in the 1990’s that wheat flour be enriched with folic acid.[i])
The specific goal of those advocating folic acid enrichment is to reduce a specific class of birth defects known as “neural tube birth defects,” those defects arising from malformation of the brain, spine, or spinal cord. Neural tube birth defects include spina bifida, anencephaly, and cleft palates, and are a class of birth defects that are most strongly linked to a deficiency in dietary folate (not folic acid; I’ll explain that in a moment).
The logic here is that corn mesa flour is an increasingly prevalent staple of the American diet and enriching it will further reduce birth defects, especially among the Hispanic population.
There are times when public medical policy is based upon what is expedient, not what is ideal. I think this is one such example and I’m troubled and conflicted by it.
On one hand, who doesn’t want to reduce birth defects? Birth defects, especially neural tube defects are heartbreaking, crippling, and even fatal. Only a heartless ogre would say, “Nah, I’m not interested in reducing birth defects!”
What troubles me is not the goal, it’s the use of folic acid to get there. Folic acid, you see, is a synthetic folate that is unusable by the human body. Folic acid must be converted by the body into folate before it is biologically useable.
Folic acid that is not converted is unusable and, research is showing, is harmful:
One animal study showed that rats given excess folic acid during pregnancy gave birth to offspring that exhibited metabolic dysfunctions, including insulin resistance and obesity.[ii] Additionally, human studies show that excess folic acid increases the incidence of asthma in offspring.[iii] Other studies show that folic acid taken at just two times the recommended amount during pregnancy promotes the growth of existing pre-cancerous or cancerous cells in the mammary glands of rats. Clearly, animal and human studies are giving reason to believe that synthetic folic acid can be harmful if taken even to slight excess during pregnancy.
In the words of one of the folic acid researchers, Professor Elisa Keating, “our study shows that it is possible to have too much of a good thing…the search for a safe upper dose of folic acid is urgently needed.”
Note that the researchers are talking about folic acid, not about folates. It’s impossible to “overdose” on green vegetables and ingest too much folate. Folates are naturally occurring, easily metabolized, and safe at any realistically possible intake. Folic acid, on the other hand, is artificial, must be converted in the body, and is not safe when taken to excess.
Complicating the discussion of safe folic acid intake is the genetic variability between individuals when metabolizing folic acid into folate. This conversion is dependent upon an enzyme that our body produces and, depending upon one’s genetic variability, one can convert folic acid to folates rather easily or rather poorly.[iv] As many as 50% of people in the world today have a variation that makes folic acid conversion less efficient, making harmful buildup of folic acid more likely. Those most likely to have the variation that most impedes folic acid conversion are those of Italian and of Hispanic descent.
As I’ve advocated many times before, from inflammatory response to blood glucose elevation to the presence of agents like glyphosate, there are plenty of reasons to avoid grains altogether, especially wheat and corn. With the enrichment of corn masa flour with folic acid, however, there’s now one more reason to avoid corn. The better way to get one’s folates is to avoid folic acid altogether and eat naturally occurring, green leafy vegetables that contain natural folates.
Therein lies the expediency of the folic acid enrichment policy. Is it reasonable to say to the public, “Just get all your folates from green vegetables? Don’t eat corn or wheat at all.” How many will follow such advice? I can promise you that very few will. Our nation’s rates of obesity, inflammatory disease, heart disease, and diabetes are a testament to that. And without the dietary enrichment of folic acid, the birth defect penalty will be exacted upon those without a voice in the matter: the child in the womb.
So, I guess my opinion boils down to this: if you’re pregnant and insist upon eating grains, it’s probably better that your grains have some folic acid in them than not. Do not, however, tell yourself that you’re doing anything optimal. You’re just doing something marginally less harmful. Much the same as if you tried to convince yourself that smoking filtered cigarettes is good for your baby because it’s much better than smoking unfiltered ones.
[iv] The variability in folic acid metabolism is centered on the MTHFR gene. Those with the most serious conversion impairment are advised to avoid folic acid altogether. The MTHFR variability, or mutation as some call it, is a topic worthy of a much larger discussion. If you’re interested in learning more, I suggest you start at mthfr.net.