Is the supplement industry putting profit and competition before our babies’ health?

This is not a question I want to ask but it’s one that I must.

In my last post, the topic was mainly about the concept of supplement excess. But when it comes to the B vitamin folic acid and pregnancy, either too little or too much can potentially have unwanted effects on babies.

The issue of excess intakes and taking steps to avoid consuming too much folic acid needs to be addressed – but not only by pregnant women or those considering pregnancy and their healthcare providers but also by the makers of prenatal supplements who need to initiate change.

The supplement industry is not required by current regulations to provide the recommended dosage in their products and as a result, there’s a lack of availability of prenatal supplements containing the recommended 400 micrograms folic acid.

Instead many formulations contain 1 milligram (1000 micrograms) which is considered to be the Tolerable Upper Intake Level (UL) from both supplements and fortified foods. So if along with a folic acid supplement you add in a 1 1/4 cup serving of a fortified pasta, with its 320 micrograms folic acid and in a flash, the upper limit has been exceeded with just one food.

But before delving into the issue of excess, the importance of meeting requirements needs to be reinforced. This post is not meant to scare women but its purpose is to create awareness.

For women contemplating pregnancy, who are at a low risk of having a baby with a neural tube defect such as spina bifida, taking a supplement containing 400 micrograms (or 0.4 milligrams) folic acid is critical to the health of their newborn: studies shows a strong protective association between women taking folic acid supplements before becoming pregnant and a decreased risk of their having babies with neural tube defects (NTD) such as spina bifida.

But because pregnancies are not always planned together with many women not heeding this advice, Canada introduced fortification of various flour products with folic acid. Following the initiation of this folic acid fortification of flour products, the incidence of spina bifida fell by over 50% in Canada and other neural tube defects by 1/3.

For those at a higher risk for having babies with these birth defects (a previous birth of a baby affected with NTD, a family history and other health conditions etc.), even higher amounts of folic acid are recommended but this would be done under the care of a healthcare professional.

But for the average woman, a supplement containing 400 micrograms plus a number of servings of folate-rich food each day is enough to meet the daily folic acid /folate recommendations.

First here’s a short folate /folic acid primer. Folate, the natural form of this vitamin, is found in a range of foods including dark leafy greens, citrus fruits, dried peas and beans and peanuts. Folic acid is the synthetic form and is used in vitamin supplements and fortified foods because it’s more easily absorbed.

When it comes to eating folate-rich foods, there are no concerns whatsoever about consuming too much. Folate is handled in a very different manner by the body. But be aware that on packaged food, the Nutrition Facts table lists both folate and folic acid under Folate.

Too much of a good thing?

While the research is preliminary, there may be issues of unintended consequences where women may be taking in excessive amounts. In a paper entitled, Is High Folic Acid Intake a Risk Factor for Autism?—A Review, which was published in the journal Brain Sciences, the authors note that some studies point to a protective effect of folic acid against the development of autism spectrum disorder (ASD), but that others have concluded there is an increased risk for ASD and other negative neurocognitive development outcomes.

They state, “Based on the evidence evaluated, we conclude that caution regarding over supplementing is warranted

Here in Canada, because of the concerns over the potential effects of too much folic acid, a workshop on the issue which included 38 stakeholders from academia, industry, government, and health professional groups was held and their conclusions published in the American Journal of Clinical Nutrition.

They point to some potential negative effects associated with supplemental folic acid intake that researchers are investigating including impaired fetal growth, promotion of cancer, an aggravating interaction with vitamin B-12 deficiency and increased risk of childhood diseases such as asthma and autism.

Workshop’s main goal: aligning Canadian supplement doses with evidence-based recommendations

Here’s the problem: it can be difficult for women to purchase supplements with the recommended doses due to the following reasons

• A lack of availability of prenatal supplements containing the recommended 400 micrograms folic acid.

• Health care providers prescribe a 1000- micrograms prenatal supplement because that is what is generally available in the marketplace, and they’re hesitant to recommend something that is not available. Insurance companies reimburse for prescribed supplements only, so women consume what their health care provider prescribes.

• Individual supplement companies are reluctant to reduce the folic acid dose in their prenatal supplements because it may put them at a competitive disadvantage if they are not comparable with other products.

• Industry is reluctant to initiate reformulation in the absence of regulatory requirement changes

A quick look at some of the pre-natal supplements sold here in Canada included Centrum, Jamieson and Kirkland brands all with 1 milligram (1000 micrograms) of folic acid, Materna with 600 micrograms and One-A-Day and First Response with 400 micrograms.

In the concluding statements of the workshop report, it states, “Based on the discussions, workshop participants felt that if health care professionals are going to advise women to take a multivitamin supplement containing 400 micrograms of folic acid, one will need to be made widely available. Further, ownership by all stakeholders and not deflection of responsibility will be required to move this forward.

Shouldn’t the supplement industry put the future physical health of our kids ahead of their financial health? Isn’t it time that the steps be taken to make supplements containing evidence-based dosages be readily available?

Tags: , , , , , , ,

Categories: Children's Health, Research Roundup, Women's Health

Author:Rosie Schwartz

Rosie Schwartz is a Toronto-based consulting dietitian and writer.

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