A recent study on folic acid published in the American Journal of Epidemiology has caused quite a stir among pregnant women and their physicians recently.  If you only read a media summary of the findings, it appears to indicate that an essential nutrient, folic acid, taken by many pregnant women as a nutritional supplement, increases the risk for asthma in their offspring.

I have covered the forms of folic acid in my recent folic acid article. Here are the key points regarding the forms of folic acid:

• Folic acid is the synthetic form while folate is the natural form.

• Technically, the oxidized form of folic acid is called Pteroyl-L- Glutamic acid, which does not naturally occur in foods.  It happens to be the most stable for adding in food, thus, it is often used in fortifying foods with folic acid.  There is no naturally occurring biochemical reaction that utilizes this form.  It must be converted using a particular enzyme in order to be used in your body.  However, an estimated 33% of people are genetically deficient in this enzyme.
• On the other hand, L-5-methyltetrahydrofolate (L-5-MTHF) is the naturally occurring form of folic acid.  Technically, this is called folate.  It naturally occurs in foods.  It is referred to as the active form because it does not need to be converted to another form for use in your body.

It is important to clearly understand these key points so that wrong conclusions are not made.

I will quote sections of the study, interpret it and put my comment below each quote.

“In early pregnancy, mothers were more likely to take folic acid as a standalone supplement than in late pregnancy (31% vs. 9%).  Stand-alone supplements contained a higher dose of folic acid than did multivitamins; that is, in early pregnancy, the median intake of folic acid from standalone supplement was 2,948 mcg/day compared with 500 mcg/day in a multivitamin.”

There is a high probability of problems whenever a person takes one specific nutrient supplement (1) without the consideration of the balance of other nutrients, (2) without an understanding of the synergistic effects of nutrients, (3) having the particular nutrient at a relatively higher dose, and (4) without consideration of the form of the nutrient.

“Dietary folate was not associated with asthma in either age group at any stage of pregnancy.”

Not surprising, because everything naturally occurring in foods is in the L-5- Methyltetrahydrofolate (folate) form.

”For every 100-mcg increase in dietary folate in early pregnancy, the relative risk of asthma for the child at 3.5 years decreased by 43% if the mother had asthma”

Not surprising;  DNA methylation is a very important process in early development of the brain, nervous system, respiratory tract and lungs.  Without sufficient folate you would expect increased problems especially in mothers with asthma.

”For child asthma at 5.5 years, significant interactions were found. For a 100-mcg unit increase in dietary folate in early pregnancy, the relative risk of the child’s having asthma at 5.5 years increased by 77% if the mother smoked during early pregnancy.”

This is to be expected due to oxidative damage.  Smoking greatly alters DNA and cell replication so you would need a great increase in all nutrients, including L-5-methyltetrahydrofolate (dietary folate) to offset the oxidative damage.  A 100 mcg increase in folate would not be enough to offset the oxidative damage from smoking.

”For every 1,000-mcg increase in folic acid in late pregnancy, the relative risk of the child’s having asthma at 5.5 years more than doubled if the mother had a previous child.”

This is reasonably to be expected because of oxidative damage to the mother’s DNA and the hormonal changes from pregnancy through the rigors of bearing a previous child. Using a synthetic folic acid rather than dietary folate predictably leads to problems with cell replication under this condition.

“For every 1,000-mcg increase in folic acid in late pregnancy, the relative risk of the child’s having asthma at 5.5 years decreased by 37% if the mother had asthma.”

This is the key sentence in the entire article! This is an expected effect.  With a pregnant woman with asthma, she should make sure to have a sufficient amount (1000mcg) of folate (not folic acid) even though the sentence says folic acid.  Some reasons  why it is protective for asthma and other atopic conditions (in relatively layman’s terms) in late pregnancy are:

• forming cells (such as in an in-utero child) are highly susceptible to folate deficiency

• folate, pyridoxyl-5-phosphate (active vitamin B6), and methylcobalamin (active vitamin B12) are critical in DNA synthesis and repair
• DNA synthesis and repair occurs with a key process called methylation
• inadequate methylation leads to chromosome breakage
• folate is involved in making the methylation cofactor S-adenosylmethionine (SAM)
• SAM deficiency is associated with congenital abnormalities
• SAM deficiency is associated with increased oxidative stress
• Asthma and atopic conditions are associated with increased oxidative stress
• the mechanisms are discussed and additional scientific support for significant folate supplementation in pregnant women with asthma in this paper recently published by researchers at Johns Hopkins School of Medicine.

In a recent video, I briefly discussed the importance of using active forms of nutrients in prenatal vitamins.

The bottom line is: using the active forms of folate (found in real foods) and all nutritional supplements is always best.  But since just about everybody does not get all the necessary nutrients from foods alone, then everyone should supplement.  The key is getting supplements that have the active forms of the nutrients.

If you have any questions or comments regarding this article, post them here at http://drhusbands.com/contact-us.  If you wish to visit us, my chiropractic and wellness clinic is in San Carlos, California, in the San Francisco bay area.

References:
—————————————————————————————————————————

1. Whitrow M, Moore V, Rumbold A, et al. Effect of supplemental folic acid in pregnancy on childhood asthma: A prospective birth cohort study.American Journal of Epidemiology 2009;170(10):1486-93.
2. Matsui E, Matsui W.  Higher Serum Folate Levels are Associated with a Lower Risk of Atopy and Wheeze. J Allergy Clin Immunol. 2009;123(6):1253–9.

Folic acid and prenatal vitamins – follow up to Dr Husbands’s folic acid article. Free 10-minute consult; get 10% coupon for new patients visit http://drhusbands.com/coupon To ask Dr Husbands a question, visit http://drhusbands.com/contact-us

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Article: Folic Acid and Folate Facts and Fallacies

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Case in point:  A lawsuit was filed on March 2, 2010 in San Francisco superior court against 8 brands of fish oil supplement manufacturers with high levels of contamination with polychlorinated biphenyl compounds (PCB’s).  The initial defendants named are (in alphabetical order): CVS Pharmacy, Inc.; General Nutrition Corp. (GNC); Now Health Group, Inc.; Omega Protein, Inc.; Pharmavite LLC (Nature Made brand); Rite Aid Corp.; Solgar, Inc.; and TwinLab Corp.  These manufacturers had fish oil supplements that exceeded the recommended safe highest limit for PCB’s of 90 parts per billion (ppb).

One fish oil supplement manufacturer that I have consistently recommended due to repeated batch testing by independent 3rd party tests showing very low contamination levels of 1.0 parts per trillion (ppt) or less, is Nordic Naturals.

Safety is just one reason why I take painstaking detail in researching fish oils and other nutrition supplements for my patients’ needs.  Knowing the nutrients required in helping restore a patient’s health is as important as choosing the right brand.  Some brands simply do not have the adequate therapeutic amounts, while some have questionable safety.  Adequate dosage, in the purest form available, and combined with other nutrients for their synergistic effect, along with functional medicine approach and effective chiropractic techniques, are components of our health restoration program in our clinic.

If you have need to consult regarding using fish oil or our health restoration programs call our appointment desk at (650) 593-4447.  We are offering a free consultation for the first 10 minutes for those who are scheduling for the first time through March 2010.

http://www.drhusbands.com/blog/ General / Is Your Fish Oil Safe?

Here is your chance for input!     Voice your opinion on improvements for food labels.  Since many of you who follow this blog are well informed on nutrition, here is your opportunity for direct input on food label that will impact our lives for years to come. The invitation to comment by the FDA can be downloaded [PDF] or viewed online.  For reference, the docket number is FDA–2009–N–0532 and you can submit your comment here.

Here are my suggestions for improving the food labels:

1. Caffeine content:  Items containing caffeine should state the exact amounts.  Often energy drinks, sodas and snacks contain a significant amount.  This information should be made available on the food label.
2. Amount of added sugar:  Presently there is no distinction between total sugar in foods and drinks, and added sugar.  The sugar found naturally in foods may be far different from the amount of sugar added.  Putting this on the food nutrition facts label would help those who are trying to better control their blood sugar, such as diabetics and pre-diabetics (insulin resistant).
3. Real amount of trans-fats:  Presently if a product contains less than 0.5 grams trans fats per serving, manufacturers can label it 0 grams trans fats.  The manufacturers often “adjust” the serving size so that it contains less than 0.5 grams trans fat, so they can legally label that as 0.  But the serving size is often a ridiculously small amount.  For instance, 3 potato chips.   In other words, the manufacturers should be required to indicate if there are any trans fats in the product based on a realistic serving size!
4. Standardized food labels:  A standard format for food labels would be helpful.  Presently, check marks, stars, and other markings are allowed.  If there is some type of standardized food nutrition facts label format, it would be easier to read and understand.
5. Percentage of ingredients: If the percentage of ingredients are known, it would shed a great amount of light on what is really in the food product.
6. Highlight controversial ingredients: Red food dye in particular is associated with hyperactivity in kids.  This warning, and others like it should be clearly available to parents on food labels!

I hope you join me in sending input to the FDA for the improvement of food labels.  Having better information on the food nutrition facts label will help those with specific health issues that require reducing or eliminating certain foods from their diet.

Copyright © 2009 Douglas Husbands, DC, CCN. All rights reserved.

http://www.drhusbands.com/blog/ Help the FDA Improve the U.S. Food Labels

Research studies support this, including a double-blind, randomized, placebo-controlled trial reported in the Lancet, a leading medical journal. 

The article states that pregnant women and infants who were given a specific strain of probiotics called Lactobacillus GG, had a 50% reduction in asthma, eczema and allergy in the children at 2 years of age.  In this 2-year study, 132 pregnant women were recruited from families with a history of eczema, allergic rhinitis, or asthma.  They were randomly given either placebo capsules or Lactobacillus GG capsules containing 2 billion organisms of Lactobacillus GG.  They took the capsules daily for 2 to 4 weeks before expected delivery.  After delivery, breastfeeding mothers took the capsules, or the capsule contents were mixed with water and given by spoon to their infants.  These infants were examined during the neonatal period, and on study visits to a department of pediatrics at ages 3, 6, 12, 18, and 24 months.  The outcome measure was atopic disease at 2 years.  Since chronic recurring atopic eczema is the main sign of atopic disease in the first years of life, it was the primary study endpoint.

The frequency of atopic eczema was reduced by half in infants given probiotics compared with those on placebo. The reduction in eczema was independent of the manner the infants received the probiotics, either breastfed or spoon-fed.  The authors of the study concluded that:  

Our results suggest that gut microflora have unique, yet largely unexplored, endogenous immunomodulatory properties. These properties might be indispensable in the fight against the increasing frequency of atopic, and possibly other, immunological diseases.

Parents of children, with eczema, allergic rhinitis or asthma, know very well the huge burden these conditions are to both the parents and the children.  Families dealing with these conditions may

1. suffer sleepless nights or interrupted sleep
2. incur the extra expense of special foods for substituting allergenic foods
3. incur the extra expense of prescription or over-the-counter medications and creams
4. buy laundry and other household products for sensitive skin to avoid additional irritants

Some believe that these conditions are genetically passed on to children.  Also, children that were born by c-section or not breastfed have been found severely deficient in beneficial microbes.  Thus, if the parents of children have a history of eczema, allergic rhinitis or asthma, or the children were born by c-section or are not breastfed, it is imperative to inoculate the children with certain strains of supplemental probiotics as early as possible.  A Certified Clinical Nutritionist or Functional Medicine doctor should be consulted for the proper strains and amounts for your child.  Giving a child the wrong strains and/or wrong concentrations could cause more problems than giving them none at all. 

If you need assistance with this, feel free to contact me at (650) 593-4447 to schedule either a phone consultation or in-office appointment. 

At the upcoming 17th Annual World Congress on Anti-Aging Medicine held in San Jose, CA on September 10th, I will be teaching on another GI topic.  Its focus is for women.  It is titled: “Optimizing GI Tract Function as a Therapeutic Component of Hormonal Regulation in Women.” 

1. What food goes into your mouth, when it goes in, and how much:

    

   1. What: Eat combinations of real, non-processed, fresh foods in following basic categories.

       

      1. Dark green leafy vegetables and bright colored fruits and vegetables – This may include sea vegetables, such as nori, hiziki, wakame, kombu.

       

      2. Lean, clean, moderate “good fat” source proteins – Good fat means high proportion of omega-3 fats, lower proportion of omega-6 and 9 fats, such as wild salmon, grass-fed free range beef and lamb, cage-free chicken and cage-free chicken eggs; nuts and nut butters, legumes and lentils; fermented soy products: natto, miso, tempeh, soy sauce, fermented tofu, fermented soy milk.

       

      3. Starchy carbohydrates such as whole grain products; root vegetables, such as beets, yams and sweet potatoes, potatoes, ginger, jicima, garlic, onions, shallots.
   2. When: Always eat breakfast, and eat every 3 waking hours thereafter. So, you’ll eat 3 healthy meals and 2 to 3 healthy snacks.

    

   3. How Much: You always have your measuring guide with you, that is, your hand!  This works for everyone because the size of our hand is typically proportionate to the size of our body. For instance, a 6’5″, 250 pound football player’s hand is typically bigger than a 5’2″, 110 pound ballerina’s hand.

       

      1. Meals
         1. For fruits and vegetables, put both your open hands in front of you, hands together, palms facing up, fingers extended. What fits in your hand is how much of fruits and vegetables you should have each meal.

          

         2. For lean, good fat proteins, put one hand in front of you, palm facing up, palm open, fingers extended.  What fits in your palm is the amount to eat each meal.  For heavy exercisers, what fits in your palm and extended fingers is the amount you need each meal.

          

         3. For starchy carbs, put one hand in front of you, palm facing up, fingers extended.  Now cup your hand and thumb as if trying to hold water in your cupped hand.  What fits in the cupped hand is the amount of starchy carbs you should have each meal.

       

      2. Snacks
         1. For snacks, any combination of vegetable/fruit and the lean good fat protein category, in equal amounts, that fits in one hand with palm and fingers extended.

2. Use the following for type, timing and frequency of exercise:

    

   1. Type: A combination of resistance exercise and aerobic exercise for a total of about 1 hour per day

    

   2. Timing: Preferably in the mornings so you get it out of the way, and morning exercisers tend to be more consistent.  If you can’t do it in the morning, do what works best for you.

    

   3. Frequency: A minimum of 4 days per week, a maximum of 6 days per week

3. Choice of Health Care Type

   You “vote with your feet” for your type of health care.  This choice affects whether you’ll receive wellness-focused care or symptom-focused sick care.  Wellness-focused care is seeing doctors that provide preventive, holistic or functional medicine services. Symptom-focused sick care includes minimal recognition and emphasis on guidelines A and B, greater reliance on drug therapies for most conditions, or seeing a doctor for emergencies only. The type of health care you choose ultimately determines how healthy you will be and impacts your quality of life. Your choice of health care should not be solely focused on who pays for it, be it a health insurance company, taxpayers through government programs or you.

I recognize there are many variables that apply based on each individuals access to fresh food, water, and economic capabilities.   Nevertheless, these guidelines are the starting points that will influence your health span and potentially your life span. They will influence your quality of life.  I welcome your comments and questions.

Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.drhusbands.com.

Chronic Fatigue Syndrome and Fibromyalgia Are Multifactorial Diseases

Numerous research studies show that there are multiple factors influencing the origin and severity of FM and CFS.  An April 2003 article in Endocrine Reviews states that:

Given the many factors that may impinge on the HPA axis in CFS, such as inactivity, sleep disturbance, psychiatric comorbidity, medication, and ongoing stress, it seems likely that HPA axis disturbance is heterogeneous and of multifactorial etiology in CFS.

The HPA, hypothalamic-pituitary-adrenal axis, is a complex group of direct influences and feedback interactions among the adrenal glands, the hypothalamus, and the pituitary gland.  It is a major component of the neuroendocrine system and regulates many systems in our bodies, such as the immune system, the digestive system, mood and emotions, etc.  It also controls reactions to stress.

Why Functional Medicine Approach

Through my training and practice of Functional Medicine, I have seen over and over again that the Functional Medicine approach is superior in resolving chronic conditions that are multifactorial.  Functional Medicine is dedicated to improved management of complex chronic disease to correct underlying imbalances.  This is done by intervening at multiple levels, such as diet, supplemental nutrients, lifestyle modification, environmental factors, structural body alignment, etc.  The objective is to restore the person’s health functionality to the greatest extent possible.

Training in Functional Medicine is applicable to all medical disciplines.  Functional Medicine doctors consider processes involved in conditions, rather than focus on the diagnosis.  When altered or dysfunctional processes are corrected, a domino effect occurs in other organ systems.

Considering that multiple factors influence the origin and severity of Fibromyalgia and Chronic Fatigue Syndrome, I emphasize a treatment that address the multiple factors.  First and foremost, nutritional and lifestyle factors must be addressed.  Altered metabolic processes must be transformed to more healthful processes.  Structural imbalances need to be addressed.  Immune system and energy imbalances must be considered.

In order to determine, which factors need to be addressed, the doctor needs to conduct a comprehensive medical history evaluation and run appropriate diagnostic tests.  The doctor needs to determine the conditions of each of the systems affected by the HPA axis.  Otherwise, the doctor will simply be putting a band-aid on the person’s condition.

The wrong treatment or a treatment that just addresses or relieves the symptoms will only prolong the patient’s suffering.  Left unresolved, Fibromyalgia and Chronic Fatigue Syndrome will lead to life threatening diseases.  Thus, proper treatment is imperative.

Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.drhusbands.com.

Copyright © 2009; Douglas Husbands, DC, CCN, ABAAHP. All rights reserved.