Folate: A Vitamin with Unintended Consequences – Frail Elderly May Get Demented Faster

January 10, 2007

Folate:  A Vitamin with Unintended Consequenses – Frail Elderly May Get Demented Faster 

 Competency # 17 Vitamins                      ReferenceAmerican Journal of Clinical Nutrition, Vol. 85, No. 1, 193-200, January 2007  Morris et al 

 This is a serious story of unintended consequences.  In an attempt to solve the problem of spina bifida, we may have created a worse problem.  Spina bifida leaves children paralyzed for life.  It has been shown to be related to folate deficiency.  (Interestingly enough, folate is degraded by sun exposure on Caucasian skin.  Pigment in skin protects that from happening, which is probably why humans evolved with dark skin.  We developed depigmented skin to live in lower sun climates where we needed Vitamin D more than folate).  In 1998, America added folate to many foods.  

Literature exists to show that it worked.  The rates of spina bifida has gone down dramatically.  Big win. We do know that Vit. B-12 deficiency causes dementia.  We get B-12 from meat.  B-12 and folate also work together to prevent anemia.   To absorb B-12, you have to have a protein in your stomach bind to it.  It’s not only a function of how much you eat, but rather how much you can absorb and how much is bound.  Getting gradually B-12 deficient can be a slow and “pernicious” process, so we call B-12 deficiency pernicious anemia.  

As we get older, it can be part of why we lose some of our mental acuity. What we didn’t expect was the effect of folate supplementation on B-12 deficiency.  The National Health and Nutrition Examination Survey or NHANES monitors our nation's nutritional health by drawing blood, testing mental acuity etc on a statistical sample of Americans every year.  What they found was very disturbing.  Since adding supplemental folate to our diets, frail elderly with B-12 deficiency may be accelerating their mental decline and getting more anemic.  And there are thousands of frail elderly at risk compared to the small number of spina bifida patients. 

 This is a big deal.  We are now living in a folate-supplemented environment.  You almost can’t avoid unless you just eat fruit and vegetables.  If we are gradually and imperceptibly becoming B-12 deficient, that extra folate may be a problem for us.   It may make our brains rot out a little faster!   You may lose it before you know it’s gone.  We all forget to buy the milk on the way home.  I want to be able to remember that I forgot! This isn't certain.  This week there was an article from the Archives of Neurology suggesting that extra folate may help prevent Alzheimer’s.  That's not necessarily conflicting, but it's a story suggesting we need the vitamin.  It's the mix and combination that may be the point. My goal for you, and for me, is to live graciously and with your brain fully loaded with its intended capacity until “your time”.  

www.What will work for me?  This changes things.  To keep your brain as healthy as possible, we need to add a new strategy to make sure we are well.   As I get closer to being “elderly”, my brain health is important.  I will never be able to beat Irene at bridge if I can’t remember she led the Queen of Hearts in the first round.  I am going to add to my annual physical exam a request to have my B-12 checked on an annual basis.  Everyone over 55 probably should too.  I take a vitamin pill every day but taking B-12 doesn’t count.  It’s what is absorbed in my stomach that counts, and the only way to know what I’m getting is to measure it in my blood.  We’re going to see more recommendations on this one.  But you heard it here first.  The trick is to remember where you heard it!  And ask your doctor.  If you have frail elderly parents, talk to them about it too.  This is important.

This column was written by Dr. John E. Whitcomb, MD. Brookfield Longevity, Brookfield, WI. (262-784-5300)