Folic acid and folate

Folate is a water-soluble B-vitamin that occurs naturally in foods. Folic acid is the synthetic form of folate that is found in supplements and added to fortified foods, such as white flour, white bread and a variety of pastas and nutrition bars.

Bacteria use folic acid in order to synthesize the nucleic acids that make up their DNA. While folic acid found naturally (folate) in food sources should not inhibit progress on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP), eating foods with supplemental folic acid may strengthen the bacteria that MP patients are trying to kill. MP patients must avoid supplements and multivitamins containing supplemental folic acid, and try to limit intake of foods containing supplemental folic acid.

Foods supplemented with folic acid

MP patients must try to limit foods containing enriched flour or supplemented with folic acid. Be sure to check the label.

Food Micrograms (μg) % “daily value”
Breakfast cereals, fortified with 100% of the DV, ¾ cup 400 100
Breakfast cereals, fortified with 25% of the DV, ¾ cup 100 25
Rice, white, long-grain, parboiled, enriched, cooked, ½ cup 65 15
Egg noodles, cooked, enriched, ½ cup 50 15
Bread, white, 1 slice 25 6
Bread, whole wheat, 1 slice 25 6

Folate naturally in foods is not bio-equivalent to synthetic sources. The equivalency is as follows (ug = microgram):

  • 1 µg of dietary folate equivalent = 0.6 µg of folic acid from fortified food, or
  • 1 µg of food folate = 0.5 µg of a supplement taken on an empty stomach

Excess folic acid can allow bacteria to proliferate

Folic acid is converted by the body into DHFR (DiHydro-Folate Reductase), which can be used by parasitic bacteria to form the nucleic acids, which are at the basis of their survival and reproductive cycles.

So important is folic acid to the growth of bacteria that many therapies for infections slow disease progress by blocking activity of folic acid. A conventional treatment for sarcoidosis confirms that folic acid does indeed affect the activity of L-form bacteriaDifficult-to-culture bacteria that lack a cell wall and are not detectable by traditional culturing processes. Sometimes referred to as cell wall deficient bacteria.. Some patients with sarcoidosis are prescribed methotrexate (MTX), a drug that temporarily slows progression of the disease by blocking the activity of folic acid and subsequently the activity of DHFR. Another drug that blocks the activity of DHFR is the antibiotic Trimethoprim, which is used to create the drug Bactrim. The antibiotic Bactrim was formerly used as part of the Marshall Protocol.

It is commonly accepted that bacteria synthesize all their DiHydro-Folate directly and do not require folic acid in order to generate the nucleic acids (for DNA and RNA and protein transcription).

Empirically, we have observed that sarcoidosis patients tend to be able to tolerate the folic acid in their diets, but their serum folates remain low even when high-dose supplementation is used. Clearly, something unexpected is going on, and we have no good handle on it right now. It could be the host, or it could be a host-pathogen interaction.

Since it is common for immune disease patients to have low serum folates and therefore to be recommended folic acid supplements, we place folic acid on the list of “medications requiring care,” so that folks would not gobble it up willy-nilly without thinking carefully first.

You know, about 3% of the population is being given regular methotrexate, a DiHydroFolateReductase antagonist, to help their arthritis. Isn't it strange that while we give these folks medicines which block their folic acid metabolism, we pour folic acid down everybody's throats by supplementing all refined flour and flour products with folates.

Trevor Marshall, PhD

Folic acid as a supplement may also mask the symptoms of severe vitamin B12 deficiency.

FDA supplementation policy

In the U.S. adult population from 1988 to 1994, which was before cereal grains were fortified with folate, the reported median intake of folate from food was approximately 250 µg/day.

In March 1996, the FDA instituted a mandate for fortification of flour and uncooked grains to a level of 140µg/100g to be fully instituted by January 1998, the reason being that B-vitamin deficiency had been linked to spina bifida and anencephaly in children born to women with poor diets.

Clinical evidence

A 2009 combined analysis and extended follow-up of participants from two randomized, double-blind, placebo-controlled clinical trials found that treatment with folic acid plus vitamin B(12) was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.1)

Epidemiological evidence

Epidemiological studies on the issue of whether folic acid is harmful in chronic disease have been somewhat equivocal.

However, one recent Chilean study analyzed hospital-discharge data for two 4-year periods — before folic acid fortification (1992–1996) and after (2001–2004) — and found a significant increase in reported cases of colon cancer. The increase was 162% in people 45 to 64 years and 190% in people 65 to 79 years.2)

A pair of commentaries appearing in the November 2007 issue of Nutrition Reviews argue that folic acid benefits some and harms others.

Dr. Solomons, author of one of the review commentaries, “Food Fortification with Folic Acid: Has the Other Shoe Dropped?”3) advises that a careful reconsideration of the fortification program is needed. “One size of dietary folic acid exposure does not fit all. It can be beneficial to some and detrimental to others at the same time,” writes Solomons.

Dr. Young-In Kim authored the second commentary: “Folic Acid Fortification and Supplementation—Good for Some but Not So Good for Others.”4) According to Kim, exposure to high intakes of folic acid in early life and young adulthood may provide life-long protection from the tendency for cancer formation in different organs, such as the large intestines, whereas such exposures later in life, when cell damage has occurred, can spur on the advance of the tumor.

A 2010 study by House et al. has shown substantial adverse outcomes associated with high-dose B vitamins in patients with advanced diabetic nephropathy.5) These side effects included myocardial infarction, stroke, revascularization, and all-cause mortality. According to one commentator, unless other explanations come to light in further analyses of the study, these findings make repetition of a similar trial in this high-risk patient group unethical.

The conclusions expressed in these studies and reviews are consistent with the contention that supplemental folic acid is most harmful for people who are older and presumably have higher microbial loads.

Natural sources of folate

Dark leafy greens, citrus, beans and lentils, avocado

Foods High in Folate

Read more

Ebbing M, Bønaa KH, Nygård O, Arnesen E, Ueland PM, Nordrehaug JE, Rasmussen K, Njølstad I, Refsum H, Nilsen DW, Tverdal A, Meyer K, Vollset SE. Cancer incidence and mortality after treatment with folic acid and vitamin B12. JAMA. 2009 Nov 18;302(19):2119-26. doi: 10.1001/jama.2009.1622.
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Hirsch S, Sanchez H, Albala C, de la Maza MP, Barrera G, Leiva L, Bunout D. Colon cancer in Chile before and after the start of the flour fortification program with folic acid. Eur J Gastroenterol Hepatol. 2009 Apr;21(4):436-9. doi: 10.1097/MEG.0b013e328306ccdb.
[PMID: 19190501] [DOI: 10.1097/MEG.0b013e328306ccdb]
Solomons NW. Food fortification with folic acid: has the other shoe dropped?. Nutr Rev. 2007 Nov;65(11):512-5. doi: 10.1111/j.1753-4887.2007.tb00276.x.
[PMID: 18038944] [DOI: 10.1111/j.1753-4887.2007.tb00276.x]
Kim Y. Folic acid fortification and supplementation--good for some but not so good for others. Nutr Rev. 2007 Nov;65(11):504-11. doi: 10.1111/j.1753-4887.2007.tb00275.x.
[PMID: 18038943] [DOI: 10.1111/j.1753-4887.2007.tb00275.x]
House AA, Eliasziw M, Cattran DC, Churchill DN, Oliver MJ, Fine A, Dresser GK, Spence JD. Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial. JAMA. 2010 Apr 28;303(16):1603-9. doi: 10.1001/jama.2010.490.
[PMID: 20424250] [DOI: 10.1001/jama.2010.490]
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