The earliest stage of pregnancy, occurring before many women know they’re pregnant, is one of the most critical to a baby’s long-term health.
Within the first 28 days of pregnancy, a growing fetus is particularly susceptible to neural tube defects (NTDs) which can lead to anencephaly and spina bifida. NTDs occur when a fetus’s neural tube, which will eventually become the brain and spine, doesn’t properly close.
Studies have found that consuming B vitamins like folic acid and folate before and during pregnancy can help women increase the likelihood their baby’s neural tube will successfully close. This positive correlation is why we’ve seen an increase in foods fortified with folic acid, the synthetic version of folate.
Unfortunately, not every woman is able to absorb folic acid. For these women, even though their diet may appear to meet the recommended daily amount of folic acid, it isn’t converted into the metabolite that promotes a healthy pregnancy. (Plus, studies have begun to find that too much folic acid can actually increase the likelihood of certain cancers.)
Metabolizing Folic Acid: MTHFR
It’s not news that folic acid contributes to a baby’s neural health. However, it’s important to be aware that increasing folic acid intake isn’t always enough for some patients. There is a widespread genetic variation that obstructs a biochemical process called methylation, in which methyl groups are added to a DNA molecule and, under optimal conditions, serves to regulate activity in a number of bodily systems.
Folate is notoriously difficult to consume at recommended levels, so many women rely on folic acid supplements to regulate the amount of the nutrient before and during pregnancy. Folic acid is a synthetic form of naturally occurring folate. Most patients consume folic acid through supplements or fortified foods.
Because neither folate nor folic acid is biologically active, they need to be converted into the metabolite 5-MTHF in order to be useful to the body. However, studies have found that around 30% of people in the U.S. have a genetic variant that prevents them from successfully converting folic acid into 5-MTHF, folate’s biologically active form.
Everyone is born with two MTHFR genes. These genes contain the instructions to create an enzyme that’s necessary to receive the benefits of folic acid. Two variations exist for the MTHFR gene: C677T and A1298C. The former, C677T, is associated with neural tube defects. Research has found that women with this variant in both copies of their MTHFR gene are two times more likely to give birth to a child with an NTD.
Patients who want to know whether they have a MTHFR variant can take a genetic test to find out. However, it’s important to note that the presence of a variant alone is not a reason for concern. Geneticists have found a way to determine whether the variant is causing a breakdown in folic acid conversion by measuring the levels of the pre-conversion amino acid, homocysteine. If your patient has elevated levels of homocysteine, then they should take preventative action.
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The Case for Methylated Vitamins
Because this genetic variance is common, a different approach might be better for your patients. Essentially, these individuals are unable to convert folic acid from one amino acid to another. Methylation is the biochemical process behind this conversion, and it supports many systems throughout the body. It’s not just folic acid intake that might be disrupted by an issue with MTHF. This is part of the reason why you should consider ordering a genetic test for your patient if any part of their treatment plan depends on healthy methylation.
Methylated vitamins outsource the work normally undertaken by your patient’s body. Instead of relying on their system to produce the enzymes that convert folate, you are providing your patient with the active metabolite 5-MTHF.
Because we understand that there’s a relationship between NTDs and folate consumption, the food industry in the U.S. has been fortifying foods and doctors have been prescribing supplements with abandon. The net-positive is that we have seen a decrease in NTDs. The negative side of this is we are now starting to understand that the genetic aberration noted above has led to a surplus of unmetabolized folic acid in people’s systems.
Methylated vitamins skirt this issue by ensuring that whatever is entering your patient’s body can be efficiently absorbed instead of lingering in fat cells or their blood stream.
If you’re unsure whether your patient falls into the group of people who are folic acid absorption-challenged, labs are a good place to start. Because compliance is a concern for mother and baby both (an expectant mother doesn’t need to be worried about taking a handful of pills every day), it’s important to find an alternative solution that’s easy on the body and the daily routine.