To think the NHS are giving women TTC the wrong advice?

[Lolloveswoody]

Im struggling to word this post because I don't want to seem alarmist but I also want to share the information because it could help others.

A close friend sadly lost her baby recently at 16 weeks gestation and one of the possible reasons she was given was not enough folic acid although she was taking the recommended dose. A little research has yielded the following information, none of which seems to be common knowledge as far as I'm aware.

Folic acid is actually a synthetic version of a vitamin called folate and it's this vitamin we need to protect again neural tube defects, assist in the healthy development of the placenta and boost our blood cell production. The synthetic version (folic acid) is metabolised in a different way to natural folate and is not always absorbed as effectively, it also doesn't cross into the placenta as efficiently. Basically natural folate is better and it is available as a supplement.

When you consider that folate deficiency is implicated in the causes of placental abruption, recurrent miscarriage and pre eclampsia it seems odd that it's folic acid that's routinely prescribed and in the pregnancy supplements we buy over the counter rather than natural folate supplements. The reason is basically money, folic acid is cheaper.

Having suffered recurrent miscarriage myself and seen the heartbreak my friend has just gone through I just think, at the very least, this information should be public knowledge. Ideally I would like to see natural folate replace folic acid as the recommended (and prescribed) supplement for all pregnancies but I suspect the NHS and those marketing OTC pregnancy supplements will, sadly, resist this for financial reasons.

Nonetheless, the more people know about it the more pressure can be brought to bear and the greater the chance that it may happen one day.

Yes user. But the state doesn't tell people this. They've been quoting from the food pyramid high carb, low fat crap for years. Ok things are starting to shift but it take as a long time for a population shift. A majority of people don't know that processed products masquerading as food are actually slowly killing us.

I think there's a difference between public health advice (which is general and will be simplistic to target the majority of people in broad terms) and personalised health advice (which applies to an individual).

Most pieces of public health advice involve a judgement call because a lot of the time there are a group of people who stand to gain from taking a piece of advice and another who stand to lose. Also, the more complicated the advice, the less likely anyone is to follow any of it appropriately.

To use the anti-malarials example. Specific types of anti-malarials can interact with folic acid. There's a theoretical but unproven risk that some anti-malarials could deplete folic acid and therefore it seems logical that higher dose supplements would be needed to get the benefits of it in pregnancy. However it's not as simple as telling every pregnant woman taking anti-malarials to take high dose folic acid because folic acid can make some anti-malarials less effective, and obviously malaria is a serious illness (especially in pregnancy).

So the answer to "should pregnant women take high dose folic acid while taking anti-malarials?" is - it depends (on which anti-malarial, which country visiting, likely effectiveness of that drug in that region, other risk factors for either malaria or neural tube defects etc etc). Which is why pretty much all drugs say something along the lines of "if you are pregnant you should talk to your dr or pharmacist" etc etc. to get the individual advice for your situation.

I have just looked for dictionary definitions of folate and folic acid.
"Folate - also known as Folic Acid"
"Folic Acid - also known as Folate"

My multivitamins also state that they are the same thing.

I knew someone who had very bad reactions to folic acid. It's rare, but some people are intolerant/allergic. Definitely agree that people should be educated about folate.

All I know about folic acid is anecdotal-there is (apparently) a lot of research going into its link to babies being born with tongue tie.

Folic acid is the name given to synthetic folate - vitamin B9.

I can't see any research that says Some people cannot absorb synthetic vitamins that hasn't been put out by the people selling natural supplements or by other groups wuth agendas. The respectable study I mound from the Mayo clinic makes no comment but does say B9 also needs B6 and B12.

If you want all of those you need to eat a healthy diet.

justilou. They aren't the same thing. I explained the difference upthread.

Champagne
Not sure about any link to tongue tie but folic acid definitely reduces the risk of the much more serious condition cleft lip & palate
I know which one I'd prefer my baby to have

Folate and Folic Acid are the same thing

C19H19N7O6

to be precise and your body cannot tell if that chemical came out of a nut or a test tube.

Also be aware when GP bashing about things they 'won't' prescribe that even if something is in theory prescribable they may not be allowed to due to lack of strong good quality evidence / cost etc. They are not being obstructive - they have to work within nhs rules. They will be held to account if they don't .

Interesting discussion. I am both overweight and on anti malarials long term. I expressly asked about taking a higher dose only for several midwives and consultants to look confused and say it's not necessary.

FWIW, the current advice on anti-malarials and folic acid from the NHS is as follows. Unless you're proguanil high dose folic acid isn't advised. (And most people on long-term anti-malarials are on hydroxychloroquine or doxycycline which have a different mechanism of action that's not related to folate).

www.evidence.nhs.uk/formulary/bnf/current/5-infections/54-antiprotozoal-drugs/541-antimalarials/prophylaxis-against-malaria

During my 1st preg I read some of these studies and decided to NOT take folic acid, but to eat foods high in folate (spinach, peanuts, oranges, etc etc). When NHS midwife asked me about folic acid and I explained approach she looked at me like I was INSANE.... I'll have to dig to find it but there is something I saw linking Folic Acid with the increase in tongue ties (it strengthens frenulums...).

I had the same thing with iron, eating iron rich foods instead of supliments. Blood levels on test were really high, NHS midwife amazed. Healthy baby resulted. Would do same again.

The studies that are out there are dubious though. There is no concrete evidence to suggest that natural folate is any more beneficial than folic acid.

I'm sorry for the losses you and your friend have experienced but the NHS really isn't at fault here.

cdtaylor. Folic acid has to be methylated by the liver into THF. Natural folate (THF) is already presented in more bio available form and does not need to go through this process for absorption. I do not follow your comment.