Folic Acid Levels Subnormal

Dr. Kilmer McCully, author of The Homocysteine Revolution, fought for years to have foods supplemented with folic acid. During this time he reviewed numerous studies of the American diet and found that subnormal values for this vital supplement were the rule rather than the exception across all ages and races in the United States.

McCully had learned of the importance of folic acid along with vitamins B6 and B12 in helping to maintain normal values of homocysteine. When any of these three vitamins were insufficient, homocysteine levels rose paralleling a tendency for atherosclerosis and other degenerative changes of the arteries.

Finally in 1998 the FDA agreed to supplement U.S. national foodstuffs with folic acid but they claimed the move was based on research showing that adequate folate intake early in pregnancy helps prevent birth defects of the brain and spine. Because neural tube defects develop in the early weeks of pregnancy, before many women even know they're pregnant, it was recommended that all women of childbearing age get 400 micrograms of folate or folic acid every day and national folate supplementation began.

Even though Dr. McCully's work had been dismissed as not sufficiently compelling to the FDA he was pleased that action had been taken.

Now, in a CDC survey of 1685 women from the ages of 15 to 49, the folic acid levels are not much different than McCully reported a decade ago. Only 40% of white women, 21 % of Hispanic and 19% of black women had the desirable blood level of folic acid. The overwhelming majority of women of childbearing age had insufficient blood folic acid to prevent neural tube defects in their children despite supplementation of our national diet with this important substance.

Equally important is the obvious inference that the majority of women have higher than desirable levels of homocysteine and therefore are at increased risk of arterial inflammation and atherosclerosis.

Public Health authorities must now consider the desirability of even greater folic acid supplementation of national foodstuffs versus the much less satisfactory alternative of encouraging folic acid supplementation by mouth for this population group. Dr. Quan-He Yang and colleagues at the U.S. Centers for Disease Control and Prevention in Atlanta reported that food supplementation of folic acid in its present form gives an adequate level in only 8% of target women.

Much of Dr. McCully's work was done on children born with genetic deficiencies of either folic acid or vitamins B6 or B12. He found that these children had excess amounts of homocysteine in their urine and a marked tendency to die in their youth of strokes, heart attacks and kidney disease secondary to arterial damage, curiously resembling that of old age.

He then went on to reveal the three vitamins that caused this problem and the benefit of supplementation of those vitamins in treatment. It was McCully whose dedicated research finally directed us to the concept of inflammation, not cholesterol, as the causative factor in atherosclerosis with homocysteine being one of the major inflammatory triggers.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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