Pregnancy & Birth Thrive

Folic Acid: Getting to the Heart of the Problem

Written by Guggie Daly

February is Congenital Heart Defect (CHD) Awareness Month. The Centers for Disease Control lists CHDs, which involve the heart and/or blood vessels connected to the heart, as the most common birth defect in our country. Not only that, but their research also shows that some CHDs are increasing, especially smaller ones known as moderate midline defects.

Roughly 25% of all CHD babies will require surgical intervention, and many of them will continue to be affected by their condition into adulthood. Although technology and techniques have come a long way since the first open heart surgery, CHDs remain a persistent, growing concern. As public health officials continue to connect the dots between maternal health and CHDs, it becomes all the more obvious that major changes are needed, related to the practices adopted during the World Wars and in the face of the Great Depression.

The Dietary and Genetic Foundation states, “Although congenital defects develop from a myriad of factors and it might be complicated or outright impossible to fully understand many of them, the medical literature on CHDs begins to show a clear picture that dietary influence is a major contributing factor. This is because CHDs are related to MTHFR polymorphisms. These polymorphisms, or genetic mutations, directly alter the person’s ability to absorb and use B vitamins. So, for a mother with MTHFR polymorphisms, her body might be low in B9, also known as folate or folic acid. This vitamin is vital during pregnancy and a deficiency in it is related not only to CHDs, but other midline defects such as Neural Tube Defects, tongue and lip ties, rib cage abnormalities, and even foreskin (raphe line) defects.” Even after a thorough meta-analysis, researchers still found a significant connection to MTHFR mutations and CHDs:

“For mothers, the MTHFRC677T polymorphism presented significantly elevated risk of CHDs without heterogeneity and publication bias. Moreover, the sensitivity analysis further indicated the stability of our results.”

Here’s the kicker. Mothers with MTHFR polymorphisms are typically unable to absorb folic acid, and the mutation prevents them from converting it through the necessary chain of events to turn it into a form that the body can use. Folic acid is the form that our government uses to fortify cereal, bread, orange juice, vitamins, and more. But, those with MTHFR cannot use it, and in fact, folic acid can harm them as it “clogs up” their methyl cycle. This in turns causes amino acid issues, which can cause risky levels of homocysteine. Homocysteine is related to heart defects, muscle damage, and other oxidation issues.

The government has been fortifying grains and some beverages since the early 1900s with folic acid and other nutrients. It made sense at the time, as people were starving from the severe events going on such as wars and the Great Depression.

“In the 1940s, several states enacted mandatory enrichment laws of various grain products. South Carolina was the first state to heed the nutritionists’ call for legislation. Other states soon followed suit. By 1950, 26 states (of a total of 48 states at the time) and 3 territories had instituted mandatory laws requiring the enrichment of cereal flour and bread.”

The choice to fortify in the face of food scarcity and poor consumer education likely saved many lives. But, it also likely pushed many lives over the edge as their bodies were unable to absorb the synthetic forms of B vitamins and couldn’t sustain health during pregnancy. As the MTHFR polymorphisms were passed down to each subsequent generation, the offspring were also given the nutritional deficiencies as the fortified vitamins couldn’t be absorbed or used. This has resulted in multiple generations experiencing a deepening genetic mutation and nutritional crisis.

This means that besides a basic folate deficiency playing a part in the formation of congenital defects, actual folic acid supplementation might also be directly harming some people with genetic mutations, increasing their risk for developing defects and other diseases. Not only are these people unable to use the folic acid form to correct potential deficiencies, but the folic acid caus-es its own set of problems on top of the original deficiency.

It’s not surprising, then, that new research continues to show the dangers of folic acid supplementation:

“We believe that this is the first published study in humans to demonstrate that increasing consumption of folic acid, and specifically supplemental folate during late pregnancy, significantly increases the risk of physician diagnosed asthma in the child at 3.5 years, persistent asthma (at 3.5 and 5.5 years), and possibly asthma at 5.5 years. This observed effect persists after adjustment for potential confounding factors (including early pregnancy intake) and was similar when looking at combined folate and folic acid intake, probably because of the small contribution of dietary folate to total daily intake.”

What’s a Mom to do now?

So, most grains and vitamins are heavily fortified with folic acid. Folic acid is poorly absorbed by up to 50% of the population. It not only potentially harms this population with genetic mutations, but also deepens existing folate deficiencies. It’s connected to congenital defects, most especially CHDs.

This should get the attention and priority of every woman preparing to conceive or already pregnant. The pertinent question is: what now?

Simply avoiding folic acid isn’tenough, because existing deficiencies also contribute to congenital defects and slow down the methyl cycle, too. The goal should be a three-step process:

1. Confirm MTHFR status through basic testing and/or medical history. There are fairly inexpensive saliva tests available such as through

2. Avoid folic acid (and all unconforted B vitamins as all of them will be difficult to properly methylate). This means cutting out most grains, although some organic brands do particularly cater to unfortified demand. It also means carefully scrutinizing all supplements, as most of them use folic acid. Be sure to investigate this issue beyond a glance. Due to lax labeling laws that were only very recently updated, many companies can use the word folate. Or they might try to use green marketing slogans to lead you to believe their vitamins are healthy, natural, and “whole foods based” but upon closer look, they disclose using folic acid. When in doubt, throw it out. Supplements with high quality ingredients will proudly advertise this, and not try to use catchy slogans or asterisks and small print.

3. Address the deficiency or manage the MTHFR mutation through dietary changes. Some people with more severe mutations might need a lifetime vitamin therapy with converted B vitamins. These converted forms are also called bioavailable or bioactive forms. They are created in a form that bypasses all of the steps normal bodies take to make a vitamin available to the body. Consider it similar to someone without a thyroid who must carefully manage levels in the body for a lifetime with a supplement. This is important outside of pregnancy, too. MTHFR mutations are related to a laundry list of issues such as liver disease, immune dysfunction, and endocrine imbalance.

In short, if a woman is preparing to conceive or already pregnant, she needs to take steps to avoid folic acid while also ensuring she has adequate natural folate in her diet. And if she has MTHFR, she needs to take the bioavailable forms of B vitamins since it’s likely that even natural sources of folate are not in useable form for her body.

The best timing for beginning this process is 3-6 months before conception, since midline defects occur very early in pregnancy, sometimes before the woman is even aware that she is pregnant. But, if a woman is reading this right now and already pregnant, it’s not too late to get rid of the folic acid and to replace it with natural food folate or bioavailable supplements. No matter what has already happened, or what window of opportunity has already passed, folate remains a vital nutrient during pregnancy and ensuring the baby has enough of it will support a healthy foundation for growth and development throughout life.


About the author

Guggie Daly