UMFA or unmetabolized folic acid is something that has been popping up on research radars more and more frequently in recent years. The combination of food fortifed with folic acid, multivitamin use, the popularity of B complex supplements for energy, and the standard practice of hyper-dosing women with at-risk pregnancies has led to UMFA becoming a common problem. Last week we discussed the remarkable results methyl folate produced in couples with infertility relative to the current standard of care, which is supplementing with folic acid. This week, I’d like to talk about the risks of too much unmetabolized folic acid or UMFA during pregnancy.
First, Let’s Talk Useable Folate
One very wisely designed study published in the American Journal of Clinical Nutrition, compared serum and red blood cell levels of total folate, 5-LMTHF, UMFA, and MeFox which is a methyl folate oxidation product – kind of the 5-LMTHF version of UMFA. The reason I call this study design “wise” is that it gives us a good window into what is actually happening here. Serum levels test the amounts in the fluid part of the blood, which is not yet inside the cells. This isn’t really a functional space for folate – it’s been absorbed digestively, but hasn’t reached useful cellular tissues yet. Red blood cell levels, however, measure the amount that is actually inside of the cell spaces and therefore doing something useful. This study didn’t differentiate between MTHFR or non-MTHFR, or at different forms of folate intake. It simply compares two different doses of folic acid.
One group received about 1.1 mg of folic acid in their prenatal vitamins. The other group received the prenatal vitamin amount plus an additional 4 mg to bring the total to 5.1 mg, or 5100 mcg of folic acid.
What they found in this study, was that the RBC folate level, which is the functional folate, didn’t differ significantly between the two groups. The high-dose folate group did have higher serum levels of total folate, UMFA, and even 5-LMTHF. Other parameters didn’t differ significantly.
The researchers came to the conclusion that there was some kind of tissue saturation happening, where more folate just can’t get into the cells, which makes sense. They also suggest that higher UMFA concentrations in the women receiving the high-dose folic acid indicates that these doses are “supraphysiologic.” That is a fancy way of saying the dose is just too high.
So What is All that UMFA Doing In Pregnancy?
Another study, also published in the American Journal of Clinical Nutrition, studied UMFA levels in cord blood relative to autism spectrum disorder. Cord blood is the blood that remains in the placenta and the attached umbilical cord after delivery.
This study found that babies in the highest quartile of UMFA percentages in the cord blood had the highest risks for autism spectrum disorder. This effect was highest in black babies and significantly correlated with race. This correlation did not apply to the concentrations of 5-MTH or to serum total folate.
Another study, published in the Journal of Allergy and Clinical Immunology In Practice, looked at the association between UMFA levels and food sensitivity and food allergy. This study tested total folate, 5-MTHF, and UMFA levels at birth and again in early childhood.
The researchers found that of 1394 children tested, 507 were found to have food sensitivities and 78 had food allergies. In those children who developed food allergies, the average total folate concentrations at birth were lower and the UMFA levels at birth were higher. Higher UMFA levels later on in childhood didn’t seem to have this same association.
I will quote from the conclusion of this study. “Higher concentrations of UMFA at birth were associated with the development of food allergies, which may be due to increased exposure to synthetic folic acid in utero.”
What To Make Of This?
These are just a few studies and so we really can’t, as much as we might like to, draw sweeping conclusions from them, but it certainly gives us some compelling evidence that too much of what is supposed to be a good thing, can rapidly become a bad thing.
Because we, with MTHFR polymorphisms, are more susceptible to problems associated with folic acid, I think it is important to have an informed and complete conversation with your health care practitioners about the risks of folic acid supplementation in pregnancy for us specifically, and the viable, albeit less well-researched option of supplementing with 5-LMTHF instead.
Links to the research studies I’ve talked about in this podcast are supplied in the complete show notes at tohealthwiththat.com, so if you’re planning a visit to your OB/GYN or midwife, go armed with research to show them.
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