Poll: GERD and Sleep Apnea

[echo]

Hey Jen,

Thanks for the info. I ordered the Betaine HCl as they didn't have it in stock, hope to get it tomorrow. If it works I'm going to force it on my sister too. The LES link is VERY interesting, I didn't realize that feedback mechanism. I also found some good websites in the meantime, and I asked my sister to order the book. Some might remember from my other posts that my dad died from esophageal cancer after having taking prilosec most of his life so I do believe that acid reducers may NOT be the way to go (not saying that the meds caused the cancer, rather since they didn't solve the real problem they may have actually made it worse by weakening the LES, based on what you've said)!

Glad to hear Harry is doing so well! And that folic acid issue is very interesting, I had never heard of that. Good luck getting it all sorted out, it definitely sounds like you're on top of it all !!! As for the hypothryoidism, if you need only the T4 then the standard levothryoxine meds should work for you. I agree, with all the recent hoop-la about hypothryoidism it is very annoying and strange that your doctors don't want to even try to treat it. From what I understand levo is one of the safest drugs available anyway! I also seem to be 'subclinical' but the levo has helped immensely. My doctor, when she started the levo treatment, said that I would know immediately if I DIDN'T need the levo, as I would get all the symptoms like heart palpitations, headaches, anxiety etc. I started at 25 ug and am up to 50 ug and haven't noticed a single negative side effect. Just the opposite, I have a lot more energy, digestion is much better (well, bowel motility), and my dry skin/thirst has gotten better in the last few weeks too.
Can you go directly to a good endocrinologist in the area??

I sooooo sympathize with you. Looking back on my past blood tests i've been 'subclinical' for at least 4 years, and I only started the meds back in December. What a waste of 4 years!!!

[socknitster]

Echo,

I didn't remember that about your dad. I'm so sorry to hear that. Well, information is so easily obtainable now and we have to become our own personal health advocates and search out what is right for us. You will be the the best judge about what will be best for your body. Just take the time to try different things and with persistence you will figure it out based on how your body reacts.

Low stomach acid production seems to be linked to low thyroid from what I can gather. Having low thyroid just puts the breaks on everything--all body processes slow down and become less efficient. With time you may find your digestion normalizing, but if not, I think you are on the right track. I no longer trust conventional medicine. I've been so incredibly sick and have seen so many doctors. If I ever get it all figured out, I'm planning my episode of "Mystery Diagnosis" on TLC! LOL!

Regarding the endocrinologist--I've seen two now in the last year--the only two in town. They just tell their nurses to call me and tell me I'm fine and don't need to come back. Then I request my bloodwork results and find that the thyroid is flagged as LOW by the LAB and know that I'm not fine and it pisses me off to no end. I plan on calling them back tomorrow and asking about this specifically. Maybe I just need to go back again to talk in person and PLEAD.

Gotta go cut Harry's hair before bed,

Jen

[echo]

Jen, thanks. BTW I ordered the Betaine HCL from TWO different stores hoping one would come in tomorrow, but tomorrow's a public holiday here so I'll just have to be patient until Friday RE: persistence and knowing our bodies... my family is pretty well versed in that though we still keep learning that lesson over and over again.... my experience started at the age of 12, when no doctor could figure out my mysterious migraines and weekly vomiting sessions (and other conditions that, again, both my dad and sister had/have). Luckily a "witch doctor" aka a kinesiologist/chiropractor figured out that we had food intolerances! That was 20 years ago, saved my life (and probably my brain, from all that inflammation, discouting OSA damage)!

Go get 'em tiger, get that hypothyroid under control You know what I finally did? I printed out one of those on-line "do you have hypthroidism" surveys, ticked in almost all the boxes (and i didn't have to even lie ), printed out an article on the recent debate about what the correct "cutoff" guidelines for the blood tests are, and went and basically demanded that my doctor treat me for the hypothyroid, and I did whine quite a bit about being "so tired" all the time. She started me out on the lowest dose, oh wait I already explained that above. So basically they can't really HARM you from giving the meds a shot. So prepare all the ammo you can and don't take NO for an answer!

You're right, once the thryoid goes it all goes haywire. I never though about the stomach _acid_ levels being linked to that but I could imagine it is. (I noticed the speed of my digestive track improved on the thryoid meds!).

[socknitster]

Echo,

I understand your impatience! I have been sick since October of last year and even though I am much better now, I still feel impatient that I want to be ALL BETTER. I'm sick and tired of messing around. I don't want my whole adult life to be about being sick. I know there is so much more to life than that!

You make a good point. I think I will go find one of those questionaires about hypothyroidism that you mention and bring it in as ammunition. It can only help. Like I said before, I tried the T3 and nothing happened--got up to 90 mcg and nothing happened. Since the body makes about 15 mcg a day, I began to think it was pretty ridiculous. So, I tapered back down and felt no change. What my blood tests show is low T4--I hope that is the final missing link.

Did you know that hypothyroid can cause OSA? ONe of the possible symptoms is swollen tongue. My tongue is so swollen that it is scalloped around the edges. I have to wonder that if I ever get this under control that I might not need cpap anymore.

Also, you might want to look into this book I mentioned above by Dr. Teitelbaum. In the book he mentions NAET for food allergies/intolerances. I have had a local alternative MD recommend I do it, as well as a friend who has multiple chemical sensitivity and is a well-educated professional in a medical-related field. It sounds like a bunch of hooey, but with so many intelligent people saying it works, I wonder if this Dr. Nambudripad (a kinesthesiologist) who discovered it didn't just happen to stumble onto some deep mystery of the human body that actually works?! I plan to start NAET soon. I'm just so sick of doctors I'm taking a little break!

[echo]

Did you know that hypothyroid can cause OSA? ONe of the possible symptoms is swollen tongue. My tongue is so swollen that it is scalloped around the edges. I have to wonder that if I ever get this under control that I might not need cpap anymore.

Hm, does hypothyroid really cause OSA, or the other way around? I suspect that, since the thyroid is one of the more delicate organs of the body, the effects of OSA could easily harm the thyroid. My blood levels from > 5 years ago were all pretty good, and I never really had the excessive fatigue issues (and was always pretty hyper), but I did have trouble waking up and snoring as a teenager. In my case I think the OSA came first. Also my facial structure makes me quite prone to OSA, and I don't think that'll change from treating the hypothyroid.

I remember quite a few discussions here about the scalloped tongue, as a sign for OSA. I don't see how that's linked with the hypothyroid?

Thanks for mentioning that book again, I had sort of skipped over it the first time you posted it. I bookmarked the link too

That would be great if solving these issues also solved your OSA In my case I won't hold my breath

whew that's one long hijacking from GERD To Hypothyroidism! The thyroid issues keep coming up quite a bit here lately!!

[socknitster]

Sorry, don't mean to be a hijacker. I'm just chatty!

Hypothyroidism is linked to problems with edema/swelling. I just went thru a bunch of symtom checklists and only found one listing tongue swelling, but I know I have seen it somewhere else before. I have had problems with energy my whole life. Sleep problems began as a teen. I guess its a chicken and egg question. However, I'm only 37, and cannot imagine spending the NEXT 37 years on cpap, though I will do it if I must. I have to hope, but like you I won't be holding my breath unless I doze off without my cpap, that is. I'm an optimist, you see.

Gravelly voice was a symptom on many of the checklists I looked at. Would that be from a goiter putting pressure on the vocal cords or from chronic reflux due to poor acid production via the route we just discussed--if it is linked to hypothyroidism, of course. So, that brings us full circle back to reflux. Ha!

I've never heard swollen tongue as a symptom of OSA. I never had it until recently. The last 6 months. It is quite startling to see, actually. My overbite predisposes me to OSA as well. That can't be changed without very invasive elective surgery which I'm really not up for.

Jen

[echo]

Sorry, don't mean to be a hijacker. I'm just chatty!

it was a jest! I'm real chatty too

Hypothyroidism is linked to problems with edema/swelling. I just went thru a bunch of symtom checklists and only found one listing tongue swelling, but I know I have seen it somewhere else before. I have had problems with energy my whole life. Sleep problems began as a teen. I guess its a chicken and egg question. However, I'm only 37, and cannot imagine spending the NEXT 37 years on cpap, though I will do it if I must. I have to hope, but like you I won't be holding my breath unless I doze off without my cpap, that is. I'm an optimist, you see.

Ah yes, you're right of course. I'm 33, I don't mind spending the next 20 years on CPAP but I hope that by the time I can't take care of myself anymore, they'll have come up with some other treatment! I don't think the nurses will be taping my mouth shut when i'm 99! (ha ha i'll never live that long).

Gravelly voice was a symptom on many of the checklists I looked at. Would that be from a goiter putting pressure on the vocal cords or from chronic reflux due to poor acid production via the route we just discussed--if it is linked to hypothyroidism, of course. So, that brings us full circle back to reflux. Ha!

Yeah! Could be either actually.

I've never heard swollen tongue as a symptom of OSA. I never had it until recently. The last 6 months. It is quite startling to see, actually. My overbite predisposes me to OSA as well. That can't be changed without very invasive elective surgery which I'm really not up for.

Scalloped / serrated / swollen tongue discussions here:
viewtopic.php?f=1&t=35905&p=309574
viewtopic.php?f=1&t=48918&p=447428
I swear there was another thread, prob in 2008, with a picture of a scalloped tongue, i can't seem to find it back anymore. Jskinner noted swollen tongue in one of his posts too, a while back. So I think it's quite common. Mine is also too large for my small mouth, I think, but I don't have the scalloped tongue.

[socknitster]

Echo, those links are interesting, but don't really dispute that all those people with scalloped tongues couldn't also be suffering some form of hypothyroidism. I probably printed off 7 or 8 "symptom checklists" for hypothyroidism last night and several of them listed OSA as a symptom of hypothyroidism. I ultimately found 2 that listed swollen tongue as a symptom of hypothyroidism. I have also found stuff about PCOS that lists hypothyroidism and OSA as common associated problems.

I just started reading a book called Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A Revolutionary Breakthrough In Understanding Hashimoto's Disease and Hypothyroidism by Datis Kharrazian. This book lists 5 or 6 underlying causes for hypothyroidism. It is quite technical and one of the more difficult books on the topic that I have read so far, but it seems logical. Under the different scenarios, only one fits my bloodwork profile. That is the one he attributes to estrogen dominance. He suggests it is from all the supplemental hormones women take from birth control pills to bioidentical creams. He even suggests that some antiaging face creams have tons of unlisted illegal estrogen in them. Well, I don't know about all that. Estrogen cream applied to the face, would give a youthful glow according to my research, so it is possible. I don't trust big industry not to lie and cheat in that way.

I did recently try using some progesterone creams which is supposed to counteract excess estrogen which my research does suggest I may have(See the late Dr. John Lee's book called What your Doctor May Not Tell You About Menopause and Premenopause). I have to wonder if it isn't from growing up rural when they were spraying the fields with all kinds of scary stuff. They say a lot of pesticides are xenoestrogens, meaning they mimic estrogens and screw up the endocrine system. So that is combining two theories from two different books to explain my symptoms. This doc says that taking thyroid hormones is not the answer and gives a long laundry list of supplements to take to correct the problem. Many of which I'm already taking.

And startlingly enough, Dr. Kharrazian mentions that the methylation cycle is blocked for this type of hypothryroidism. This is the same metabolic cycle that is blocked with folate malabsorption. So, I keep coming round and round back to the same conclusions from different doctors on different medical topics which is a sign that I'm on the right track, I suppose.

Whatever has been wrong with me since I got the flu in October must have triggered the swollen/scalloped tongue, because I never noticed its presence before (my tongue feels like it barely fits in my mouth which is a new sensation), though I'm not in the habit of sticking my tongue out much, lol. Severe hypothyroidism is called myxedema and causes severe swelling all over the body, including the face. For pics of how that might look, see Dr. Mark Starr's book: Hypothyroidism Type 2: The Epidemic. His theory is thyroid resistance, like insulin resistance. While the book is extremely interesting and well worth reading for the history behind thyroid treatment, his theory doesn't make as much sense to me and I don't think it tells the whole story for everyone. I'm more inclined to believe that people who have hypothyroid symptoms but normal blood tests have metabolic problems that block the action of the thyroid hormone rather than not having enough of it. Adding more isn't necessarily going to help much in the long term.

My goal is to try to optimize my diet and supplement intake to stop these blocked cycles and acheive optimal health. That is why I'm juicing now. I eat a fair amount of fruit and veg, but can consume so many more in a glass full of fresh juice made from raw foods--just one glass of juice has probably 6-7 servings of fruit and veg. Typically I juice 2-3 apples, 2-3 carrots, a stalk of broccoli, a handful of spinach, an orange, half a lime. Sometimes I use cabbage or kale or some other fruit. Looking forward to this summer when fruit/veg will be abundant from the local farmers market and I can try all kinds of things. My kids like it too.

Ok, I'm rambling now, sorry!

Jen

[Julie]

"Low folates can affect the brain including being a causal agent of depression and schizophrenia, high cholesterol, osteoporosis, cancer, among many, many other things." Look, I understand that you are really into alternative meds, and while I have issues with your giving them to your children, who have no say in the matter, I can't just sit and ignore that sentence you wrote - it's so flagrantly cuckoo! Right now folates are being looked at as being important to various medical conditions, most notably spina bifida, but to say lack of them causes the above conditions, including cancer, is just such nonsense that I have to ask you to reconsider what you're spouting! Even the old snake oil sales guys didn't go this far. And you're reading random lists of symptoms (most of which when I read them are 90% interchangable) and picking and choosing what fits your 'symptoms' to decide you have whatever condition of the day suits you. Do you really think that's any kind of science? I just worry that 'newbies' will think some of this actually has significance in OSA (if 1-2 things do, it would be coincidental) and start trying to treat themselves, or go to quacks who push these things, and be in worse trouble than they already are. I just don't think a forum on Cpap/OSA is the place for all that, and it's a shame that you're throwing so much all into the same pot based on 1-2 bks by non- medically qualified authors, because it insults the good name that some alternative medicine people do have, based on proper research.

[socknitster]

It is most certainly NOT cucoo.

I'm just sharing what I have learned and it is based on SCIENCE. For your gratification, I will tell you that I have a BA in BIOLOGY and have worked in labs doing RESEARCH. I know the difference between heresay and quakery and scientific fact.

I have studied this stuff in depth and there is a lot of research out there that doesn't get into the popular media. Stuff studied in universities that goes into scientific journals and searchable on PubMed, a database for searching for published scientific literature. Just because they don't report about it on Good Morning America or in Newsweek, doesn't mean that someone hasn't looked at it.

Clinical studies have shown that low folates, particularly in people who are missing an enzyme to break down folate, can cause treatment-resistant depression and schizophrenia. I have purchased a MEDICAL TEXTBOOK meant for MAINSTREAM DOCTORS on the treatment of depression and bipolar disorder and it specifically states to try patients on 5-MTHF if they are not responding to standard treatment with SSRI's http://www.amazon.com/Stahls-Illustrate ... r=8-3#noop (you can "look inside the book" and search the term 5-MTHF and it will show you the same info. In addition I have found information related to this on Dr. Oz's website as well as on PubMed.

Folate is also is responsible for reducing homocysteine, a chemical, which when too high, is related to poor cardiac health and also plays a role in reducing cholesterol. Folates also play a role in cell apoptosis or cell death and turnover--if you don't have enough folate, cells that would normally turn off and die keep growing and multiplying and turn into: cancer. I could go on and on and on--because mother nature or God or whomever you believe made us the way we are didn't use each vitamin/mineral for just one thing, but for many things. Rather than criticizying and calling me "cuckoo" maybe you should know that I have spent literally HOURS every single day for the last 6 months pouring over medical information and books written by DOCTORS.

As far as giving it to my children, that is none of your business. But it is a freaking vitamin--just in a slightly more bioavailable form. 5-MTHF is the form folic acid takes when the liver uses the enzyme MTHFR to break folic acid down. If you don't have that enzyme, you can take the form directly. Do you even realize that folic acid is not one chemical compound but many, depending on what stage of its metabolic pathway it is in?

Folic acid is critical to a part of the metabolism called the methylation pathway. You can google it--it is a real, scientifically studied aspect of our biology. If you don't have enough folic acid, you are going to have ALL KINDS of problems. I have been extremely cautious about giving my children the same amount of this vitamin that would be in a multivitamin for their agegroup, FYI. I don't give my kids any weird supplements. Just a multi-vitamin/multimineral, a childrens calcium vitamin and some omega 3 vitamins and the 5-MTHF because this defect is genetic and it won't hurt them to have folic acid. Some vitamin companies even use this form of folic acid instead of the standard form in their multi-vitamins but I cannot find this available in a kids vitamin.

And since you are so mean, I will tell you this--my family has a long history of neural tube defects, despite good diet and folic acid supplementation. My brother was born anencephalic. So I know what spina bifida is. I have had multiple miscarriages which my doctors now believe was probably due to this defective gene. My REGULAR INTERNIST was convinced after I showed him all my research and told him my family history and he is sending me to a MEDICAL GENETICIST to be tested for this DEFECTIVE GENE which is a real thing.

The symptoms I have are real and I have been to so many doctors it makes my head spin. If they can't figure out what is wrong with me, that it is up to me to research and keep trying to figure it out and keep going to doctors. Rather than just exist, I want to live and be happy. And I'm not going to let my children go through life with a sick mom when I could be really healthy. So, I have devoted all my spare time into this. I would rather have a fun hobby. Instead I'm trying to get well.

You don't know anything about me or what I have been through. Maybe you shouldn't leap to such harsh judgement.

THis most certainly IS relavent to a cpap forum. There are many of us here suffering from chronic fatigue despite successful CPAP treatment. We are all just looking for answers. Many of these people may be hypothyroid. Maybe others will discover that they have the same defective gene that I believe I do. I'm betting that this information about folic acid is going to become common knowledge eventually.

Did you know that the government mandated in the 1990's that all bread and flour products be supplemented with folic acid. And they recently have realized that not only did it reduce neural tube defects, but cancer rates and cardiac rates have gone down as well, and the government is now considering increasing the dose of folic acid in these foods? Why don't you try a simple google search before you spout your vitriol: Here, I'll do the work for you:

folic acid and depression About 1,650,000 results (0.28 seconds)

http://www.google.com/search?hl=en&rls= ... =&gs_rfai=

folic acid and schizophrenia About 414,000 results (0.43 seconds)

http://www.google.com/search?hl=en&rls= ... c&gs_rfai=

folic acid and cholesterol About 1,410,000 results (0.27 seconds)

http://www.google.com/search?hl=en&rls= ... =&gs_rfai=

folic acid osteoporosis About 788,000 results (0.27 seconds)

http://www.google.com/search?hl=en&rls= ... p&gs_rfai=

folic acid and heart About 3,230,000 results (0.28 seconds)

http://www.google.com/search?q=folic+ac ... 1I7GZAZ_en

folic acid prevent cancer Advanced searchAbout 153,000 results (0.27 seconds)

http://www.google.com/search?hl=en&rls= ... =&gs_rfai=

folic acid fatigue About 950,000 results (0.27 seconds)

http://www.google.com/search?hl=en&rls= ... =&gs_rfai=

MTHFR gene mutation About 129,000 results (0.27 seconds)

http://www.google.com/search?hl=en&rls= ... R&gs_rfai=


Oh, yeah, type MTHFR into PubMed, like I just did, and words come up in the top 20 results like cancer, cancer and cancer, homocysteinemia (homocysteine is too high which is bad for the heart), miscarriage, cleft palate, stroke, hypercholesterolemia (too much cholesterol), glaucoma, hypertension disorders of pregnancy (which I had as well). So, yeah, they are doing scientific research on this defective gene and how it relates to all kinds of things that affect the body in all kinds of ways.

Most medical doctors working today are NOT aware of all this scientific work going on. They are only aware of the info the drug companies bring them. No drug company can patent a vitamin because it is a natural substance, so they are not interested in it, since anyone can make it. They won't make the money back that they would put into testing for safety etc. This leaves people like me completely in the dark, searching for answers. Luckily I live in the age of information. There are books, medical websites and forums where I can share information with others who are suffering the same thing. This gives me a much better chance of finding an answer.

Before I started taking 5-MTHF, again, a special form of folic acid that most people's bodies just make on their own, but some can't, I had to drag myself through every day. Barely able to function. My body had no energy and my cognitive function and mood were impaired. No medication the doctor gave me made a dent in how I felt. Within four days of starting the 5-MTHF, I started regaining energy, and my mood improved and it all kept improving with time. Now I'm doing far more every day than just the bare minimum and that is better for me and my children. I'm currently researching medical geneticists. I will have to travel an hour just to see one.

Ask anyone who is familiar with me and my posts here on cpaptalk, and they will tell you, "Jen knows her shit."

[echo]

Julie, i have been debating replying to your post. At first I thought to ignore it, but I must say a few words in Jen's defense. Also while I at first reacted very strongly and emotionally to your post, I've re-read it and it's not so harsh, but still I feel the need to respond.

First, perhaps you're right that this particular THREAD in this particular context isn't the right place to discuss the issue of folates or whatever else Jen may be experiencing in relation to her OSA or not, but in all fairness please don't blast her for discussing this or any other issue in this FORUM because as we all know, (a) many things affect OSA or are affected by, whether we realize it or not and (b) there are many other weird off-topic things that are discussed here and should be, since we are all human and suffer many other maladies besides OSA and need to learn from each other.

Second, while to the claims made related to folates may be cuckoo-talk to you, I have a few comments on that:
- Everyone here on this forum should always subscribe to the "buyer beware" philosophy with ANYthing that's said here. All (well most) of us are not medical professionals, and everything we say is either the result of opinion, deep thought, experience, or lots of self education. Lots of us give dial-winging advice without knowing what other medical issues may be at play... not every poster reveals that they may have COPD, or epilepsy, or heart disease, yet we tell them to raise or lower the pressure, tape their mouths, or whatever. Usually this is carried with a disclaimer but not always. Newbies should be aware of this at all times regardless of who is giving the advice!

- Many medical conditions are also a hodge podge of symptoms that we all pick and choose from. OSA can cause anything from daytime tiredness to morning headaches, but also irritability, heart disease and attacks, stroke, memory problems, verbal problems, ... all seemingly unrelated conditions that we can all pick and choose from. Not everyone suffers from every single symptom of OSA, or hypothryoidism, or whatever, rather we look for patterns. Anyway I wouldn't be surprised that untreated OSA also increases the risk of cancer due to increasing the inflammation in the body from reduced oxygen levels. Would we call that crazy-talk here?

- Finally, there are again much crazy-talk that has been labelled as such for the last, say, 20 years ago, but people are FINALLY starting to realize that it's not so crazy. Recently even the AHA has started accepting the fact that CARBS and NOT FATS may be the culprit in heart disease, despite the fact that they have been encouraging a low fat diet for decades, and despite the fact that many crazy-talkers have been pushing low carb diets for just as long (and they were labelled crazy. Look at Atkins? Montignac? The Carbohydrate-Addiction authors. Not all the low-carb people were medical doctors either.). Same can be said for food allergies and food intolerances - how long has it taken the medical community to accept these are real medical issues, causing anything from hives and rashes to headaches and mood changes (they're still working on accepting the latter issues BTW). And finally what about good gut bacteria? People have been saying for years that many symptoms and un-related issues are actually due to an imbalance in the gut bacteria, it's only in recent years that this has gone from witch-doctor status to accepted medical fact. I'm sure there are many other examples.

So while I agree with your general statements that: we should be careful what we say to "newbies" and we should keep posts in the right threads, I also say that this is a free forum and that anyone reading these posts should practice the "buyer beware" philosophy.

Jen, I suggest that you start a new thread from your last post or two and we start a healthy debate on that new post.

EDIT: Jen I see that you made a post just 3 minutes before mine. I should have known you didn't need ME to defend YOU. Still , shall we move this to a new thread ? I find it all very fascinating.

[socknitster]

And for a comprehensive overview of the importance of folic acid, all in one place (and LOOK, there are scientific references right there at the bottom of the page)

http://www.whfoods.com/genpage.php?tnam ... nt&dbid=63

folate

What can high-folate foods do for you?
Support red blood cell production and help prevent anemia
Help prevent homocysteine build-up in your blood
Support cell production, especially in your skin
Allow nerves to function properly
Help prevent osteoporosis-related bone fractures
Help prevent dementias including Alzheimer's disease
What events can indicate a need for more high-folate foods?

Irritability
Mental fatigue, forgetfulness, or confusion
Depression
Insomnia
General or muscular fatigue
Gingivitis or periodontal disease
Excellent sources of folate include romaine lettuce, spinach, asparagus, turnip greens, mustard greens, calf's liver, parsley, collard greens, broccoli, cauliflower, beets, and lentils.



For serving size for specific foods, see Nutrient Rating Chart below at the bottom of this page.

Description
Function
Deficiency Symptoms
Toxicity Symptoms
Cooking, storage and processing
Factors that affect function
Drug-nutrient interaction
Nutrient interaction
Health conditions
Supplements
Food Sources
Public Recommendations
References



Description

What is folate?

Folic acid, also called folate or folacin, is a B-complex vitamin most publicized for its importance in pregnancy and prevention of pregnancy defects. These defects involve malformation of a structure in the fetus called the neural tube. As the baby develops, the top part of this tube helps form the baby's brain, and the bottom part unfolds to become the baby's spinal column.

When the neural tube fails to close properly, serious brain and spinal problems result. Mothers with inadequate supplies of folic acid have been determined to give birth to a greater number of infants with neural tube defects. Beginning in the early 1980's, researchers began to successfully use folic acid supplementation to reduce the risk of nervous system problems in newborn infants.

Folic acid is one of the most chemically complicated vitamins, with a three-part structure that puts special demands on the body's metabolism. The three primary components of folic acid are called PABA, glutamic acid, and pteridine. (Two of these components, glutamic acid and pteridine, help explain the technical chemical name for folate, namely pteroylmonoglutamate.)

As complex as this vitamin is in its structure, it is equally as complicated in its interaction with the human body. For example, most foods do not contain folic acid in the exact form described above, and enzymes inside the intestine have to chemically alter food forms of folate in order for this vitamin to be absorbed. Even when the body is operating at full efficiency, only about 50% of ingested food folate can be absorbed.

How it Functions

What is the function of folate?

Red blood cell formation and circulation support

One of folate's key functions as a vitamin is to allow for complete development of red blood cells. These cells help carry oxygen around the body. When folic acid is deficient, the red bloods cannot form properly, and continue to grow without dividing. This condition is called macrocytic anemia, and one of its most common causes is folic acid deficiency.

In addition to its support of red blood cell formation, folate also helps maintain healthy circulation of the blood throughout the body by preventing build-up of a substance called homocysteine. A high serum homocysteine level (called hyperhomocysteinemia) is associated with increased risk of cardiovascular disease, and low intake of folate is a key risk factor for hyperhomocysteinemia. Increased intake of folic acid, particularly by men, has repeatedly been suggested as a simply way to lower risk of cardiovascular disease by preventing build-up of homocysteine in the blood.

Preliminary research also suggests that high homocysteine levels can lead to the deterioration of dopamine-producing brain cells and may therefore contribute to the development of Parkinson's disease. Therefore, folate deficiency may have an important relationship to neurological health.

Research is now confirming a link between blood levels of folate and not only cardiovascular disease, but dementias, including Alzheimer's disease.

One of the most recent studies, which was published in the July 2004 issue of the American Journal of Clinical Nutrition evaluated 228 subjects. In those whose blood levels of folate were lowest, the risk for mild cognitive impairment was more than tripled, and risk of dementia increased almost four fold. Homocysteine, a potentially harmful product of cellular metabolism that is converted into other useful compounds by folate, along with vitamin B6 and B 12, was also linked to dementia and Alzheimer's disease. Individuals whose homocysteine levels were elevated had a 4.3 (more than four fold) increased risk of dementia and a 3.7 (almost four fold) increased risk of Alzheimer's disease.

Research teams in the Netherlands and the U.S. have confirmed that low levels of folic acid in the diet significantly increases risk of osteporosis-related bone fractures due to the resulting increase in homocysteine levels. Homocysteine has already been linked to damage to the arteries and atherosclerosis, plus increased risk of dementia in the elderly. Now, in a study that appeared in the May 2004 issue of the New England Journal of Medicine, researchers at the Eramus Medical Center, Rotterdam, Holland, and another team in Boston have confirmed that individuals with the highest levels of homocysteine have a much higher risk of osteoporotic fracture.

In the Rotterdam study, which included 2,406 subjects aged 55 years or older, those with the highest homocysteine levels, whether men or women, almost doubled their risk of fracture. The Boston team found that risk of hip fracture nearly quadrupled in men and doubled in women in the top 25% of homocysteine levels.

Both groups found that folic acid reduced the risk of osteoporotic fractures by reducing high levels of homocysteine. While the researchers are suggesting that bread and cereal products intended for the elderly should be fortified with folic acid to reduce homocysteine levels and thus the risk of bone fracture, we at the World's Healthiest Foods have a simpler suggestion: Eat a minimum of 5 servings of folic acid-rich foods each day! Why settle just for folic acid when these vegetables provide not only folic acid, but hundreds of other nutrients that promote your health and well-being in dozens of ways. Plus, with the quick, easy and delicious recipes George Mateljan has created for you, getting your folic acid can be an infinitely more interesting and pleasant experience than eating a piece of fortified bread!

Cell Production

Cells with very short life spans (like skin cells, intestinal cells, and most cells that line the body's exposed surfaces or cavities) are highly dependent on folic acid for their creation. For this reason, folic acid deficiency has repeatedly been linked to problems in these types of tissue.

In the mouth, these problems include gingivitis, cleft palate, and periodontal disease. In the skin, the most common folate deficiency-related condition is seborrheic dermatitis. Vitiligo (loss of skin pigment) can also be related to folic acid deficiency. Cancers of the esophagus and lung, uterus and cervix, and intestine (especially the colon) have been repeatedly linked to folate deficiency.

Nervous system support

Prevention of neural tube defects in newborn infants is only one of the nervous system-related functions of folic acid. Deficiency of folate has been linked to a wide variety of nervous system problems, including general mental fatigue, non-senile dementia, depression, restless leg syndrome, nervous system problems in the hands and feet, irritability, forgetfulness, confusion, and insomnia. The link between folate and many of these conditions may involve the role of folate in maintaining proper balance in nervous system's message-carrying molecules. These molecules, called neurotransmitters, often depend upon folic acid for their synthesis. It's been fascinating to see a link discovered by researchers between mothers who follow a Mediterranean-style diet and lowered risk of spina bifida (SB) in their infants. (SB is a set of conditions that include neural tube defects.) The ability of a Mediterranean-type diet to supply rich amounts of folic acid and other nervous system supportive nutrients is believed to be the reason that a Mediterranean-type diet in the lifestyle of the mother works so well in decreasing her infant's SB risk.

Deficiency Symptoms

What are deficiency symptoms for folate?

Because of its link with the nervous system, folate deficiency can be associated with irritability, mental fatigue, forgetfulness, confusion, depression, and insomnia. The connections between folate, circulation, and red blood cell status make folate deficiency a possible cause of general or muscular fatigue. The role of folate in protecting the lining of body cavities means that folate deficiency can also result in intestinal tract symptoms (like diarrhea) or mouth-related symptoms like gingivitis or periodontal disease.

Toxicity Symptoms

What are toxicity symptoms for folate?

At very high doses greater than 1,000-2,000 micrograms, folate intake can trigger the same kinds of nervous system-related symptoms that it is ordinarily used to prevent. These symptoms include insomnia, malaise, irritability, and intestinal dysfunction. Primarily for these reasons, the Institute of Medicine at the National Academy of Sciences set a tolerable upper limit (UL) in 1998 of 1,000 mcg for men and women 19 years and older. This UL was only designed to apply to "synthetic folate" defined as the forms obtained from supplements and/or fortified foods.

Impact of Cooking, Storage and Processing

How do cooking, storage, or processing affect folate?

Folate contained in animal products (like beef liver) appears to be relatively stable to cooking, unlike folate in plant products (like cabbage) which can lose up to 40% of their folate content from cooking. Processed grains and flours can lose up to 70% of their folate, and despite this processing loss, processed grains and flours are not required to be enriched with folate, even though they are legally required to be enriched with other B vitamins including B1, B2, and B3.

Factors that Affect Function

What factors might contribute to a deficiency of folate?

In addition to poor dietary intake of folate itself, deficient intake of other B vitamins can contribute to folate deficiency. These vitamins include B1, B2, and B3 which are all involved in folate recycling. Poor protein intake can cause deficiency of folate binding protein which is needed for optimal absorption of folate from the intestine, and can also be related to an insufficient supply of glycine and serine, the amino acids that directly participate in metabolic recycling of folate. Excessive intake of alcohol, smoking, and heavy coffee drinking can also contribute to folate deficiency.

Drug-Nutrient Interactions

What medications affect folate?

Medications that can help deplete the body's supply of folate include: anticancer drugs like methotrexate; cholesterol-lowering drugs like cholestyramine; anti-inflammatory drugs like sulfasalazine; biguanide drugs like buformin, phenformin, or metformin used in the treatment of diabetes; birth control pills (oral contraceptives); potassium-sparing diuretics like triamterene; and antibiotics like trimethoprim or pyrimethamine. While the anti-convulsant drug phenytoin (sold under the brand name of Dilantin or Phenytek) remains somewhat controversial in terms of its impact on folate, several animal studies have shown a lowering of the liver's ability to make polyglutamyl forms of this vitamin following adminstration of phenytoin.

Nutrient Interactions

How do other nutrients interact with folate?

Vitamins B1, B2, and B3 must be present in adequate amounts to enable folic acid to undergo metabolic recycling in the body. Excessive amounts of folic acid, however, can hide a vitamin B12 deficiency, by masking blood-related symptoms.

Health Conditions

What health conditions require special emphasis on folate?

Folate may play a role in the prevention and/or treatment of the following health conditions:

Alcoholism
Anemias (especially macrocytic anemia)
Atherosclerosis
Cervical dysplasia
Cervical tumors
Cleft palate or cleft lip
Crohn's disease
Depression
Diarrhea
Gingivitis
Glossitis
Glycogen storage disease type I
Hyperhomocysteinemia
Inflammatory bowel disease
Insomnia
Myelopathy
Neural tube defects
Non-senile dementia
Ovarian tumors
Periodontal disease
Restless leg syndrome
Schizophrenia
Seborrheic dermatitis
Tropical sprue
Uterine tumors
Form in Dietary Supplements

What forms of folate are found in dietary supplements?

Folic acid is normally found in its simple form (also called pteroylmonoglutamic acid) in dietary supplements. Folinic acid (also called 5-formyltetrahydrofolate) is also available, and can help by-pass certain biochemical steps that occur in the body once folate has been absorbed from the intestine.

Food Sources

What foods provide folate?

Excellent sources of folate include romaine lettuce, spinach, asparagus, turnip greens, mustard greens, calf's liver, parsley, collard greens, broccoli, cauliflower, beets, and lentils.

Very good sources include squash, black beans, pinto beans, garbanzo beans, papaya and string beans.



Introduction to Nutrient Rating System Chart
In order to better help you identify foods that feature a high concentration of nutrients for the calories they contain, we created a Food Rating System. This system allows us to highlight the foods that are especially rich in particular nutrients. The following chart shows the World's Healthiest Foods that are either an excellent, very good, or good source of folate. Next to each food name, you'll find the serving size we used to calculate the food's nutrient composition, the calories contained in the serving, the amount of folate contained in one serving size of the food, the percent Daily Value (DV%) that this amount represents, the nutrient density that we calculated for this food and nutrient, and the rating we established in our rating system. For most of our nutrient ratings, we adopted the government standards for food labeling that are found in the U.S. Food and Drug Administration's "Reference Values for Nutrition Labeling." Read more background information and details of our rating system.
World's Healthiest Foods ranked as quality sources of:
folate
Food Serving
Size Cals Amount
(mcg) DV
(%) Nutrient
Density World's
Healthiest
Foods Rating
Romaine lettuce 2 cup 15.7 151.98 38.0 43.6 excellent
Spinach, boiled 1 cup 41.4 262.80 65.7 28.6 excellent
Asparagus, boiled 1 cup 43.2 262.80 65.7 27.4 excellent
Turnip greens, cooked 1 cup 28.8 170.50 42.6 26.6 excellent
Mustard greens, boiled 1 cup 21.0 102.76 25.7 22.0 excellent
Calf's liver, braised 4 oz-wt 187.1 860.70 215.2 20.7 excellent
Parsley, fresh 2 tbs 2.7 11.40 2.9 19.0 good
Kelp (sea vegetable) 0.25 cup 8.6 36.00 9.0 18.8 very good
Collard greens, boiled 1 cup 49.4 176.70 44.2 16.1 excellent
Broccoli, steamed 1 cup 43.7 93.91 23.5 9.7 excellent
Cauliflower, boiled 1 cup 28.5 54.56 13.6 8.6 excellent
Beets, Boiled 1 cup 74.8 136.00 34.0 8.2 excellent
Celery, raw 1 cup 19.2 33.60 8.4 7.9 very good
Lentils, cooked 1 cup 229.7 357.98 89.5 7.0 excellent
Brussel sprouts, boiled 1 cup 60.8 93.60 23.4 6.9 very good
Pinto beans, cooked 1 cup 234.3 294.12 73.5 5.6 very good
Black beans, cooked 1 cup 227.0 255.94 64.0 5.1 very good
Garbanzo beans (chickpeas), cooked 1 cup 269.0 282.08 70.5 4.7 very good
Kidney beans, cooked 1 cup 224.8 229.39 57.3 4.6 very good
Summer squash, cooked, slices 1 cup 36.0 36.18 9.0 4.5 very good
Cucumbers, slices, with peel 1 cup 13.5 13.52 3.4 4.5 good
Navy beans, cooked 1 cup 258.4 254.62 63.7 4.4 very good
Papaya 1 each 118.6 115.52 28.9 4.4 very good
Green beans, boiled 1 cup 43.8 41.63 10.4 4.3 very good
Cabbage, shredded, boiled 1 cup 33.0 30.00 7.5 4.1 very good
Fennel, raw, sliced 1 cup 27.0 23.50 5.9 3.9 very good
Bell peppers, red, raw, slices 1 cup 24.8 20.24 5.1 3.7 very good
Leeks, boiled 0.50 cup 16.1 12.64 3.2 3.5 good
Green peas, boiled 1 cup 134.4 101.28 25.3 3.4 very good
Lima beans, cooked 1 cup 216.2 156.23 39.1 3.3 good
Winter squash, baked, cubes 1 cup 80.0 57.40 14.3 3.2 good
Tomato, ripe 1 cup 37.8 27.00 6.8 3.2 good
Oranges 1 each 61.6 39.69 9.9 2.9 good
Crimini mushrooms, raw 5 oz-wt 31.2 19.85 5.0 2.9 good
Strawberries 1 cup 43.2 25.49 6.4 2.7 good
Flaxseeds 2 tbs 95.3 53.86 13.5 2.5 good
Split peas, cooked 1 cup 231.3 127.20 31.8 2.5 good
Raspberries 1 cup 60.3 31.98 8.0 2.4 good
Eggplant, cooked, cubes 1 cup 27.7 14.26 3.6 2.3 good
Onions, raw 1 cup 60.8 30.40 7.6 2.3 good
Cantaloupe, cubes 1 cup 56.0 27.20 6.8 2.2 good
Kale, boiled 1 cup 36.4 17.29 4.3 2.1 good
Swiss chard, boiled 1 cup 35.0 15.05 3.8 1.9 good
Corn, yellow, cooked 1 cup 177.1 76.10 19.0 1.9 good
Peanuts, raw 0.25 cup 207.0 87.53 21.9 1.9 good
Grapefruit 0.50 each 36.9 15.01 3.8 1.8 good
Sunflower seeds, raw 0.25 cup 205.2 81.86 20.5 1.8 good
Avocado, slices 1 cup 235.1 90.37 22.6 1.7 good
Carrots, raw 1 cup 52.5 17.08 4.3 1.5 good
World's Healthiest
Foods Rating Rule
excellent DV>=75% OR Density>=7.6 AND DV>=10%
very good DV>=50% OR Density>=3.4 AND DV>=5%
good DV>=25% OR Density>=1.5 AND DV>=2.5%


Public Health Recommendations

What are current public health recommendations for folate?

The Recommended Dietary Allowances for folic acid, set in 1998 by the Institute of Medicine at the National Academy of Sciences, are as follows:

0-6 months: 65 micrograms
6-12 months: 80 micrograms
1-3 years: 150 micrograms
4-8 years: 200 micrograms
Males 9-13 years: 300 micrograms
Males 14 years and older: 400 micrograms
Females 9-13 years: 300 micrograms
Females 14 years and older: 400 micrograms
Pregnant females of any age: 600 micrograms
Lactating females of any age: 500 micrograms
References

Bazzano LA, He J, Odgen LG et al. Dietary intake of folate and risk of stroke in US men and women:NHANES I Epidemiologic Follow-up Study. Stroke 2002 May;33(5):1183-9 2002.
Beers MH, Berkow R. The Merck manual of diagnosis and therapy. Merck Research Laboratories, Whitehouse Station, New Jersey, 1999;850-870 1999.
Bower C, Stanley FJ, Nicol DJ. Maternal folate status and the risk for neural tube defects. The role of dietary folate. Ann N Y Acad Sci 1993;678:146-55 1993.
Brody T, Shane B, Stokstad ELR. Folic acid. In: Machlin LJ. (Ed). Handbook of vitamins. Marcel Dekker, New York, 1984 1984.
Coombs GF. The vitamins. Academic Press, San Diego, 1992;357-376 1992.
Duan W, Ladenheim B, Cutler RG et al. Dietary folate deficiency and elevated homocysteine levels endanger dopiminergic neurons in models of Parkinson's disease. J Neurochem 2002 Jan;80(1):101-10 2002.
Fernstrom JD. Can nutrient supplements modify brain function. Am J Clin Nutr 2000;71:(6 Suppl):1669S-75S 2000.
Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995 1995.
Mason JB, Levesque T. Folate: effects on carcinogenesis and the potential for cancer chemoprevention. Oncology (Huntingt) 1996;10(11): 1727-1743 1996.
Montes LF, Diaz ML, Lajous J, et al. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis 1992;50:39-42 1992.
Onicescu D, Marin A, Mischiu L. Folate metabolism in normal human gingiva and in chronic marginal periodontitis. Rev Chir Oncol Radiol 1978;25(4): 257-64 1978.
Pancharuniti N, Lewis CA, Sauberlich HE, et al. Plasma homocyst(e)ine, folate, and vitamin B12 concentrations and risk for early-onset coronary artery disease. Am J Clin Nutr 1994;59:940-948 1994.
Quadri P, Fragiacomo C, Pezzati R, Zanda E, Forloni G, Tettamanti M, Lucca U. Homocysteine, folate, and vitamin B-12 in mild cognitive impairment, Alzheimer disease, and vascular dementia. Am J Clin Nutr. 2004 Jul;80(1):114-22. 2004. PMID:15213037.
Ristow KA, Gregory JF, Damron BL. Thermal processing effects on folacin bioavailability in liquid model food systems, liver and cabbage. J Agr Food Chem 1982;30(5):801-806 1982.
Scholl TO, Johnson WG. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr 2000 May;71(5 Suppl):1295S-303S 2000. PMID:10430.
Steinberg SE. Mechanisms of folate homeostasis. Am J Physiol 1984;246:G319-G324 1984.
Terry P, Jain M, Miller AB et al. Dietary intake of folic acid and colorectal cancer risk in a cohort of women. Int J Cancer 2002 Feb 20;97(6):864-7 2002.
Ubbink JB, Vermaak WJ, van der Merwe A, Becker PJ. Vitamin B-12, vitamin B-6, and folate nutritional status in men with hyperhomocysteinemia. Am J Clin Nutr 1993 Jan;57(1):47-53 1993. PMID:19560.
van Meurs JB, Dhonukshe-Rutten RA, Pluijm SM, van der Klift M, de Jonge R, Lindemans J, de Groot LC, Hofman A, Witteman JC, van Leeuwen JP, Breteler MM, Lips P, Pols HA, Uitterlinden AG. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med. 2004 May 13;350(20):2033-41. 2004. PMID:15141041.
Vujkovic M, Steegers EA, Looman CW et al. The maternal Mediterranean dietary pattern is associated with a reduced risk of spina bifida in the offspring. BJOG: An International Journal of Obstetrics and Gynaecology. Kidlington: Feb 2009. Vol. 116, Iss. 3; pg. 408-415. 2009.
Zimmerman MB, Shane B. Supplemental folic acid. Am J Clin Nutr 1993;58:127-128 1993.

[socknitster]

EDIT: Jen I see that you made a post just 3 minutes before mine. I should have known you didn't need ME to defend YOU. Still , shall we move this to a new thread ? I find it all very fascinating.

Agreed.

viewtopic.php?f=1&t=52164

Here it is.

[Julie]

Well, I suppose I expected a strong reaction to my note, though I"m not sure anyone believes how strongly I felt when posting it. I just find it hard to accept that you really imagined no one would question that line I quoted from your note. I wasn't saying I thought you were cuckoo, but absolutely had to respond to that statement about how what you yourself say is just a vitamin causes every serious disease known to man, more or less. I also was not dissing folates, they were just the chemical in question. However, I would like to ask when you got your degree (in biology), what (one) textbook you read and when was it published, and to say that I believe children are everyone's business when it comes to their wellbeing (I am right now hugely resisting the urge to sound off very loudly on this, but won't). I am more than familiar with homocysteine, folates, and a slew of other substances of all kinds, from vitamins to self-made (by the body) ones, to the many manufactured drugs which I myself question every day - the list of side effects scare the living daylights out of me even while I know the list is published mostly at the behest of drug co's lawyers, and may only reflect a tiny fraction of people taking the meds. But that's another discussion. For the record, I spent over 30 yrs in teaching hospitals, working in research depts. from genetics to neurology, pathology to endocrinology, and everything else in between, some of the time with doctors short-listed for Nobels, and if you want me to cite articles or opinions or whatever here, I'd be happy to, though probably won't - not interested in competing with your endless lists. It was not my intention to upset anyone, and I believe you are sincere in your beliefs, as well as quite likely correct in many of your conclusions whatever 'science' they are based on, but I would hope you could understand that for a person coming from a strongly traditional medical background, that statement (and other things asserted in your note) was at least as incendiary to me as mine was to you.

[socknitster]

I think it is interesting that you ask for my credentials but do not offer your own besides the vague, "worked with nobel laureates."

FYI, my degree in Biology is from Monmouth College, 1995. I did science research internships at University of Illinois and a school sponsored internship in Costa Rica. I also worked for years at the Purdue University Veterinary School in the Serology laboratory. I have taken further coursework in horticulture and landscape architecture at Purdue. I am now a stay at home mom and ADORE my children and want only the absolute best for them. Your comments to the contrary are incredibly insulting.

I never said every serious disease known to man was related to folic acid. Now who is being inflammatory? I just listed the ailments that I had read were associated with it. I listed a link to amazon.com where you can check out the book I mentioned that talks about 5-MTHF and its use in drug-treament-resistant depression. If you just look, the information is all right there ready for you to click on above. You can search and read excerps from the book yourself, right there on amazon. And it was published recently, btw. 2009 or 2010.

You know, I'm just doing the best I can. Do you get that? I have been very, very sick and no doctor has been able to help me. Over the years I have seen several internists, endocrinologists, rheumatologists, sleep doctors, hematologists and none of them have helped besides giving me antidepressants. What am I supposed to do, curl myself in a ball and wait for death? My CRP was so high, the lab flagged it as being at increased risk of a cardiac event. I am in serious pain and have suffered debilitating fatigue. If I have found something that has actually helped me, why do you have a problem with me telling other people about it?
Who made you the moderator of this forum?

Did you look at the links I provided, because they show that folates are implicated in all of the ailments I mentioned--some of this stuff is actually common knowledge. There is more to folic acid than spina bifida. A lot more. It is in the popular media all the time that people should take them for heart health.

Medical, shmedical. If no doctor has helped me yet, I guess I shouldn't expect any different from someone with a "strong medical background" whatever your supposed credentials. It WAS your intention to upset me, or you would have worded your post more kindly. Nice bedside manner.