Nutrition is Public Health - Folate and Folic Acid

Folate (vitamin B9) prenatal vitamins and food fortification is classic public health. 

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Transcript

SPEAKER_01 0:05

Welcome back to Everything is Public Health. I'm MJ. And I'm Cass. Do you take any supplements? Why or why not?

SPEAKER_00 0:12

Okay. How do you define a supplement? Like vitamins?

SPEAKER_01 0:15

It has to be like a pill.

SPEAKER_00 0:17

Yeah, but like something to supplement my diet that's not food.

SPEAKER_01 0:22

Yeah.

SPEAKER_00 0:22

So, like, yeah, I take multivitamin every morning. I take collagen because I was getting achy, achy joints. Like my knees and my hips were getting super achy. And more and more there is recognition that women who are approaching perimenopause and menopause are losing muscle mass far too quickly and issues related to bone density and all of that. So I take creatine and yeah, whatever's in my vitamins. Like I take a woman-specific multivitamin every day, collagen and creatine.

SPEAKER_01 0:59

I mean, you exercise a lot, so I think that definitely helps.

SPEAKER_00 1:02

I do exercise a lot. So I I run a lot, obviously, and I do general strength training, but I know from a lot of older women in my social circle, along with women sports medicine doctors and those kinds of things, that women tend to not start to think about their bone health, muscle tone, all that kind of stuff until after menopause. And then it is too late. Like a lot of that is lost already. There's a growing recognition that women should probably be doing a lot more in terms of vitamins and things throughout their lives, but certainly sort of the age that I am, that's something I need to be thinking about.

SPEAKER_01 1:39

I mean, I guess that counts as your general impression on supplements, unless you have other things to add.

SPEAKER_00 1:43

So I would say I think we have a tendency in this country to think that a pill or some other simple solution will suddenly make us healthy. And I have a lot of issues with like We talked about this before, the magic bullet. Exactly. Like the general, like the supplement industry I don't love. I have a lot of issues with. Everything that I take is in consultation with my physician and as it should be. It's evidence-based, right? Like there are a couple of really well-known female orthopedic and sports medicine doctors who post recommendations, obviously, that then get discussed with your own physician. But you know, everything has like, hey, here's the 12 papers that we cited to make this recommendation.

SPEAKER_01 2:27

Real papers. Real actual papers. Not AI hallucinated papers.

SPEAKER_00 2:31

Right. Yes. These are actual physicians.

SPEAKER_01 2:34

Actual medicine.

SPEAKER_00 2:35

You know, not somebody who's genetically gifted and super fit, who's on Instagram telling you, ooh, I lost all this weight because I took this supplement, but like they never probably overweight to start with.

SPEAKER_01 2:46

Also, a red flag if they are selling the supplement. Of course. Red flag.

SPEAKER_00 2:50

Yeah.

SPEAKER_01 2:51

So my general impression of supplement is that we should take them if we need them.

SPEAKER_00 2:55

Yeah, absolutely.

SPEAKER_01 2:56

Pretty straightforward. Um, however, the wellness industry has completely captured the idea of the supplement. They would have people believe that the average person without taking any supplement is unhealthy. We're not going to break down the wellness industry, but we're here to discuss a public health intervention. This episode is about folic acid specifically.

SPEAKER_00 3:14

Folic acid is amazing. It is the precursor to folate, also known as vitamin B9, and our bodies turn folic acid into vitamin folate. Folic acid is what we manufacture artificially since folate is unstable and therefore unable to be stored long term. You can't go with folate, you do folic acid. But folate is an essential nutrient. That means this is not, we cannot make this ourselves. We must acquire it through our diet, the things that we're eating. Folate is necessary for DNA and RNA synthesis, metabolism, cell division, and production of certain cells. If you are deficient in folate, you can have anemia, fatigue, bleeding and sores, circulation issues, heart palpitations, and a bunch of other bad stuff. Folate, very good for you.

SPEAKER_01 4:01

And this is one of those where you really want to have enough of because the effect of it is very noticeable very quickly. Unsurprisingly, the vitamin responsible for cell division and DNA synthesis is particularly important during pregnancy, a time of rapid cell growth. As one of my physiology professors in college once said, the fastest growing tumor is a baby. And honestly, yes. Um, deficiency during pregnancy is bad for both the mother and the child. Specifically, it causes birth defects in the fetus if the mother has a folate deficiency. Mild deficiency will lead to low birth weight, which is not optimal. You want your baby to be healthy and big, while serious deficiencies will lead to serious neurotube defect. I don't know about you, Cass, but I think birth defects should be prevented if possible, especially if the prevention is very simple.

SPEAKER_00 4:48

Yeah, absolutely. This is one where it doesn't take a lot or even a lot of money, like it's not a lot of efforts, not a lot of money to prevent. It's very simple prenatal vitamins. All we have to do is have people take some pills while they're pregnant. In some cases, maybe before they even get pregnant in the lead up, but certainly after. And this is the standard of care. Pregnant people get prescribed these prenatal vitamins. You buy them over the counter, but really you're told, okay, you need to start taking prenatal vitamins that include folic acid and other vitamins and minerals that are good for both the pregnant person and the baby.

SPEAKER_01 5:23

A very simple solution to a very serious problem, such as a neurotube defects. Uh, some of them serious enough where the baby's health is compromised. Because the solution to this very serious problem is relatively simple and straightforward, taking a supplement, this is the perfect opportunity to treat this problem from a public health approach rather than strictly a medical approach. Having these prenatal vitamins as the standard of care is certainly public health because it's health policy, right? What we decide as the standard of care has wide-ranging implications about the health of the people in general. But ideally, folate level, and you mentioned this, should be adequate prior to the actual pregnancy. It's not just a prenatal vitamin. While people are trying to get pregnant, they may preemptively take folate supplement because it's very important. However, people who can become pregnant may not know that they are pregnant until weeks after conception. We mentioned this in the abortion episode. That's why, like, a four-week, six-week abortion restriction is very stupid because a lot of women simply wouldn't know that they're pregnant. So, from a public health perspective, we need another approach to prevent these birth defects because, again, we want that folate level to be high prior to the actual conception.

SPEAKER_00 6:30

Right on. And another consideration: not everyone, especially folks living in the US, have access to prenatal care or even health care in general. An intervention based on the standard of care where you are quote unquote prescribed prenatal vitamins might not reach everyone. So another public health approach is something called food fortification. So in the US, starting in 1998, breads, cereals, flours, cornmeals, pastas, rice, and other grain products received fortification with folic acid. Think about what we did with salt and iodine, right? And this reduced folate deficiency-related birth defects by 35%, which is absolutely huge. This general population level strategy of fortifying food reduced birth defects by a third.

SPEAKER_01 7:18

Yeah. So it's a massive public health intervention. And I sort of want to talk about this a little bit about the idea of food fortification, because it's just such a public health concept. And I love these interventions where it is the floor. You cannot get lower than this in terms of these wide-ranging interventions. And this reminds me of the whole fluoridation and water thing.

SPEAKER_00 7:43

Oh goodness. Yeah.

SPEAKER_01 7:45

But a lot of people are like, oh, people brush their teeth now. Why do we still need to fluoridate water? And I'm like, well, I know you certainly can think of someone who don't brush their teeth, but there's a lot of people out there who don't brush their teeth or can't brush their teeth.

SPEAKER_00 7:59

Maybe don't brush their teeth twice a day. Maybe they only brush once a day.

SPEAKER_01 8:03

Yeah. And it's just such a blanket floor public health intervention that I just love it. I love things like this. You know, it's so good.

SPEAKER_00 8:11

I love anything that can reach a broad population. And this is the kind of thing, like when we think about interventions, there are active interventions in there, passive interventions. Active requires you to do a thing. Like in the context of motor vehicle safety, getting into my car and putting my seatbelt on is an active intervention versus having passenger airbags and crumple zones and all that kind of stuff. That's passive, right? I don't have to do anything. My car came with it. I don't have to turn it on. And so in this case, food fortification is a passive intervention. As long as you are eating food that you are purchasing through the normal market, even flour that you purchase and then make your own food, you're going to be having fortification.

SPEAKER_01 8:52

Yeah. And like you said, the prenatal standard of care is active because you actually need to seek prenatal care. Not a lot of people have the option to do that. This is a very passive way of just ensuring coverage. Unfortunately, we live in times of rampant misinformation. Oh, you're shaking your head already.

SPEAKER_00 9:08

It's just, it makes me so sad.

SPEAKER_01 9:09

It does make me sad.

SPEAKER_00 9:10

Go to the source. Sorry, go ahead. Go to the source.

SPEAKER_01 9:14

Well, to them, the source is themselves.

SPEAKER_00 9:16

Social media is not a source, and your own opinion on a scientific fact is not a source unless you have the same kind of scientific training as the person who produced the data point.

SPEAKER_01 9:30

Which I think makes doctors who turn pseudoscience even more egregious because they can use their quote unquote credential. I don't know, maybe they're disbarred or uh they lost their license already. Doctor Yeah, like those are more egregious because then people can point to them and say, Oh, he has an MD. What he must say must be right. Does he?

SPEAKER_00 9:48

I mean Does he though?

SPEAKER_01 9:49

Not really.

SPEAKER_00 9:50

No, I mean he does, but like we should probably delete this portion about Dr. so we don't get sued for libel.

SPEAKER_01 9:57

Yeah, sure. But yeah, but the point is, there's a lot of misinformation out there perpetrated by normal people, but also people with degrees. There are a lot of pseudoscience scrifters out there who are pushing the lies that folic acid is dangerous and making us sick. This range from the minor folate in food is better than supplement to folic acid fortification is toxic and harming us. Now, I want to extend a slight, slight, tiny, tiny bit of sympathy towards at least the minor claim on this scale. Thinking folate from food is better than the supplement. Technically, not true, but I I sympathize with that, you know?

SPEAKER_00 10:35

Oh, 100%. Okay, so hang on. I am a proponent of a whole food diet, right? We would all be healthier and be leading more robust lives if we just ate whole foods. We buy foods, we cook them. It is the consumption of highly processed, packaged foods that are causing a lot of issues in the US in particular. And so, sure, you know, folate from food is better than a supplement if you're eating a balanced and healthy diet. But the reality is, as we've talked about many times on the show, not everybody actually has access to those kinds of healthy foods. Even if you were in an area where they were available, we have made choices to restrict access to those kinds of foods among certain groups because of concentrated disadvantage and disenfranchisement. So, yeah, on its face, sure. Okay, I can understand how people may say that, but also putting folic acid into food to fortify it, reduce birth defects by a third, how anybody could say, well, we should take it out is wild and allow all of these birth defects to occur is just moronic. Yeah.

SPEAKER_01 11:50

And again, if you want to eat a whole food diet, if you want to get your vitamins and minerals from Whole Foods, go for it.

SPEAKER_00 11:57

Have at it. And the concept of Whole Foods, not the store. Yeah.

SPEAKER_01 12:00

Also, just we don't, we're not, you know, supporting the store. If that's what you want to do, go for it, right? Like live your life. Eat food however you want to consume it, whether it's cooked or boiled or steamed, whatever. Right. But I think the issue is thinking that naturally occurring compounds and lab-made compounds are functionally different, which I think is one of the main common threads that we see over and over again. Yeah.

SPEAKER_00 12:24

Yeah. I think at the end of the day, what gets missed is our bodies don't care how a compound is made. We just need it. Like if I were to eat a bowl of sauteed spinach, functionally my body is going to treat that exactly the same as folic acid from a prenatal vitamin or some other source, right? My body can't tell the difference. But also what's important is folate is water soluble. So if you consume more than your body needs, it gets processed out and you pee it out and you go to the bathroom. So barring some like very rare condition or circumstance, it's not like we need to worry about excessive folate. And so it's uh something that you can create some panic over that doesn't actually have any impact on people's well-being, except when you don't get enough of it.

SPEAKER_01 13:10

Yeah. Again, we're not gonna dive into the wellness industry, but to me, it's ironic that the industry that's all about taking supplements is also responsible for people refusing prenatal supplements. It's such a weird space that these wellness gurus are operating in. And also they're always selling something. They're almost always the rejection of modern medicine is followed by a vocal promotion of some product that they're selling. And you just can't help but wonder what's your motivation here?

SPEAKER_00 13:39

Oh, it's capitalism. Always.

SPEAKER_01 13:41

Yeah, always capitalism. It's a weird space because they say they reject ultra-processed food, for example, which we're like, okay, yeah, you know, we should be eating whole, not the store again, whole foods. And then they will swing so hard to the other side of that's why we need to eat tallow instead of canola oil.

SPEAKER_00 13:58

Or like, yeah, we, you know, like we should be getting our vitamins and nutrients from food here, buy these gummies that give you your serving of spinach. Yeah. Because, you know, you don't want to eat vegetables or buy these capsules of ground-up vegetables. And it's like just eat the vegetables.

SPEAKER_01 14:19

I'm glad we're thinking of the same thing. But anyway, so folate and folic acid is one of those public health interventions that I love because it sets the floor, it is available to everyone, and it lowers birth defects by a whopping 35%. So two thumbs up to folate and folic acid. Two thumbs up. All right, micro good time.

SPEAKER_00 14:37

All right, I got a micro good for today.

SPEAKER_01 14:39

Ooh, tell us, tell us.

SPEAKER_00 14:40

Today, my micro good is please recycle your electronic waste. If you have a broken electronic of some kind, usually there is a way that you can recycle it. Because rather than continuing to strip our planet from metals and precious things that we need to make electronics, you can recycle the ones that you have that don't work anymore, and people can reprocess all of those expensive and important components and make something new and not pollute the environment.

SPEAKER_01 15:08

Very bad to have electronic waste in a landfill because they leach a lot of things into the ground. Another tip about e-waste recycling. Oftentimes, this varies depending on where you live, but some big companies will do e-waste drives, or some uh community centers will do e-waste drives. So it's sometimes it might be hard for you individually to e-waste recycle. But look for these, I don't know, big companies e-waste drives or like local community-based e-waste drive. Like they're probably your better options instead of you yourself taking the e-waste to a recycling plant. So yeah.

SPEAKER_00 15:40

So at least in where I live, our county dump, that's that's what I always grew up calling it the dump.

SPEAKER_01 15:47

I guess that's how you call it.

SPEAKER_00 15:49

They have special places where you can take cans of paint, you can take batteries, you can take electronics, and there's special places that you put each of the things. Our community has organized a paper shred and e-waste event before, and anybody could come to it. And actually, the new building that we're in right now temporarily while they're building our new building, they did a big e-waste push to do recycling in November. So, yeah, like you said, there are places that you can find them in your local community if you don't have easy access to something in your county, for example.

SPEAKER_01 16:23

Yeah. So look for those and sort of piggyback off of that. If you again, this might not be available to everyone, but if you can try to get your electronics repaired instead of throwing them out. There are a lot of places, at least where I live, that repairs laptops and phones. So I had an old laptop and it was running slow. I took it in and they said, Oh, we just need to replace this, and then it was working fine again. So saves me from throwing away an entire laptop. So you look into that as well. Thank you so much for listening to this episode of Everything is Public Health. New episodes every other week. If you like the show, please tell everyone you know about the show. That helps us immensely. Commenting, subscribing, and leaving us a review also helps us a bunch as well.

SPEAKER_00 17:04

If you have any questions or think we missed an important perspective, you can reach out to us at everythingispublichealth at gmail.com. Follow us on our website, everythingispublichealth.com, for all show updates and bonus material. And remember, everything is public health.

SPEAKER_01 17:18

Everything is public health.