Folate : Supplements 101

0:00 Welcome to episode 22 of The Cancer Pod. Today, we're talking about folate. What is it? Where does it come from? Why do we need it? What happens if we don't get enough? All this and more on today's episode of The Cancer Pod Supplements. 1 0 1. I'm Dr. Tina Kaeser and I like roasted brussel sprouts. And I'm Dr. Lee Sherman and I like steamed asparagus. And we're two naturopathic doctors who practice integrative cancer care, but we're not your doctors. This is for education, entertainment, and informational purposes only do not apply any of this information. Without first speaking to your doctor, the views and opinions expressed on this podcast by the host and their guests are solely their own welcome to the cancer.

1:02 So Tina, Yes, Leah. What's the deal with folate folic acid, vitamin B nine, so many names. Yeah, I think it's something that's really confusing, especially because there are people out there writing almost scientifically valid blog pieces, but missing the accuracy they're interchanging. The, the words around. Yes. So let's just be really clear. Folic acid does not occur in nature folate does. So first things first, when we're talking about B9, all of these are considered B9 variations.

1:44 Not to be confused with"benign." Right, not to be confused with the"benign." Folic acid and folate are used interchangeably a lot, but they're not the same molecule. And so chemically, the compounds are completely different. Folic acid is what is used to fortify foods. So it's added back after you process a food and pull B-vitamins out of a food. Folic acid is what's added back folate- And it's also what's used in supplements. Often it's what's used in supplements, especially if it's a less high quality supplement. Right. But it's probably more common in like certain grades. Higher grade supplements folate is used.

2:26 The common over the counter shelf stuff. You're mostly going to see folic acid. Yes. And of course we as always advocate food over supplements anyways, right And folate, which is found in food, can be gone from the diet. You can get plenty of full, late from the. How much someone needs depends on that person. Right? A pregnant woman, needs more folate than someone who's not going to be carrying a baby. For example, um, folic acid is absorbed more readily. ate and it's more stable. That's why they put it into supplements, that's why they put it into food. Folate degrades more quickly. So you need the plant cell wall to keep it inside the plant cell and the folate doesn't degrade until the actual food stuff, degrades.

3:10 But as long as it's inside the plant cell wall, it's fairly stable. And once you pull it out of there, like. Cook your food and left on the counter. It's going to degrade. So folate is very fragile. So it comes from green leafy vegetables. Um, so like your asparagus, your broccoli or kale, your, you know, anything that's green. And so using those as fresh as possible, you're guaranteeing to get a decent folate level. So like the wilted chard that's in my fridge that's been there for two weeks. Probably doesn't have the best levels. I'm guessing. You're right. You're right. And this goes back to that thing that we've talked about before, which is when you cook vegetables, if you are cooking them in any way and however you do it, steam it stir fry it, whatever the brightness signifies the most bioavailable moment.

3:59 You know, when we eat a plant, if we can see the broccoli is really bright green, that's when you've broken open those cell walls, the plant cell walls, and you're looking right at the chlorophyll. So it seems brighter than it did when it was raw, for example. And if you keep cooking it, it's going to get more and more gray really. So when you see like things of like different levels of full light in food, you'll sometimes see that cooked foods have higher folate content because it's more bioavailable because of steaming or, you know, however you've cooked it until that bright green point. Yes. Yeah. It's kind of one of those things that, isn't mentioned very often right in that is. Whenever we talk about nutrients in plants, they're inside the cell wall, which is made of cellulose and you and I can't digest cellulose.

4:39 We have to break it open either by chewing it, cooking it slightly, putting it in a blender, whatever we're going to do, we have to break, open that cell wall to get to the goodies inside. That's our cooking tip for today. not a big fan of green leafy vegetables. You can find folate in beans, peanuts, whole grains, sunflower seeds, seafood, eggs, even liver. So for those who have read about this before, you may have come across the term 5- M T H F, which is methyl-tetra-hydro- folate, or 5-methyltetrahydrofolate.

5:20 That is the most active forms of folate within the cell. the reason I'm mentioning this is there is anenzyme that some people are getting tested for to see if they even create that within their cells. So that's the M T H F R The genetic mutation. Yeah. So the MTHFR is an enzyme and that stands for methylene tetrahydrofolate reductase. Which is why we all say MTHFR, and that's why you say it. And not me. And some people are checking whether they got a little glitch, a little, what we call a snip M S N P snip stands for. Single nucleotide polymorphism.

6:02 That's it I'm done. That's all the big words I'll use today. I promise. Um, but anyways, those snips, if you got one from mom or one from dad, you may not convert folate, into a usable form as efficiently. Then you are going to produce less of this five MTHF, which is the very active form that's needed in the chemical reactions in the body. So those people often do better when they take a supplement that contains 5- M T H F And you had mentioned when we are offline. That actually can degrade quickly too. Yes. Very volatile. So the best supplement companies are putting that the actual active five methyltetrahydrofolic you'll see on the label, five dash M T H F.

6:51 That's the most usable form. with the caveat that it degrades quickly. And it's not as absorbable as some of the other folates out there. So if you have a bottle of, a multivitamin and it has this in it, and it's been sitting on your shelf for five years, maybe get rid of it. If it's past the expiration date, it's probably going to degrade quickly just like a plant would on your counter or if you overcook it. Right, right. So it's probably good to point out that folic acid, which is found in supplements and in fortified foods, it needs to be converted to folate and that conversion happens in the liver. And then it's absorbed in the upper third of the small intestine.

7:31 So that kind of gets like, you know, cancer patients, cancer survivors, thinking in terms of like, if there's any impairment to those parts of your body, there may be a potential for deficiency. Deficiencies also can happen with people with a history of alcoholism or just the non-alcoholic fatty liver because of the fact that folate is stored in the, and along those lines of who might be deficient as anyone who doesn't have a good, healthy, upper, small intestine, cause both folic acid folate. However you're taking it in right? So like somebody with celiac disease. Yeah, because that was a prime example of where the, the Villa, the microvilli of the small intestine are damaged and it's celiac disease.

8:13 And this is one of many nutrient deficiencies that can result. So there are also medications that can interfere with, with folate metabolism. That are better used in cancer care. So like methotrexate is one, pemetrexed, Alimta is another. And so sometimes if you're receiving one of those treatments, You may be prescribed a supplement from your doctor, um, because these medications are targeting that. Yeah. Can I mention right there? That's an interesting phenomenon, right? So the drugs you just met. Actually target the. Pathways. That's how they stop the cells from dividing. That's how they're used in cancer care.

8:53 As anti-cancer agents, a rapidly dividing cell needs to make a lot of DNA, right? So as you have a cell dividing over and over, it needs to make a new batch of DNA in the nucleus. Every time it does it in what methotrexate and Alimta do is they block that by blocking folate. Cause folate is required to make DNA and they give you a form of. Folic acid alongside to make sure that there is just enough to rescue your normal cells, right. So this brings up something reminds me of the fact that every nutrient has what I would call a sweet spot, where you have just enough, not too much, you're not deficient and you're not, megadosing, there's a sweet spot for every single essential nutrient there is.

9:39 And in the case, Benign or folate we should discuss that. That what's a deficiency in what's too much. So the recommended amount in micrograms, not milligrams in micrograms. folate is 400 micrograms and that's an adults and those are non-pregnant adults. so if someone is pregnant, then it is 600 micrograms a day. So what I find really interesting. Folic acid as a supplement or in fortified foods is absorbed twice as much as the folate that's found in nature. And another little interesting tidbit is you'll only see folic acid on a nutrition label if it's been added.

10:23 So if you're looking at whole wheat bread, that is not fortified, it's not going to have a folate level on there. But if it's a fortifying whole wheat bread, it will Oh, so interesting. Yeah. Yeah. That's an interesting thought because I just, I'm thinking about how many things have a label and then, you know, there's no, one's really telling us nutrient breakdown unless they know it because they put it back in there. Yeah. And I even looked at some things that I had in the house and, you know, you'll see like calcium level and, some other nutrients, but. If it's not fortified with folic acid, you're not going to see it on the label. You're not gonna know what's in a nice, you know, boule, a nice, a nice artisinal right. You're not gonna know what's in a nice artisinal loaf, right.

11:04 That's something to think about. Yeah. Things that make you go. Hmm. Um, okay. So. folate itself has been shown to help with, you know, not only prevent well folate and folic acid are used to prevent anemia, right? So you're, you're taking the amount to reduce your risk of a certain disease So that's why pregnant women are recommended to supplement with. Folate or folic acid because it prevents neural tube defects. And so it's needed, like you're saying, like for DNA and for cellular development. And so that's really important when someone is pregnant because there's a lot of cell division going on.

11:45 It's also has been shown to be helpful for cardiovascular support. Um, not only in. a developing fetus to prevent certain congenital heart defects, Foltate has been shown to reduce the risk of certain cancers. And that's sort of a double-edged sword, right? Because folate coming from food, fruits and vegetables has been shown to reduce the risk of certain cancers, but then taking too much folic acid. The synthetic version has been shown to possibly have adverse effects. There was a study many years ago that came out and when folic acid began to be fortified in bread, there was a study that showed there was an uptick of colorectal cancer.

12:33 the question became, does folic acid promote colorectal cancer? Well, it turns out if you looked at the. Incidents of colorectal cancer over time, it bumped up and then it came back down. And now after many experiments with animals and further data, it's pretty clear what's happening. adequate folate helps normal division of cells. Once there's a polyp or add, Anoma When that is given folic acid, usually in a supplement or fortified food, it will grow. It will actually promote the growth of a precancerous adenomas into cancer. And once cancer is. It can promote the progression of colorectal cancer but cancer of the colon follows a very clear path from normal cells to polyp, to add Anoma to colorectal cancer.

13:22 So if the folic acid is being given or eaten in any form, including folic acid, you know, in a supplement or fortified food, and there's no abnormal cells yet there's no precancerous lesions. That doesn't look like it's a risk factor. If anything, it's giving repletion of folate in the cells But what we don't know is, you know, who has precancerous, adenomas and who doesn't. And so when that was done in a large population and folic acid suddenly was in the bread supply, there was an uptake of colorectal cancer until that subpopulation didn't show up on any more in the data. So it's an, it's an interesting scenario of the same molecule folic acid, having a benefit for risk reduction of colorectal cancer and a detriment once there's precancer or cancer present.

14:07 And it's pretty clear now that that's what's going on. So I do not recommend folic acid supplement. Especially in a higher dose, like over one milligram or, that's 1000 micrograms to anybody with a tendency towards a colorectal cancer or your history of, a history of colorectal cancer because we don't know if there's recurrence right. Ever, or anyone with actual known colorectal cancer. I prefer they get it all from food. and I think it's good to point out that like if somebody does, you know, is trying to reduce the risk or prevent cancer, taking higher doses of folic acid has not shown any benefit at all. So it's more the low folate status. That's. Associated with an increased cancer risk, but by supplementing with folic acid, it's not really going to be.

14:54 Moving the bar. Right. And it may actually be detrimental if you have this history. Right, right. And yes, whether it's family history or personal history. Yeah. And you know, that, as a general rule, if something is known to reduce the risk of developing a cancer, you cannot extrapolate that. And say, once you have a known cancer, have history of a cancer that it's going to translate to that ever. Yeah. That's a perfect thing to point out. So one thing I do want to mention is, not only is folic acid found in foods like the fortified foods, like cereals and breads, but also it's in supplements and it's not necessarily just in B complex or multivitamins, because it can reduce the risk of.

15:35 Things like Alzheimer's fully can, folic acid can be found in more of those kinds of cognitive supplements, the memory ones, the ones that are promoted as like this is going to make, uh, remember everything. the other place where I've seen it hidden. And I'm sure there are tons of places, but, um, I've also seen it hidden in energy drinks. Yeah. And so, and those doses can be the 400 microgram. So that's, that's another place to really be cautious because a lot of cancer survivors, a lot of cancer patients are really tired. And if they're pounding these, you know, energy drinks, maybe they're on a medication where, you know, you don't want them to take too much, or you don't want them to take it at all, or, you know, whatever.

16:19 Like it's just, it's, it's looking at labels. Yeah. And it's easy to do because I think for the most part, people think B vitamins must only do. Right. You can compete them out. That's what everyone says. Oh, you can take as much as you want. You're just going to pee out what you don't need. Yeah. So another point that I think we had talked about the other day was that leucovorin, which is often part of the treatment for colorectal cancer. In addition to other cancers, it's, it's part of FOLFOX, right? It's the five Fu and leucovorin and then the oxaliplatin. That is a form of folic acid. Yeah. Yeah. I mean, the fact that they gave it a name like leucovorin, I mean, it sounds awfully Thomas, it sounds ominous, right?

17:04 Leucovorin it's not a chemo. No, it's just a form of a foliate compound. Right. And what it's doing is it's activating the five F-you to kind of convert into. The cancer-fighting drug that it is. And so when somebody is is on FOLFOX or Fulfirinox or a five F-you, I think they're still using that to treat breast cancer. You don't want to take a vitamin that has folic acid in it. Full weight is fine. Fully from food is fine during that time, but you don't want to take folic acid because you might be. Ramping up that activation, which can create more side effects. Right. You do want to tightly control your intake of exogenous folic acid, because exogenous that's such a good word.

17:53 I'm like external exoticness. Yeah, it's important. And they usually tell you when you're getting that chemo, but for some reason they didn't tell you or you miss that. Piece on the paper or the lesson or chemo class? Um, yeah. It's okay. And you just found out you had cancer? Yeah. Yeah. Everything else is crickets in the background. Hey, I have a quick little story about five. I had a patient young woman with colorectal cancer and she was getting five, a few. And I love the fact that she really disliked the name. So she decided that she didn't like the name five F U and she didn't want to sit in a chair and take that. And so she renamed it and only referred to it as.

18:37 You know, I've seen these stickers that people put on their, um, infusion bags that they look like old school, like pharmaceutical labels, and they have words like hope and like really like positive things. That was her way of being like no F you too. Exactly. Exactly. It. I get it In 1931. British physician, Dr. Lucy wills used Marmite. A yeast extract to reverse macrocytic anemia of pregnancy. A few years later. The molecule full lake was identified as the reason Marmite worked. Foley deficiency can sometimes be seen on certain labs.

19:17 So if somebody is getting a workup for cardiovascular disease, elevated levels of homocysteine may be seen another lab that may show, potentially. Folate deficiency is, when they're looking at the red blood cells, It might show larger cells, Macrocytic anemia and it can look similar to a B12 deficiency. Yes. And so by taking high levels of folic acid, Someone may be masking a B12 deficiency, right. So when they have their lab, the way that they could see that their red blood cells are larger than normal is through the parameter called M C V, which is mean corpuscular volume.

20:01 And that volume is the volume of the red cells. And so generally speaking, when it's, you know, a hundred or more, you start to look at that and wonder why, if you're in active treatment, Baby red blood cells or chubby. So that's how, that's how I explain it to people. Ignore it because you got chubby red blood cells. That's perfectly normal. They're just babies. You're trying to reproduce them. Right, your your bone marrow is just shooting it out there. They're trying to catch up to some deficiency because of the bone marrow suppression of the drug. That's fine. But if you're post-treatment and you still see a high MCV, that has to be. Figured out. And so what you're talking about is that it could be full, late deficiency. It could be B12 deficiency, but it's important to figure out.

20:43 Right. So in terms of supplementing, like I, I often think, and I'm in no way, an expert, there are doctors who like their practice focuses on MTHFR mutations. It's such a hot topic. Especially among integrative doctors, but I wonder if somebody's. Has this M T HFR mutation. And they're taking supplements that have, you know, that have the active form of, of folic acid. They have full eight in them and they have a history of cancer. Like how does that play out? I think it gets complicated quickly. one, I think people, if they have identified a snip. And they know they're not going to take the folate in their diet and make it into active five methyl.

21:27 Tetrahydrofolate late. If they know that they have a glitch there, then it becomes more complicated for sure, because you want to get enough for your normal cells, but not so much that you're putting yourself at risk of, basically accelerating the growth of cancer that you don't know is. So I would say you'd eat it from food I would, yeah, I would, I would really focus on the food more than a supplement. yeah. Yeah. I I'm just, I'm, I'm kind of sitting here thinking like, in my mind, I'd be like, let's up greens intake. Let's up the food source intake before adding in. Uh, supplement and again, that's because it's not my, it's not my concentration. I think when I was in school, it wasn't even really discussed. And then while it was being discussed, I was working in cancer care and had a very, specific, um, modus operandi.

22:11 I had a very specific, style of practicing. And so it wasn't something. Occasionally we'd get patients in and they're like, oh, I have this MTHFR mutation. And my integrative doctor has me on these supplements. And for the most part, as long as they weren't getting a medication where it would potentially be an interaction, you know, I'd make sure that it wasn't like some exorbitant amount. Allow them to continue it. Yeah. I think that in those people, I would say to be very strict and avoiding folic acid as a, an additive or folic acid in any supplements, or, you know, like you mentioned, there's other ways that, that it sneaks into, complex formulas to make sure that that's not going in because there's no reason for that.

22:55 And then to get as much from diet as. I feel like we kind of covered everything that we're going to talk about. We did, there's so much more detail that we could talk about with Foley in these pathways and how the foods that have fully also have the vitamin B3 that you need to process the full orbit. Right. So there's a lot more we could talk about, but let's keep it short and sweet and go into more detail either at another time or on our. Yeah. And, um, you know, I don't want people to think that anytime we list medications where there are potential interactions or, you know, I don't want them to think that that's a complete list. we're just kinda mentioning things, you know, their insides and other things that might potentially interfere with, with full aid as well.

23:38 So it's, it's more like we've said before Tina, you know, like check with. Your pharmacist. And then on the basics episode, in the show notes, there are some sources to see if there are interactions. Again, those aren't complete lists either, and it's constantly changing as more information comes out because it's science. Yeah. And can I just say that if you really want the short story folate or folic acid, all of this stuff, and the things that we mentioned today really lend them. Pictures. So even if you go to, Google and you start looking around going to Google images and you'll see what we're talking about a little bit. I mean, I think that it's very visual to pick your house. Folic acid or folate is absorbed, converted, transported in the body used.

24:22 I mean, it's very. We're putting that in our show notes, we've got some links, so perfect. Find it on our website or wherever you listen to this podcast. And that's what this kind of brings us to. It's going to bring us to our song, our song for this episode. And you mentioned the role of. Fully in DNA, the importance of full aid. And so our song is called DNA and it's by a band called BTS and they are a boy band. And I played the video for you the other day. And how fun is that song? That's awesome. I know it gets you dancing.

25:03 It's a really fun song. I I'm not, Of the age of, BTS fans, I don't think, but I could totally see why they are the phenomenon that they are. Yeah, no offense, but either one of us would definitely stand out at the concert. I don't think that people would be. Oh, where's your, where's your kid, right? Why did, why did you bring your mother? Yeah. Why, why did these people bring their mother? But I get it now. Like I've heard their name, all over and I totally get it. So that is our song that will be in our show notes as well, as well as on our Pinterest page, you can find us on social media, on the Facebook and on the Instagram and on the Twitter.

25:44 and when you listen to an episode, if you like it, leave a review. If you don't like it, leave a nice review. Let us know if there's something you might want to hear otherwise, um, Subscribe, follow us and share. And share. Yeah, mostly, I mean, this might be of interest to you or marginally interesting to you, but you might have a friend or a relative who was more interested or you want to validate what we're saying with some expert, you personally know, go ahead and send it to them. I'm all for it. Good. Old grassroots grapevine stuff. That's right. So on that note, I'm Dr. Leah sherman and I'm Dr. Tina Kaczor, and this is The Cancer Pod until next time.