Wheat and spina bifida

Spina bifida and neural tube defects are a devastating condition that affect 1 in 800 births. They represent the failure of the spinal column and overlying tissues to close in utero during the first trimester of pregnancy, leaving the spinal cord, and sometimes the brain, exposed. It is attributable in large part to dietary lack of folate, a B vitamin.

If pregnant mothers obtain 400 mcg per day of folate, the incidence of spina bifida is slashed by 72%–not eliminated, but markedly reduced (since there are causes outside of lack of dietary folate). Given the severity of this condition, it is an incredibly small effort for a potentially marvelous gain.

Because many Americans have chosen to adopt a diet based on fast foods and junk foods, many women of childbearing age develop deficiency in this ordinarily ubiquitous nutrient. For this reason, in 1998, the FDA passed a regulation requiring bread makers to add 40 mcg of folic acid per 100 grams (3.5 ounces or approximately four slices of white bread, medium thickness) of enriched (processed) bread; the requirement does not apply to whole grain breads. A typical two-slice white bread serving as, say, a sandwich, adds 20 mcg of folic acid.

The Wheat Lobby is trying to paint themselves as the champions in the fight against spina bifida with this press release via their Six Servings. Among young people and others unschooled or uncaring in nutrition, folic acid fortification of white flour products has indeed exerted a positive effect: Fortification of white bread products has indeed been associated with a reduction in spina bifida and neural tube defects. (Or perhaps it was the heightened awareness of folic acid and the need for prenatal vitamins that discussions of fortification encouraged, but we’ll concede the point.)

But it definitely does NOT mean that fortified white flour products SHOULD be the solution to these conditions. After all, the folic acid is added and, of course, added to foods that have plenty of problems associated with their consumption.

Here’s a partial list of how you SHOULD obtain folates/folic acid:

Asparagus, boiled, 8 spears 178 mcg
Avocado, raw, sliced, 1 cup 118 mcg
Beef liver (6 ounces) 430 mcg
Broccoli, chopped, cooked, 1 cup 104 mcg
Brussels sprouts, 1 cup 156 mcg
Egg, whole, hard-boiled, 3 large 66 mcg
Peanuts, dry roasted, 4 ounces 164 mcg
Spinach, raw, 2 cups 116 mcg

You can see that there are many natural sources of folate/folic acid that far exceed the paltry 20 mcg from two slices of white bread.

There are many other lesser natural sources of folic acid and folates, too, all of which generally add another 40-200 mcg or more per day. If you take a multivitamin or B-complex, you usually add another 200-400 mcg of folic acid per day. You can also purchase 400 mcg tablets of folic acid for something like $3 for 100 tablets (400 mcg per tablet, non-prescription). Because of the potential benefits of folic acid in the first trimester of pregnancy, all prenatal vitamins contain 400 mcg or more folic acid.

Obtaining a healthy quantity of folic acid is therefore quite easy given its presence in food and the ease of supplementation. Just adding 40 mcg of folic acid to 3.5 ounces of white bread does NOT somehow make white bread a good thing.

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Comments & Feedback...

  1. Maria

    Many people do not metabolize folic acid due to MTHFR. Spina bifida, tongue tie, cleft lip, etc all are related to methylation issues. I agree that eating wheat/gluten does not help, but not eating those foods will not necessarily give someone with a methylation issues the amount of folate needed either.

    Vit. B 12 deficiency, also a symptom of methylation issues, will cause the folate to not be metabolized properly as well.

    Folic acid is a form of folate that is actually also toxic to the body. When people are looking to supplement I suggest looking into methylated forms of B12 (methylcobalamin) and folate (methylafolate or MTHFR). Many high end supplement companies are now adding those forms as opposed to the non methylated forms.

    • derp

      Folate is not metabolized by MTHFR. MTHFR function is the catalysis of 5,10-MTHF to 5-MTHF. So folate is a precursor; no amount of folate will help if your MTHF reductase is defunct.

  2. Mike

    Dr. Davis. Not only do I like the information you disseminate, I like the manner in which you do it. You’re not afraid to call things for what they really are. The marketing scheme of “fortified with this, enhanced with that” is such a load of B.S. Eat real food. Not food stuff that have to have the real stuff put back in. Thanks for the work you do.

  3. Alice

    I have been reading about folic acid vs. folate. They aren’t the same thing, and there is some question about the safety of folic acid supplementation (it’s used because of course it’s much cheaper). I prefer methylfolate.

    • derp

      Folic acid and folate differ by one easily exchangable proton, so they are the same. Methylfolate is a different animal, with a CH3 group added.

  4. Kevin

    Hi Dr.Davis,
    Here’s another “aha” moment for the books which I’m sure you’ve come across, but I’ve posted the link for those who haven’t seen it…..And BTW I’m down almost 50 lbs since Aug.1….All bloodwork is excellent. Cholestral is 3.2 …Sugar is 6.0…. BP 130/84….Triglycerides excellent for a 57 year old …Thank you so much once again. Have a great day!


    • derp

      “Observational study” – excuse me, but who cares? Observational studies are useless in revealing cause-effect relationships.

      • Jennifer Snow

        A properly-conducted observational study can reveal the existence of a previously unsuspected causal relationship, but it can’t *establish* that relationship (particularly if the correlation is small).

        If the correlation is HUGE, you may not need an experimental study to further establish the causal relation, though, as in the case of smoking and lung cancer.

        • derp

          It cannot reveal the existence of a previously unassumed cause-effect relationship, it can give you a hint that there might be one that can be tested. Observational studies need experimental validation; there is no logically possible way to draw conclusions from observational studies. Except for, as you say, HUGE correlations and even then, you cannot be sure. Of course you are right, in the case of i.e. smoking, I would try to quit immediately after such a study and wouldn’t wait for the experimental trial.
          What one also needs before conducting a study: a plausible physiological model based on the existing research. This does not exist in nutrition, it is a pseudo-physical one (calorie equals calorie and all the other nonsense).

  5. Boundless

    Is there a link to the actual study?

    Third party summaries like this are very unsatisfying: “Other research has found that high supplementation of synthetic folic acid can increase malignant tumor proliferation and increase cancer risk in general.”

    If the subjects are getting their “folate” from wheat, yes, I’d tend to expect that very result. I’ll be very surprised if the study isolated for how glycemic the diets were, or even how much gluten-bearing grain was consumed.

    The form of folate may ultimately not matter. If recent reports are true, that cancer cells are glucose-brittle, then cancer is an easily avoided ailment for people on nutritionally ketotic diets, and the statistics for folate type will simply collapse for them. No harm in switching to natural sources, of course.

    But even taking the study summary at face value, wheat not only feeds cancer with glucose, and may cause it via normal wheat inflammation, but it contains extra carcinogen as a bonus.

    • JoAnne

      Keep asking the questions that challenge the assumptions made when accepting these summaries/studies at face value. We can all learn from this. Keep it coming, Boundless! ;)

    • Uncle Roscoe

      Cancer starts when cells starve from being insulin resistant in an environment high in glucose and cytokine inflammation. They seek out other food sources. Cells in this fix turn to glutamate for food.

      Tissue transglutaminase (ttg) forms the extracellular matrix, and forms the structure of tissue. Ttg also limits glutamate intake. Inflammation causes immune attacks which remove ttg, and deplete the extracellular matrix. Glutamate becomes abundantly accessible. Once inside the cell glutamate subverts the Krebs cycle. Instead of using the Krebs cycle to produce ATP for energy, cells start using the glutamate cycle to produce mutated tissue. From this point evolution takes over. Mutated cells which can feed on glucose, reproduce, and avoid the immune system survive. Other cells off. Soon you get cancer.

      Cancer represents cells starving for food in a glucose-charged environment. The cells find ways to mutate in order to feed on the glucose. Unfortunately the mutated cells have no differentiation, and are incapable of performing the tasks of the origin cells. They become a mass of useless tissue.

      Wheat provides the perfect storm for cancer. Wheat causes insulin resistance and elevates blood sugar. It contains far more glutamate than virtually any other food. Wheat causes inflammation, and causes immune attacks against tissue transglutaminase.

      • Dr. Davis

        This would be consistent with the observations made in primitive non-wheat- and sugar-consuming societies that cancers are rarely seen, compared to the relatively high frequency in our modern world.

        • Brenda

          This is consistent with my experience. I have been diagnosed with insulin resistance ~ a condition that has not afflicted anyone else in my family so I don’t think it is genetic and I was a carb junkie for most of my life. Also, I “was” on medication for high blood pressure. I started a wheat free diet on January 1 of this year and at the time asked my doctor to let me try going off my blood pressure medication, which he did as long as I monitored it. For a while the blood pressure readings were still somewhat high, so he called in a diuretic. I took it twice and had muscle cramps so I stopped. Now, after a little more than a month and on no blood pressure medication, I am getting readings in the normal range (yesterday 125/79).

  6. Jolinda Dallin

    Dr. Davis I heard you speak on Dr. Oz’s show and I went cold turkey right then. My husband and I have always tried to eat healthy but I have always suffered with my weight and more recently with mental fog, hitting the snooze button 5-6 times before getting up, joint aches, binge eating, watching too much TV, logging into Facebook multiple times in a day. For 20 years now I have not been able to smell fragrances and since loss of smell is an early symptom of Alzheimer’s disease I figured I was destined to finish out my years in a total fog. I am 63 and have worked as a Physical Therapist for 40 years. I see very unhealthy people everyday with very long lists of medications; often they are in their 50’s and 60’s and look like they are in their 80’s. At the first of the year my facility started a 5 month biggest loser contest which I joined. I have lost 15 pounds, have very little abdominal bloating, am seeing my abdomen shrink incredibly. AND I can smell perfumes, flowers, even the icky stuff!! This makes me wonder how many of our older folks sitting in the nursing homes could resume active and cognitively strong lives if wheat was removed from their diet. People need to understand that for most of us the “gluten thing” is not where the cure lies. It is the “wheat thing” and i will never go back. Thank you, thank you, thank you. Jolinda from New Mexico.

    • Jolinda Dallin

      By the way…I closed my facebook page; I am watching very little TV; I have no cravings. My appetite is minimal now and for the first time in my adult life I am drinking tea and enjoying it.

    • Boundless

      > This makes me wonder how many of our older folks sitting in
      > the nursing homes could resume active and cognitively
      > strong lives if wheat was removed from their diet.

      Almost all of them would see improved quality of life. A significant percentage of them could leave. Talk to the home management about this. Odds are they’ll ask YOU to leave. Concern for the well-being of their profitable captives is usually not their priority.

      > People need to understand that for most of us the
      > “gluten thing” is not where the cure lies. It is the
      > “wheat thing” and i will never go back.

      No, actually, it’s the glycemic metabolism thing. Where the WB recommendations end up is in a ketogenic metabolism. In keto, you aren’t eating much carb anyway, so if you started out seeking keto, and had never heard of WB, little of your diet would be gluten-bearing grains. It would still be important, however, that GB grains constitute NONE of your carb intake.

      • Jolinda Dallin

        Since mid-2012 I have been taking an antidepressant because I felt no motivation. Like I said I could sleep through 4-5 snooze alarms before dragging myself out of bed. I found myself often just sitting, not really thinking about anything, just sitting doing nothing. There have been days when I am off that I did not get one thing done I had planned. Just fogged out. I told my daughter just yesterday that I have so much energy and I am running all over the place so much that I can hardly stand myself. I am cheerful. Sometimes I have to dampen it down especially if I am with a patient who is struggling. I have a granddaughter who will be 2 on St. Patrick’s Day and I plan to be around and involved at least another 20 years.

        And I don’t plan to take the Celexa much longer. I just don’t feel like I need it anymore. Thanks for your responses.

  7. Byron King

    Brewer’s Yeast is the best natural source of Folic Acid that I know. Goes well mixed with low-sodium VG.

  8. Wendy

    When you want to address what women are eating during pregnancy to reduce spina bifida, you have to remember that MOST of the population cannot afford to eat the foods you are suggesting- especially the women that are most at risk of fetal defects. Cheap white bread (although not perfect by any means) is just fine for pregnant women to consume in their diet.

    • Boundless

      > Cheap white bread … is just fine for pregnant women to consume in their diet.
      Absolutely not. With what we now know to be the consequences for adults consuming that toxin, it is quite likely vastly more dangerous for pregnant women to consume than almost everything else they are told to avoid. Once we have a statistically significant number of pre-natal wheat-abstaining families to study, the exact hazards will become more apparent.

  9. Brenda

    I noticed that dry roasted peanuts are listed as one of the food items for obtaining folates. Just be careful and read the labels. My jar of dry roasted peanuts lists wheat as one of the ingredients.