Take a B vitamin supplement? Read this.

A lot of clients I see take a general multivitamin tablet, kind of as an ‘insurance’ to optimise their nutrient intake (or as a bandaid for a less-than-ideal diet). Some also specifically eat fortified foods to make up for the lack of nutrients in their food choices later in the day. Fortification is the addition of nutrients into a food product by manufacturers that are not originally present. Why eat real food when you can get all the nutrients you need in a box of cereal, right? Special K is high in protein (thanks to the addition of wheat gluten) and contains 18 essential vitamins and minerals. Despite not having research studies specifically telling me so, I’ve been mildly suspicious for years that our absorption of these would be different if they are added to a food product. A good example of this is iron – Nestles’ Milo contains 5.3mg of iron per serve (to add to our recommended 8mg – 18mg per day we should obtain from diet)  – but that certainly doesn’t come naturally from a…. milo bean. Whenever anyone asked my thoughts on how useful it is to incorporate Milo in their diet due to the addition of iron, I was more inclined to direct them to mussels and beef as a better source*.

I tend to think my suspicion could be more intuition as I delved more into the availability of other nutrients from the foods we eat. Take our B vitamins folate (B9) and cobalamin (B12) for example. These are found in the diet in leafy green vegetables (folate) and animal protein sources (B12), with beef and chicken liver being a great source of both. These are also a favourite addition to the raft of supplements provided by breakfast cereal and the B vitamins as a group are often a supplement listed by clients filling out a health information sheet prior to a consultation, often as part of a stress complex (or de-stress) or prenatal formula. There are a number of different formulations for vitamins, and those  most widely available in supplements and in fortified foods are folic acid (as opposed to folate) and cynacobalamin. Does this matter? It could. Folic acid added to flour in many countries has been effective at lowering the rate of neural tube defects (NTDs) but if choosing to supplement rather than rely on fortified foods, it might not be the best form of folate to seek out.

I should back the truck up a little bit here. Firstly, folic acid is often used interchangeably with folate but they aren’t the same thing – and therein lies a (potential) problem. Folate is more of an umbrella term that encompasses a group of compounds from the biologically active form that the body uses to the synthetic folic acid produced in a laboratory to be shelf stable to be able to be added to food products or as part of a supplement. In between we’ve got a host of different forms of folate (folic acid, methylfolate, tetrahydrofolate as examples) and if you looked at the chemical structure of these they would look very similar – however there are differences which can determine their usefulness in the body. The most bioactive form of folate has a methyl group attached, and folic acid does not. This means that folic acid has to go through a bunch of different steps in the body to be converted into methylfolate.

Folate is not just beneficial for women of childbearing age to protect the foetus from NTDs – its functions are wide and varied. Our skin is regenerating itself on a daily basis, as are the cells related to our gut, our brain…. In fact, everywhere in our body. This is only made possible by our body’s ability to produce DNA. Folate plays an important role in methylation  – which is a whole series of posts within itself, and I’m not smart enough to write those. It is a fascinating area and one which I learned a whole lot more about at the Ancestral Health Society Symposium earlier this year from Dr Tim Gerstmar (who will be presenting at our AHSNZ conference in Queenstown, October 2015). Basically it’s responsible for turning on and off genes in our body (some we want to have on, others we want to have off), making certain genes, is vital for controlling inflammatory pathways, for detoxification…. Co-factors responsible for processes in the body (such as creatinine, Co-Q 10, phosphatylcholine to name a few) requires methylation, as does neurotransmitter production – melatonin and serotonin production. And methylation requires folate. Folate is also necessary for red blood cells, white blood cells and platelets – clearly, it’s critical! Without the necessary levels in your body, you can see that these everyday reactions could well be compromised.

When folic acid from supplements and fortified foods goes through the conversion process to the more bioactive forms, it is a slow process. This can lead to an accumulation of unmetabolised folic acid (UMFA). There’s uncertainty around the implications of this particularly with our immune system – as UMFA appears to inhibit the action of natural killer cells, an innate part of our immune system responsible for rejecting foreign bodies. . Further, high levels of folic acid can mask B12 deficiency.

What about B12? Same deal. It works alongside folate (and the other b vitamins) and is also required for methylation. While you might take a supplement (and your serum level of B12 when tested reflects a good intake) it doesn’t mean that you have good levels of active B12. Measuring methylmalonic acid (MMA) – which accumulates in the absence of adequate vitamin B12 can be tested alongside serum B12 to get an idea of functional B12, but I don’t know how standard it is to do so. If you suspect you are low (or your health professional does) then testing this could be a good idea.

So…  while I think that getting what we need from food should be a given, I’m not actually against supplements. Truth be told, more and more people I see tend to benefit from adding in supplements such as a B complex to help support energy metabolism (among other things) in addition to an awesome diet. So if you do supplement it makes sense to me to get the most bang for your buck and supplement with the most active forms, such as a methylated folate and cobalamin. I’ve come across the Biobalance brand as one such form (and, no, I’m not affiliated with this, but it’s good to share when you find something useful).

* Related, when I was investigating the cost of the average family’s food intake I was surprised to see that Milo was included as a staple from the ‘basic’ trolley to the more ‘liberal’. Milo had apparently become a staple food for all New Zealanders. After reading that the New Zealand Food Cost Survey aimed to meet current dietary recommendations for nutrients…it made more sense to me. After all, Milo also contains B vitamins, vitamin C and vitamin A… and when teamed with trim milk it’s low GI. Wow, a superfood that could bump up the nutrient intake of all people, regardless of food budget. Who knew?!