The Folic Acid Paradox and the Importance of Vitamin Balancing

by Kelly Dorfman, M.S., L.N (Co-Founder of DDR)

Folic acid (or folate) is one of the most deficient and problematic nutrients in the American diet. While small amounts are in orange juice, folic acid is found mainly in dark green "foliage," from which its name derives. Many children with developmental and attentional issues - and most children with sensory issues - seem particularly repelled by green food.

Typically, picky eaters reject their desperate parents‘ attempts to provide a balanced diet. Nonetheless, if a child is on the growth chart despite limited eating habits, physicians tend to discount parental concerns.

Persistent parents and conscientious doctors have sometimes tested blood nutrient levels in a child‘s plasma to assure that all is well. Generally, the testing reveals nothing unusual, with one exception. Folic acid, a B-vitamin, is sometimes found in high amounts in ostensibly malnourished children. Some professionals may mistakenly suggest that the child is not only sufficient in nutrients, but is close to toxicity and should, therefore, avoid added nutrients. This advice is based on the dubious, but common, medical practice of treating a test instead of a patient.

High folic acid levels in a child who consumes a limited diet are highly suspicious. Furthermore, high levels are puzzling because folate (like all B-vitamins) is water soluble and does not tend to accumulate in the blood, even when extra is taken. Something else must account for the paradoxical findings.

Dr. Derrick Lonsdale, a pediatrician in Westlake, Ohio, and the world‘s leading expert on vitamin B-1, may have stumbled on an explanation. He discovered high folic acid levels in the blood of a child with a rare lymphatic condition. Confused, he consulted a biochemist hoping to find a plausible reason.

The chemist explained that vitamin B-1 is a co-factor in utilizing folate. Perhaps, if B-1 were deficient, the underutilized folic acid would back up in the blood. Dr. Lonsdale confirmed the theory by prescribing a large dose of B-1, along with a B-complex. Not only were the youngster‘s folic acid levels normal upon retesting, but also his lymphatic condition significantly improved.

In 1980, Dr. Lonsdale showed a relationship between low vitamin B-1 and behavior problems in children. He discovered this relationship not by measuring B-1 (or thiamine) levels in the blood, but by monitoring an enzyme that depends on thiamine to function. Checking enzymes (in this case, red blood cell transketolase) that vitamins regulate is more accurate than trying to catch individual B vitamins themselves because they work together. Thus, a problem with one can distort the assessment of another. (Indeed, assessing vitamin sufficiency by measuring blood levels is analogous to judging factory efficiency by counting workers, rather than looking at product output.)

While Dr. Lonsdale has a particular interest in B-1, he emphasizes that B-vitamins must be balanced. They interact in ways that we have yet to understand. The application of this insight is two-fold.

B-vitamins are not dangerous. We must simply respect the way they work in nature, which is together, in balance. Many other vitamins and minerals work in teams, too. Vitamin E, for example, is a complex, called mixed tocopherols. The inexpensive versions available at many drug stores are often synthetic and represent one piece of the known complex. Gamma- tocopherol, which is not present in synthetic vitamin E, is now believed to be a factor responsible for protecting against heart disease. Those taking synthetic E (dl-alpha- tocopherol) may not be getting the benefits they seek. Therefore, study findings may disagree (depending on what exact kind of vitamin E the test subjects use).

To learn more about B vitamins and folic acid, read the Kirschmanns' Nutrition Almanac and Smart Medicine for a Healthier Child by Zand, et al.

[Initially published in New Developments: Volume 4, Number 3 - Winter, 1998-1999]

All material in this web site is given for information purposes only and is not to be substituted for advice from your health care provider.


5801 Beacon Street, Pittsburgh, PA 15217 | P: 800.497.0944 | F: 412.422.1374

Page last modified: February 23, 2009
©2009 Developmental Delay Resources. All rights reserved.