Folic Acid: The Bottom Line
Folic Acid: The Bottom Line?
I received the following email recently:
“In the recent "Center For Science in the Public Interest's "Nutrition Action Healthletter....they write that we should not take more than 400 mcg/day [of folic acid]. For older women it can be especially dangerous. In some of my vitamins, over 800 mcg are included, then when we eat bread or other "fortified food" we get into the 1,000s. I have cut out regular multivitamins on days that I take supplements that contain additional folic acid. I'm puzzled.”
This type of question troubles me quite a bit. Maybe it shouldn’t.
Inherent Bias: Looking At The Same Thing and Seeing Something Different
As I think about it, when it comes to supplements and related health matters, perhaps there are three kinds of people. There are those with an existing bias–for a given issue, some will have a positive bias, and others will have a negative bias. Each of these two groups filter incoming information in a way that just confirms their inherent beliefs. Then, there is a third group that I call the “indecision” group. These folks seem afraid of doing anything. They come to a fork in the road, and they are afraid to go either way. They see goblins behind every tree. They can easily find reasons for not doing almost anything. Not because of any inherent bias, but merely because they are afraid and indecisive–they see everything as possibly negative. They cannot make a rational benefit to risk evaluation..
When it comes to our health, you can see this every day. Those with the positive bias pay little attention to the occasional negative supplement study, and those with the negative bias seem to only see the negative studies. Those in the “indecision” group can’t quite decide if the study is negative or positive.
This does not just apply to supplements, of course. I see it every day. Politics is a good example. People watch politicians debate on TV, and come away with totally different conclusions as to who was the “winner.” The reason is that they already had a preference, a bias, and that bias influenced how they interpreted what they saw. Unfortunately, that bias can be disturbingly irrelevant to the important issues at hand–relying more on race, gender, good looks, etc. Unfortunate, also, is the willingness, it seems, for so many people to believe something because they want it to be true.
How may people listen to testimonial-laden supplement infomercials, with too-good-to-be-true promises, and actually send in their money?
Contradictory Studies Cause Confusion
Not that there is not good reason to be confused. The constant stream of contradictory information, especially in the medical and healthcare fields, can be very confusing and frustrating. Is hormone replacement therapy good or bad? Does it cause heart disease, or prevent it? Does it cause cancer, or prevent it? Are statin drugs good for you or not? One brand is ok, but the another is not? Are stents good for cardiac patients, or not? Should you get a drug-coated stent, or bare-metal type? Should angioplasty be performed 12 hours or more after a heart attack? Or is noninvasive treatment with beta-blockers and other heart drugs just as effective? How often should you get a colonoscopy? How often should you get a mammogram? Are you healthier if you are underweight, or a little overweight? In 1999, the “miracle-drugs” for arthritis, Vioxx, Celebrex, and other COX-2 inhibitors were introduced. Several years later, Vioxx was withdrawn from the market because it increased the risk of heart attacks and strokes in some patients. Is the diabetes drug, Avandia, in the same boat?
What about supplements? Many claims are made about the benefits of various supplements, with varying degrees of scientific support. Is there reason to be concerned about the validit