Researchers in China recently released findings from a large study of 20,000 patients looking at whether folic acid (yes, the synthetic form) affected the stroke risk in those with high blood pressure. Several of the findings underscore the importance of the methylation cycle in cardiovascular health. Both individuals with MTHFR 677 mutations and those without should take notice of this study.
The study monitored 20,000 patients over a median of 4.5 years in China, dividing them into groups that received enalapril (a blood pressure medication) alone or in combination with 800mcg of folic acid, the synthetic version of the vitamin. The study also looked at the patients’ folic acid level and which MTHFR 677 combination they had. Regardless of folate level and MTHFR status, patients who took 800 mcg of folic acid decreased their risk of a first time stroke from 3.4% to 2.7% over that time period. The effect was greater for those who had low blood folate levels, decreasing the rate from 4.8% to 2.8%. The strength of these finding prompted the researchers to end the study before its original 5 year planned length.
Findings which considered MTHFR 677 status support the role of the methylation cycle more emphatically. For example, those with two copies of the variant (TT) had the highest rates of new strokes in the study. This reached statistical significance and fit with the known increased clotting risk for such individuals. Interestingly, whereas the normal variant (CC) or the heterozygous (CT) patients benefited from the additional folate dose, the homozygous variant (TT) individuals only benefited when their blood folate levels were already higher. At first this may not make sense, but a scientific explanation could be that much more folate is required to overcome the MTHFR roadblock. MTHFR 677 individuals clearly react differently to this synthetic folate.
On the other hand, the article then goes on to advocate for synthetic folic acid supplementation. No mention is made of any side effects or harms of high synthetic folic acid. No mention of finding ways of lowering the higher stroke risk of MTHFR 677 TT individuals is made. No mention is made despite almost a quarter of the Chinese patients have the TT combination placing them at higher stroke risks. I pray that others pick up the baton and take another step towards fuller understanding of the methylation cycle so that we can apply personalized medicine in the most beneficial manner possible, rather than setting for a universal, one size fits all approach of drowning everyone in folic acid.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.