Look at that headline! Sounds awful doesn’t it? But what this is really about is fortified bread. In many countries bread has added folic acid (an artificial, non-nature identical form of folate, also known as vitamin B9) to ensure mothers get enough of this essential nutrient to avoid neural tube defects (NTDs) – such as spina bifida – in their babies. Being on a low carb, paleo, ketogenic or gluten free diet means not eating bread, so mums might not be getting this particular additive. So what earns this story our coverted fake news award?
Firstly, here in the UK bread is not fortified with folic acid in the first place (although calls for it to be introduced have been increasing recently) so it will make no difference to your folate status whether you eat bread or not.
Secondly, it is easy for anyone to eat high folate foods, and anyone on a quality low-carb diet is likely to be eating more of such foods than your average junk food junky anyway. The name of this vitamin, by the way, reflects where to obtain it: foliage! So “eat your greens”. Below is a brief list of low-carb foods with high levels of folate, but many natural foods such as eggs, vegetables, seeds and nuts provide reasonable amounts and it all adds up. Generally the more processed and refined a food is the less folate it contains.
Thirdly, the papers uncritically reported that those mothers on a low carb diet had a 30% increased risk of having babies with neural tube defects, failing to point out that this is a relative risk as incidence in the low carb group . The absolute risk increase was less than one tenth of one percent (<0.03%) – a far less headline-grabbing figure.
So what was presented in UK papers was just irresponsible scare mongering as it does not apply to UK women regardless of whether they are eating a diet high or low in carbohydrates. Having said that, I would advise any woman of child bearing age to make sure they are getting sufficient folate through their diet and/or by supplementation, and here is a list of low carb folate sources:
Sources of folate suitable for Low-carb, Gluten-free and Paleo diets
- Liver (chicken livers are highest next lamb lowest is beef liver)*
- Brussels sprouts, spinach, kale, broccoli, asparagus, greens, lettuce, rocket, parsley, cauliflower,
- Avocado, peanuts, almonds, sunflower seeds
*Current advice is for pregnant women to avoid liver, but my reading of the literature suggests that this is a mistake. It is all about quantity, but some liver is required if natural, complete vitamin A is to be adequate for foetal and maternal needs. (See our article vitamin A from animal sources here, then do your research and make up your own mind).
Because of its importance for proper development of the embryo, all pregnant women will be offered a supplement, but all supplements are not equal, with most containing the cheap and potentially disruptive synthetic form called ‘folic acid’ when true ‘folate’ supplements are available. Methylfolate or methyletetrahydrofolate are what you should look for. If the diet has been low in green leafy vegetables and liver, supplementation along with improving the diet, may well be necessary.
Cytoplan produce an excellent range of methylfolate based supplements several of which I use in my clinic. You can find them here.
The original paper that the Daily Mail article was based on:
Low carbohydrate diets may increase risk of neural tube defects, Tania A. Desrosiers et al. (Jan 2018) Full Text