Nutrition
Folic Acid Supplementation and Risk of Gestational Diabetes Mellitus: A Systematic Review of the Literature
“Although current evidence is inconclusive, these results support cautious use of high-dose folic acid supplementation and the importance of individualized prenatal nutrition, particularly considering B12 status.”
This is an area that needs more research. Most people have no idea about their gene variants, some may have heard of the MTHFR variant, but the folate pathway is far more complicated than that one gene. Other players include SLC19A1, DHFR, MTHFD1, MTHFD1L and SHMT. If someone carries a few of these variants (which isn't uncommon), they may struggle to metabolise folic acid, the synthetic form of folate. And if they're also eating foods fortified with folic acid, think bread and cereal, they could be consuming a lot more of it than they realise.
And what about B12? We can't talk about folate without talking about B12. How do we accurately measure B12 status? Serum? Holotranscobalamin? Methylmalonic acid? Medicare only covers serum testing, which is a whole discussion in itself.
“In my opinion, the B6 story isn't straightforward either. She suspects some people have a slow-acting pyridoxal kinase enzyme, the enzyme needed to convert vitamin B6 (pyridoxine) into its active form, pyridoxal-5-phosphate. This creates a bottleneck, which may contribute to B6 toxicity.”
- Alvina Foo
