Be careful with Folic acid if you have (or had) Prostate Cancer

What do you know about Folic acid?

Well I asked a few people at my office today and the basic response was,” Doesn’t it has something to do with pregnant woman and babies or something like that?”

Ok, here’s the meat (organic, grass-fed of course) and potatoes (only sweet potato, right?) of folic acid:

• Folic acid is a B-vitamin (Vitamin B9) also known as Folate.

• Folic Acid is best known for the prevention neural tube defect in fetuses.

• It, with vitamin B12, lowers homocysteine levels – a blood marker that has been linked to heart disease (homocysteine’s link to heart disease has been controversial and debunked by a few studies by the way)

• Promotes the production of DNA, your body’s genetic code.

• Has shown to decrease the risk of colon cancer in most studies.

• It is depleted by alcohol consumption. (Halstead et al. 2002) Those who drink 2 drinks or more a day should consider supplementing ONLY with the natural form called methyltetrahydrofolate ( say that 3 times really fast after two drinks;)

• Alcohol consumption has been shown to contribute to low folic acid level and increase risk of colon cancer

• In one big study of more than 45,000 male health professionals, current intake of more than two alcoholic drinks per day doubled the risk of colon cancer. The combination of high alcohol and low folate intake yielded an even greater risk of colon cancer; however, increased alcohol intake in individuals who consumed 650 mcg or more of folate per day was not associated with an increased risk of colon cancer.

• In women consuming at least one alcoholic drink per day, folic acid intake of at least 600 mcg daily resulted in about half the risk of breast cancer compared with women who consumed less that 300 mcg of folic acid daily

OK men, here’s the zinger. In a well designed randomized trial carried out over 10 years (Figueiredo et al. 2009)in which a group of men received 1000 μg of oral Folic Acid daily there was a near tripling of the incidence of prostate cancer compared to controls (those followed for study purposes but not taking Folic Acid).

Details of case report published in 2011 of a man consuming B- vitamins:
A 71-year-old Caucasian man had been diagnosed in 1997 with prostate cancer had a PSA level was 8 ng/mL. All six biopsy cores contained 90% Gleason scores of 3+4 = 7 adenocarcinoma, and positive perineural invasion.
He elected therapy with intermittent androgen deprivation (IAD) with flutamide, leuprolide, and finasteride. In 2007, after the third cycle of IAD, his PSA level slowly increased into the 3 ng/mL range and his serum testosterone remained < 20 ng/dl (Really, really low. Considered castrate levels at this amount).

His PSA began rising. He then received docetaxel (popular chemo drug for advanced prostate cancer) 30 mg/m2 for three of every four weeks while his leuprolide treatment was continued. His PSA level continued to rise exponentially for 18 weeks, thus docetaxel resistance was assumed by his physician. The patient revealed that he was ingesting a supplement of 10 daily dose units of Intrinsi B12/folate ( a supplement by Metagenics) Each dose unit contained 20 mg of porcine intrinsic factor and 500 micrograms of vitamin B12, as well as 400 micrograms of Folic Acid, and 400 micrograms of L-5-methyltetrahydrofolate (for a total of 800 μg of mixed Folic Acid’s).

In essence he consumed a grand total of 5000micrograms of B12 and 8000 micrograms of Folic Acid.

On February 2010, his PSA level reached 21.3 ng/mL, and on 25 February 2010, his serum Folic Acid level was increased to  134 ng/mL (normal range 5 ng/mL to 24 ng/mL), his serum vitamin B12 level was > 1500 pg/mL (normal range 300 pg/mL to 900 pg/mL), his serum testosterone level was < 20 ng/mL (normal range 212 ng/mL to 755 ng/mL), and his total serum homocysteine was 12.0 μmol/L (normal range 7 μmol/L to 12 μmol/L).
The patient discontinued the oral supplement and within two weeks his serum PSA level started to decline. And reached a level is 2.08 ng/mL. He continued to receive weekly docetaxel chemotherapy. His last serum FA level was 4.0 ng/mL (borderline deficient), his serum vitamin B12 level was 377 pg/mL, and his total serum homocysteine level was 17.8 μmol/L (Tisman & Garcia 2011)

My take on this:
Sometimes a little of a good thing does not mean more is better. The Figueiredo study clearly indicates that up to 1000 micrograms of Folic acid, a synthetic version of Folate, can aggravate the progression prostate cancer cells.

There is no need for Folic acid supplementation unless:
1. You are pregnant ( let me know if you have a prostate and are pregnant – we’ll get rich in short order)
2. You have a kind of anemia called megaloblastic anemia (different from iron deficiency anemia)
3. Possibly for colon cancer protection
Lastly, Folic acid is found in abundance in green leafy vegetables and that is the best form of consumption. Many grain are also fortified with this vitamin. It’s important to also mention that the case report of the 71 year old man indicates that he was taking a total of 8000 micrograms of Folic acid.

I have no idea why he was taking this much Folic Acid other than to reduce homocysteine levels. Still, that dosage is way too high in my opinion.

This underscores the importance of being properly managed by a nutritionally oriented physician for anyone fighting prostate cancer or interested in preventing a prostate cancer recurrence.



Halsted CH, Villanueva JA, Devlin AM, Chandler CJ. Metabolic interactions of alcohol and folate. J Nutr 2002;132:2367–72S.

Figueiredo JC, Grau MV, Haile RW, Sandler RS, Summers RW, Bresalier RS, Burke CA, McKeown-Eyssen GE, Baron JA. Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst. 2009;101:432–435

Tisman G, Garcia A. Control of prostate cancer associated with withdrawal of a supplement containing folic acid, L-methyltetrahydrofolate and vitamin B12: a case report. J Med Case Rep. 2011 Aug 25;5:413.

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