Latest / Wellness by Designs - Practitioner Podcast / Defining “Excess” Folic Acid: Risks, Research, and Clinical Impacts with Carolyn Ledowsky

Transcript

Defining “Excess” Folic Acid: Risks, Research, and Clinical Impacts with Carolyn Ledowsky · Wellness by Designs - Practitioner Podcast

• 0:12
  SPEAKER_00: Welcome back to Wellness by Designs.
• 0:14
  SPEAKER_00: I'm your host, Andrew Whitfield Cook, and joining us again today is Carolyn Ludowski, nearly Dr.
• 0:22
  SPEAKER_00: Carolyn Ludowski, who's a naturopathic practitioner, clinician, researcher who specializes in methylation issues.
• 0:30
  SPEAKER_00: And today we're going to be discussing indeed that and her research.
• 0:33
  SPEAKER_00: Welcome back to Wellness by Designs, Carolyn.
• 0:35
  SPEAKER_00: How are you going?
• 0:36
  SPEAKER_01: I'm well, Andrew.
• 0:37
  SPEAKER_01: Great to be back again.
• 0:40
  SPEAKER_00: Great to be speaking with you again.
• 0:41
  SPEAKER_00: This is such a it's a vital piece of research that you're doing.
• 0:46
  SPEAKER_00: Um, because there were some sort of hints along the way, but I think we should get into it.
• 0:51
  SPEAKER_00: And and I should say for all those people who might not have listened to Carolyn's previous podcasts, listen to those as well because you'll learn a heck of a lot of the backstory that we're going to be talking about today.
• 1:05
  SPEAKER_00: So we've spoken about your research before.
• 1:08
  SPEAKER_00: Um, can you give us an update on what's happening with that and where it'll be lying with your PhD project?
• 1:15
  SPEAKER_01: It's very nearly at the end, Andrew.
• 1:18
  SPEAKER_01: I'm very pleased to say.
• 1:20
  SPEAKER_01: Um it's it'll be the final submission in December.
• 1:24
  SPEAKER_01: So at the moment it's head down, 12 hours a day writing and just pulling it all together, which is is it's very, very exciting.
• 1:34
  SPEAKER_01: So, yes, it's been a long four years, but I would be very glad to get to the end of it.
• 1:40
  SPEAKER_00: I I gotta say though, four years, like you, I mean, you are a machine.
• 1:45
  SPEAKER_00: Anybody who's worked with you, anybody who knows you you're a machine, but this has taken other people, not this, but you know, other people's PhD projects can take, you know, four, five, seven years.
• 1:57
  SPEAKER_00: You've done a heck of a lot in four years.
• 2:00
  SPEAKER_00: What is this based on with regards to the research, though?
• 2:03
  SPEAKER_00: Have you seen this exponential increase in what we're going to be talking about today?
• 2:08
  SPEAKER_01: Look, it's really interesting, and and as my PhD supervisor, one of Amy Steele said to me, you know, you you had so much knowledge about MTH far and methylation and folic acid and methylfolate coming into this.
• 2:24
  SPEAKER_01: So it may not be that I have learned more.
• 2:29
  SPEAKER_01: I certainly have about methodology, I certainly have about how you approach the research, because at the very beginning she said to me, you know nothing, you have to let the research guide you.
• 2:43
  SPEAKER_01: And so that is a very difficult process for a practitioner who knows clinically the effect that she can get from methylfolate as opposed to folic acid, particularly infertility.
• 2:58
  SPEAKER_01: So it is a completely different skill set to actually start at the very beginning and say, you know nothing, the research must guide you.
• 3:08
  SPEAKER_01: And so that's a really interesting process that, as a researcher, you go through.
• 3:15
  SPEAKER_01: And what's very exciting is the research has guided to the point that I'm not as fanatical as I was.
• 3:27
  SPEAKER_01: I'm a lot more balanced, but I have still the very strong uh opinion, and now backed up by research, that if you exceed certain levels of folbic acid, it's definitely problematic.
• 3:45
  SPEAKER_01: And what we don't know, which is has to be established with further study, is what is excess and what does it look like?
• 3:56
  SPEAKER_01: Because the Institute of Medicine in the United States back in 1998 said, well, it's a thousand micrograms, but that's only based on it masking a B12 deficiency.
• 4:11
  SPEAKER_01: It has nothing to do with the biochemical way that folic acid is processed.
• 4:18
  SPEAKER_01: And this is my argument that we can no longer say the only problem with excessive is the masking of a B12 deficiency.
• 4:28
  SPEAKER_01: We have to be looking at it from a biochemical point of view.
• 4:32
  SPEAKER_01: What does it do to methylfolate?
• 4:36
  SPEAKER_01: What does it do to the epigenetic effect in the offspring?
• 4:42
  SPEAKER_01: And so that is a completely different conversation and one that is a public health emergency.
• 4:50
  SPEAKER_01: And I actually saw this morning on the news that one in four children under the age of 10 are with the NDIS for ADHD and autism.
• 5:05
  SPEAKER_01: Now we have animal studies dating back to 1998 that says if you exceed certain levels of folic acid, the effect in the offspring is neurodevelopmental disorders, including autism.
• 5:25
  SPEAKER_01: So it's no longer okay, let's just let everybody go the way we're going.
• 5:31
  SPEAKER_01: We as a as an probably one of the most important things to come out of this is we have to define what excess is.
• 5:41
  SPEAKER_01: And that's not only in supplement use, but also in red blood cell folate and serum folate.
• 5:47
  SPEAKER_01: We need to define it, and that is the most important thing, I think, that's come out of this.
• 5:53
  SPEAKER_01: Because as you know, at a low level, 200, 300 micrograms, it's probably not an issue.
• 6:03
  SPEAKER_01: But we have uncontrolled voluntary fortification, and so these young kids are getting excessive levels even without a supplement.
• 6:15
  SPEAKER_01: And I don't think parents understand that.
• 6:20
  SPEAKER_01: I don't think public health policy understands that.
• 6:25
  SPEAKER_01: And it is a real problem.
• 6:28
  SPEAKER_00: Absolutely.
• 6:29
  SPEAKER_00: And I'm so glad you said that, because indeed the folic acid issue is largely, not solely, but largely from food fortification.
• 6:38
  SPEAKER_00: And it would be, it would be really interesting to look at um those countries that did not fortify foods with folic acid and to see what happens with their neuroatypical um prevalence.
• 6:52
  SPEAKER_00: Um but you know, I I guess one of the issues is you know, with a with a a B vitamin deficiencies, you know, palagro or something like that, you see the issue.
• 7:03
  SPEAKER_00: You know, with a B12 deficiency, you will feel the paresthesia.
• 7:08
  SPEAKER_00: With a folate issue and an over an excess, what do you see?
• 7:15
  SPEAKER_01: Anxiety is probably the number one.
• 7:18
  SPEAKER_01: Anxiety and pain.
• 7:20
  SPEAKER_01: And when you consider how stressed out everybody is, I honestly believe that most young kids suffering from anxiety have this problem.
• 7:30
  SPEAKER_01: Because we know that if we can clinically reduce that folic acid or folate getting blocked, that that block that we've always spoken about, then usually their anxiety will come down.
• 7:45
  SPEAKER_01: And I think the folic acid, there's no question that at an excessive level it is causing a metal metabolic block.
• 7:54
  SPEAKER_01: So we we we need to define it, number one, but we need the governments now to be responsible because there's no question that 800 micrograms in the leading prenatal multivitamin in Australia is too much.
• 8:13
  SPEAKER_01: And that's what this paper that we have coming out, hopefully published very, very soon.
• 8:19
  SPEAKER_01: It's been with the journal for some months.
• 8:22
  SPEAKER_01: It basically says, well, you know, all the governments recommend 400 to 500.
• 8:28
  SPEAKER_01: It seems sensible, 400 micrograms, if you don't have an MTH4 polymorphism and you don't have problems with metabolizing your folate through other genetics, but not 800.
• 8:41
  SPEAKER_01: No.
• 8:41
  SPEAKER_01: So it looks like anything over 400 is is problematic from a supplemental point of view.
• 8:48
  SPEAKER_01: So why are we allowing the leading prenatal to have 800?
• 8:52
  SPEAKER_01: Yeah.
• 8:52
  SPEAKER_01: So I think things like that need to be looked at.
• 8:56
  SPEAKER_01: And in a preconception and pregnancy perspective, we did find in our paper that was published in 2022 that that excessive level of a thousand micrograms is always due to supplements in preconception and pregnancy.
• 9:14
  SPEAKER_00: Right.
• 9:14
  SPEAKER_01: So this is but but the general population probably doesn't always take a multivitamin.
• 9:21
  SPEAKER_01: And so you're right, from their perspective, if it's going to be excessive, it will be from food.
• 9:28
  SPEAKER_01: But if someone takes a uh a multi, it's probably 400 micrograms.
• 9:33
  SPEAKER_01: We don't have many multivitamins, as far as I know, with folic acid above 400 micrograms in this country, but we do have a prenatal.
• 9:42
  SPEAKER_01: And so I think we also need to review that.
• 9:46
  SPEAKER_00: So in in your reviews of um serum folate, uh folic acid, I should say, uh, did you find indeed that disparity with regards to food versus supplements?
• 10:00
  SPEAKER_00: Did you find that food would only give you um this amount, food fortification of folic acid, not green leafy vegetables with the active folates, um, but for food fortification would only give you that, but supplements would bump you up to this?
• 10:15
  SPEAKER_01: Yes.
• 10:16
  SPEAKER_01: So in that, in that particular paper where we evaluated how much folic acid um or or indeed folate, because we did look at natural food sources as well, we absolutely established that women are not getting enough, they're not getting nearly 400 micrograms from food alone.
• 10:37
  SPEAKER_01: However, there was some that had that typical um Western diet where they wake up in the morning, they have breakfast cereal, then they have, you know, a sandwich for lunch, and they've got a lot of packaged foods.
• 10:50
  SPEAKER_01: Some of them were getting over 800 micrograms in their food.
• 10:56
  SPEAKER_01: So that's very problematic if you then add a supplement on top of that.
• 11:02
  SPEAKER_01: So it depends, but I think the people that are most at risk are the pregnant and prenatal women that are taking these 800 microgram plus um multivitamins, but it's the young kids, and and if it's a neurodevelopmental disorder because of the epigenetic effect, then it's every newborn if mum has taken excessive levels of folic acid.
• 11:34
  SPEAKER_01: Of folic acid.
• 11:36
  SPEAKER_01: And so that's that's a that is a public health thing that we need to address.
• 11:42
  SPEAKER_01: We need to have the caution around how much is too much, and we don't know the answer to that.
• 11:50
  SPEAKER_00: When you're start talking about governments being responsible and you know, public healthcare messages and things like that, we've seen it before where you know there's a real um uh protection, let's say a protection of what's gone before, you know, and then the the slow change, if you like, so that those people that are affected by one um policy issue.
• 12:13
  SPEAKER_00: We could talk about asbestos here.
• 12:15
  SPEAKER_00: So, you know, asbestos is outlawed at a certain point, and it took decades for any legal recourse to happen, by which time many of those victims had already passed on.
• 12:29
  SPEAKER_00: We're seeing this with PFAS issues, with um um, you know, aviation support people around airports.
• 12:37
  SPEAKER_00: Um anyway, blah, blah, blah, that sort of thing, you know.
• 12:41
  SPEAKER_00: Yeah.
• 12:42
  SPEAKER_00: So we're seeing this lag time of those people affected where they encounter health issues.
• 12:47
  SPEAKER_00: That generation, if you like, dies out, and therefore it's like, oh, yeah, we knew that.
• 12:51
  SPEAKER_00: Um now it's a real big issue, sort of thing.
• 12:54
  SPEAKER_00: Um you know, I I'm forgive me for being so negative, but I just I can see governments just going, nah no, nothing to see here until bang.
• 13:06
  SPEAKER_00: Three generations later, when things have changed, they'll go, oh, sure, we knew about that.
• 13:11
  SPEAKER_01: Yeah, look, I I don't think it's an easy thing because you're talking about a worldwide public health policy.
• 13:18
  SPEAKER_01: And we're not saying that folic acid is a no-go zone.
• 13:23
  SPEAKER_01: What we're saying is we now have clear evidence from animal and human studies that there is a problem with excessive levels.
• 13:33
  SPEAKER_01: So let's define it.
• 13:34
  SPEAKER_01: If we're saying that 400 micrograms is the recommendation worldwide, then we need to counsel women that they shouldn't exceed that.
• 13:47
  SPEAKER_01: We also need an alternative.
• 13:49
  SPEAKER_01: So if someone does have problems with methylation or they've got an MTHR polymorphism or they've got other genes in that folate pathway, then the sensible alternative is the methylfolate, which doesn't build up.
• 14:03
  SPEAKER_01: And so I think the problem, part of the problem is we have this one size fits all.
• 14:10
  SPEAKER_01: And I think we need to be more individualized in our prescriptions.
• 14:14
  SPEAKER_01: And I think we can't assume that more is better when it comes to folic acid.
• 14:20
  SPEAKER_01: I think has it done its job from preventing neural tube defects?
• 14:26
  SPEAKER_01: Yes, but it was only ever meant to contribute 100 micrograms per 100 grams of flour.
• 14:33
  SPEAKER_01: We're way beyond that.
• 14:35
  SPEAKER_01: Way beyond that.
• 14:36
  SPEAKER_01: Some breakfast cereals have 400.
• 14:39
  SPEAKER_01: So this is part of the problem.
• 14:42
  SPEAKER_01: It's it's we've got this attitude that more is better, let's just get more, more, more, more, more.
• 14:48
  SPEAKER_01: And you know, there's some researchers in the UK that are actually proposing we now supplement our food with a thousand micrograms.
• 14:57
  SPEAKER_01: It's insanity, absolute insanity.
• 15:00
  SPEAKER_01: We can't wait, which is the average of research to the population, 20 years.
• 15:08
  SPEAKER_01: We can't wait 20 years for this to be resolved.
• 15:11
  SPEAKER_01: We need to be looking at this excess level now, and we need to say, okay, for the majority of the population, there's no problem if you're under 400 micrograms of combined food and supplements, which means we've got to drastically change what people are having access to on the supermarket shelf.
• 15:31
  SPEAKER_01: But then we also need to be able to say, okay, if you do have MTHFR, or we do know that you have problems with not metabolizing that folic acid, you might have a DHFR, dihydrofolate reductase polymorphism as well.
• 15:48
  SPEAKER_01: We think the better option for you is methylfolate, particularly in recurrent pregnancy loss.
• 15:56
  SPEAKER_01: And I'm really, I think that's one of the things that I've come out of this definitely saying if you've got recurrent pregnancy loss, I don't think there's any option other than to swap to methylfolate and really go at a higher level.
• 16:14
  SPEAKER_00: So let's just say, let's just dream for a second that governments listened and said, okay, we're going to swap to the methylfolate, which is one of the ones, one of the active folates found in food, normal food, not fortified food.
• 16:31
  SPEAKER_00: Um, is it stable if they decided to fortify with methylfolate?
• 16:36
  SPEAKER_00: And not at the end point.
• 16:39
  SPEAKER_00: Right.
• 16:40
  SPEAKER_01: This is the biggest problem we have.
• 16:42
  SPEAKER_01: And I look, I don't think that there's any, I don't think there's any chance that you will get a complete change in swap to methylfolate.
• 16:52
  SPEAKER_01: I think where we we need to go initially is say, okay, we're still saying that folic acid is generally fine for the population.
• 17:02
  SPEAKER_01: We'll stick it at 400 micrograms, but we have to minimize the voluntary folic acid.
• 17:11
  SPEAKER_01: I think if we could actually um delete a voluntary folic acid fortification and say we're only sticking with the mandatory, you can easily then guess how much someone is getting from their food.
• 17:25
  SPEAKER_01: Right.
• 17:26
  SPEAKER_01: And then say, okay, we want you to have a total of 400 micrograms to support the pregnancy.
• 17:32
  SPEAKER_01: Therefore, you you can have a supplement of 200 micrograms.
• 17:37
  SPEAKER_01: And then say to those people that are having problems or having recurrent pregnancy loss, we think that we need a personalized prescription for you, and we don't think methylfol the folic acid is the right way to go.
• 17:51
  SPEAKER_01: Let's go with methylfolate.
• 17:54
  SPEAKER_01: And I think if we if we plan it out as a slow transition, I don't think there's any chance there will be a complete swap.
• 18:04
  SPEAKER_01: Because we do have problems, and this was one of the things unfortunately that came up in the trial is that we did have stability issues with the methylfolate product, which I think did absolutely affect the outcomes.
• 18:17
  SPEAKER_01: So the stability of methyl fro methylfolate is problematic, and as yet, the one of the I think one of the reasons it hasn't been approved for food fortification is that it's not stable.
• 18:34
  SPEAKER_01: And it's only in certain instances that you could improve that stability.
• 18:39
  SPEAKER_01: So I think it is a problem, and we we probably need to just say keep the methylfolate in the supplements.
• 18:47
  SPEAKER_01: But then, given what we went through, stability is key.
• 18:53
  SPEAKER_01: And I have to question a lot of the research that's come before that's used methylfolate and hasn't found it to be therapeutic, particularly in fertility and with MTH of R, whether that's part of the problem, because they didn't check most of I don't know of any other study that actually did test stability of the product.
• 19:15
  SPEAKER_00: Wow.
• 19:16
  SPEAKER_00: Okay.
• 19:17
  SPEAKER_00: So what about I um introducing the halfway measure, the folinic acid?
• 19:22
  SPEAKER_00: Where does that sit in the population versus a personal sort of issue?
• 19:26
  SPEAKER_00: Somebody with SNPs on it versus a population basis.
• 19:30
  SPEAKER_00: Food fortification I'm talking about here.
• 19:32
  SPEAKER_01: It's definitely stable.
• 19:34
  SPEAKER_01: And that's one of the huge advantages of folinic is it is stable and it is, you could absolutely put it in food instead of folic acid with no problem.
• 19:43
  SPEAKER_01: And would that be a good interim step?
• 19:45
  SPEAKER_01: Probably, particularly for food fortification.
• 19:49
  SPEAKER_00: Yeah.
• 19:49
  SPEAKER_01: It's still in my mind, though, not the ideal, particularly for those people with MTH VAR who have got recurrent pregnancy loss.
• 19:58
  SPEAKER_01: And also for to prevent if you're using it in fortification, yes.
• 20:06
  SPEAKER_01: Um, but in terms of preventing the epigenetic effect, you still need that methyl folate.
• 20:12
  SPEAKER_01: So that would depend on a conversion issue.
• 20:16
  SPEAKER_01: It would um be an individualized, I think, approach.
• 20:22
  SPEAKER_01: But from food fortification, yes, it's so stable.
• 20:25
  SPEAKER_01: And it and it would be a very good choice.
• 20:28
  SPEAKER_00: From a healthcare policy and costing um issue, uh, A, would it be viable?
• 20:35
  SPEAKER_00: B, if you're thinking about sub-populations that might be affected by a methylation SNP and would require methyl folate more than just the folinic acid.
• 20:46
  SPEAKER_00: Um, and then you've got to think about the testing.
• 20:47
  SPEAKER_00: I mean, at the moment, anybody trying to get a um a methylation SNP tested, you've got to qualify uh by basically having a um, what is it, a cleft pallet or a baby with cleft pallet previously or something?
• 21:01
  SPEAKER_00: Yeah.
• 21:02
  SPEAKER_00: Um so it's almost like you have to have been proven to have had an issue with your pregnancy, not just no pregnancy.
• 21:11
  SPEAKER_01: It's it's a really Well I I really think that all women with recurrent pregnancy loss should fit into that category.
• 21:20
  SPEAKER_01: You've had a problem, let's make sure that we're doing something differently.
• 21:25
  SPEAKER_01: Because what our research found, and it was just a small subsection of the women from the um pilot study, where we interviewed them about their experiences in the medical system with their recurrent pregnancy losses.
• 21:41
  SPEAKER_01: And there's a real there's there's a lot of different problems when we we look at these this recurrent pregnancy loss situation because these women are not pregnant, but they're not not pregnant.
• 21:54
  SPEAKER_01: They're getting pregnant usually with no problem whatsoever.
• 21:58
  SPEAKER_01: They ring their GP and they say, I'm having a miscarriage, and the GP says, well, go to the emergency, I can't do anything.
• 22:05
  SPEAKER_01: The emergency center puts them in the maternity ward to have their miscarriage, and then they're told go home and keep trying.
• 22:15
  SPEAKER_01: So there's this loss of this lack of appreciation of what they've gone through, and just can, I guess, thinking about it from a physical point of view and not an emotional point of view, it's very lacking.
• 22:30
  SPEAKER_01: And these women are saying, hey, we don't fit into the system.
• 22:35
  SPEAKER_01: We're not we're asking what we can do differently, we're asking how we can prevent it, and they're told nothing, go home and keep trying.
• 22:44
  SPEAKER_01: So I think there's real issues.
• 22:46
  SPEAKER_01: And if we could come back to these women, and that's why they love to see us in clinic, because we say, Yes, we actually believe there's a lot you can do.
• 22:54
  SPEAKER_01: First of all, get rid of the folic acid out of your diet.
• 22:57
  SPEAKER_01: Second, let's move you to methyl folate, let's test you for MTHFR, let's increase the folate if it's warranted, and let's look at all the other.
• 23:08
  SPEAKER_01: And if they say there's nothing physical, that's when I say, great, perfect.
• 23:12
  SPEAKER_01: And you know, 80, 85% of the time they will get pregnant naturally.
• 23:18
  SPEAKER_01: So I think there's a lot we can do if we're a bit more individualized in the approach, and we we put these women that are having recurrent pregnancy loss not into the mainstream medical system, but we're saying, okay, we accept that what we need to do for you is actually very different.
• 23:38
  SPEAKER_01: And let's do that protocol, let's change you to methyl folate and see if you get an improved response.
• 23:44
  SPEAKER_01: And they probably would.
• 23:47
  SPEAKER_00: Can I ask the question about uh dosage and I think you've sort of answered the question, so forgive me for asking it again if I've um just re-asking, but with regards to what you saw with unmetabolized folic acid in supplemented individuals versus unmetabolized um folic acid in those people just on uh quote unquote uh standard Australian diet, sad.
• 24:14
  SPEAKER_00: Um is the issue just that, simply that, solely that they're taking folic acid, and if they stopped that intake of folic acid, their folic acid levels would drop to normal, i.e., the issue of high folic acid is quote unquote supplementation of some form, whether that be from a tablet or food.
• 24:37
  SPEAKER_00: Is that the issue, or does unmetabolized folic acid remain an issue after cessation of folic acid intake?
• 24:47
  SPEAKER_01: The there's previous research, not mine, that that basically says if you live in a country of fortification and you are eating a normal, what they call a normal diet, you will have levels of unmetabolized folic acid.
• 25:03
  SPEAKER_01: Every single person in a supplemented country that has bread or breakfast cereals or anything in a packet absolutely will have unmetabolized folic acid.
• 25:12
  SPEAKER_01: One of the things we found in the trial, though, that was very exciting, is that the women on the folic acid had really high levels of unmetabolized folic acid.
• 25:21
  SPEAKER_01: The women on the methylfolate did not.
• 25:24
  SPEAKER_01: It was really low.
• 25:27
  SPEAKER_00: Well, hang on.
• 25:28
  SPEAKER_00: So that would that would indicate, therefore, that the issue is supplementation, i.e.
• 25:31
  SPEAKER_00: tablets, not food fortification.
• 25:33
  SPEAKER_01: We took them all off.
• 25:34
  SPEAKER_01: Every single person in the trial was off folic acid-based foods.
• 25:38
  SPEAKER_01: And that was what was totally unique about this trial is that it was one of the only trials in the world to take people off the food fortified with folic acid and also to include the male partners.
• 25:52
  SPEAKER_01: And what was really interesting is that the male partners were the ones mostly with the homozygous MTH of R.
• 26:01
  SPEAKER_00: Right.
• 26:02
  SPEAKER_01: Not the women.
• 26:03
  SPEAKER_01: And yet we do nothing for men.
• 26:05
  SPEAKER_01: We don't tell them to take any folate, we don't counsel them to take, well, we do, but most practitioners don't.
• 26:13
  SPEAKER_01: Um, so what the women did in the trial, the men did too.
• 26:18
  SPEAKER_01: They had to go off the folic acid foods, they had to take their prenatal multivitamin, um, and they did exactly the same.
• 26:25
  SPEAKER_01: But it was really interesting that it was the men.
• 26:28
  SPEAKER_01: And we know from previous research, there is a lot of research around how folic acid affects sperm.
• 26:39
  SPEAKER_01: And those people, those males with MTH of R polymorphisms have been shown to have azoospermia, oligosoospermia, and infertility.
• 26:50
  SPEAKER_01: And there's multiple, multiple studies that reinforce that and back that up.
• 26:55
  SPEAKER_00: It's it raises a really interesting question regards the regarding the prevalence of neuroatypical um issues, disorders, if you like, in young children, male to female prevalence.
• 27:06
  SPEAKER_01: Yeah.
• 27:07
  SPEAKER_00: Wow.
• 27:08
  SPEAKER_01: Absolutely.
• 27:09
  SPEAKER_00: I know yet again.
• 27:10
  SPEAKER_01: Yeah, it's it's but it's so interesting.
• 27:13
  SPEAKER_01: And I guess what I'm, you know, what I I've got to really sit down now is pull all this together in a sensible way.
• 27:22
  SPEAKER_01: Because as I said, I just don't think there's any hope in public health policy changing overnight.
• 27:30
  SPEAKER_01: It's just not going to happen.
• 27:32
  SPEAKER_01: But but if but if we're saying, hey, 400 uh micrograms is the recommendation, then why are we allowing more than that?
• 27:41
  SPEAKER_01: You know, we we have to, and and we can't have this attitude that more is better with folic acid because we know it's not.
• 27:50
  SPEAKER_00: Is part of it also balance, i.e., we're seeing an issue with B6, you know, vitamin B6.
• 27:56
  SPEAKER_00: It's being, you know, uh, in my opinion, um, a little bit lamb-based in that we're seeing toxicities, but is it largely?
• 28:06
  SPEAKER_00: Um, is it solely?
• 28:07
  SPEAKER_00: I don't know.
• 28:08
  SPEAKER_00: But um I don't know of a naturopath who would use massive doses of B6 solely for an extended period of time without supplementing with other B vitamins, preferably activated.
• 28:20
  SPEAKER_00: Indeed, it was the the natural health practitioners in this country that sort of lobbied, and and the companies which lobbied for the activated uh B vitamins to be to be listable.
• 28:31
  SPEAKER_01: Um you know, you know why I think that is happening, the whole B6 issue?
• 28:35
  SPEAKER_00: Tell me.
• 28:36
  SPEAKER_01: So we need B6 has a lysine residue in it, right?
• 28:42
  SPEAKER_01: So to metabolize B6, you need lysine.
• 28:46
  SPEAKER_01: We have come off five years of a high viral load.
• 28:52
  SPEAKER_01: And everybody, in my opinion, is lysine deficient.
• 28:57
  SPEAKER_01: We have proved hundreds of times in clinic if we give lysine, the B6 comes down instantly, like within weeks.
• 29:08
  SPEAKER_00: Wow.
• 29:09
  SPEAKER_01: So I believe this whole issue is a lysine deficiency and has nothing to do with B6 toxicity.
• 29:19
  SPEAKER_00: That's a big statement.
• 29:20
  SPEAKER_01: I but I do because how can you then explain that you give someone lysine for three weeks and their B6 comes back to normal?
• 29:29
  SPEAKER_01: And they're still they're not necessarily and we put them back on the B6, keep the lysine in, and there's no toxicity.
• 29:37
  SPEAKER_01: Because you need lysine to metabolize your B6.
• 29:42
  SPEAKER_00: Yeah.
• 29:42
  SPEAKER_00: Wow.
• 29:44
  SPEAKER_00: Wow, that's an interesting comment.
• 29:46
  SPEAKER_00: I didn't look into that.
• 29:47
  SPEAKER_01: Yeah.
• 29:47
  SPEAKER_00: So because if you look at if you look at the the Australian Bureau of Statistics, the ABS, and you look at their nutrient sort of deficiencies over lifespans, you know, B6 in young women and and uh I'm gonna say middle age women, but you know, the sort of mature woman.
• 30:04
  SPEAKER_00: Um, they're huge.
• 30:06
  SPEAKER_00: Yeah.
• 30:07
  SPEAKER_00: Um wow.
• 30:10
  SPEAKER_00: I need to think about that to think even of questions I can ask.
• 30:13
  SPEAKER_01: Well, I've I've been I've been doing that in clinic for probably eight years.
• 30:19
  SPEAKER_01: If I see B6 elevated, I give lysine, it comes straight back down.
• 30:23
  SPEAKER_00: Wow.
• 30:24
  SPEAKER_00: Cool bananas.
• 30:26
  SPEAKER_00: Okay, uh, let's go back to your research because um you said earlier about your attitude towards changing folic acid and things like that.
• 30:33
  SPEAKER_00: Is there any other messages that we need to heed that you've learnt along your journey with your research?
• 30:40
  SPEAKER_01: Yes, I I'm I'm more absolutely 100% determined to ensure that men are included in preconception care across the board.
• 30:54
  SPEAKER_01: I mean, we when you look at the all the policy recommendations, um, all the protocols that doctors are following in regards to recurrent pregnancy loss, men are pretty much nigh absolutely ignored.
• 31:10
  SPEAKER_01: And so I think we can't expect all these women to be pin cushions in IVF and doing all the right thing and taking all the supplements and being injected with hormones and everything else, and then just ignore them in and go, oh well, it's not your issue.
• 31:27
  SPEAKER_01: We need to really be looking at DNA fragmentation rates across the board.
• 31:31
  SPEAKER_01: We need to be checking them for MTHFR, we need to be putting them on the same diets.
• 31:36
  SPEAKER_01: We we did in the um practitioner research that we've just had published last week, that was one of the things that really stood out when we asked them how many actually included males in preconception care, was 11%.
• 31:53
  SPEAKER_00: Wow.
• 31:55
  SPEAKER_01: 11% of fertility specialists, midwives, GPs, um rates, 11%, and that can't continue because what what is this?
• 32:09
  SPEAKER_01: Do men a do we not teach kids in school that they're involved in making a baby?
• 32:16
  SPEAKER_01: Two, do men have no idea that 50% of their DNA is contributing?
• 32:23
  SPEAKER_01: I mean, the amount of times that males say men say this has nothing to do with me, it's like, oh my goodness, I wish I had a daughter for every time.
• 32:31
  SPEAKER_01: So, and then because we're not addressing it from a public health perspective, we need messaging out there for men, and it's got to start at school.
• 32:41
  SPEAKER_01: Hey, you're 50% responsible.
• 32:44
  SPEAKER_01: So what your wife does, you do, or what your partner does, you do.
• 32:49
  SPEAKER_01: And that was a big eye-opener, particularly when we found in the trial that it was the men that had the MTH pharaoh polymorphisms homozygous.
• 33:02
  SPEAKER_01: So that raises the whole question is why do we only consider that the woman has has the problem?
• 33:11
  SPEAKER_01: And the amount of times that we've seen, you know, these women in clinic that have struggled and struggled and struggled to get pregnant, and all the time it was their partner.
• 33:22
  SPEAKER_01: Yeah.
• 33:22
  SPEAKER_01: So I think I mean, most naturopaths would absolutely address the um the male, but it's not happening at the front line.
• 33:33
  SPEAKER_01: It's not happening with GPs and it's not happening with fertility specialists on the whole.
• 33:39
  SPEAKER_01: So we really need to change that whole dimension that, hey, we need protocols for men as women and women, not just women.
• 33:50
  SPEAKER_00: What about things like other B vitamins, e.g.
• 33:52
  SPEAKER_00: B12?
• 33:53
  SPEAKER_00: You know, like I I never ever used to give folic acid in my younger days.
• 33:58
  SPEAKER_00: Um, I never used to give folic acid without giving B12, just wouldn't do it.
• 34:02
  SPEAKER_01: Yeah.
• 34:02
  SPEAKER_00: Um what have we learned?
• 34:04
  SPEAKER_00: What what sort of other issues have you learned with generalized nutrition?
• 34:08
  SPEAKER_00: Uh ID deficiency, for instance.
• 34:10
  SPEAKER_00: Are you seeing this being a concordant issue?
• 34:15
  SPEAKER_01: Yes.
• 34:16
  SPEAKER_01: I mean, I think I think the problem is now that our food doesn't supply us with what we think it should.
• 34:23
  SPEAKER_01: And I think a lot of um GPs still have the attitude that it's food is fine when you're preparing for pregnancy.
• 34:32
  SPEAKER_01: And I just don't think we can say that anymore with the processing and everything.
• 34:36
  SPEAKER_01: So all the things that we know we've got to check, B12 is critical when it comes to folate absorption.
• 34:44
  SPEAKER_01: Absolutely critical, because you can't absorb your folate without B12.
• 34:48
  SPEAKER_01: And so if we consider that folic acid does mask a B12 deficiency, anyone taking folic acid is at huge risk.
• 34:58
  SPEAKER_01: And so I think we've got to be checking those absolutely.
• 35:01
  SPEAKER_01: And as a general rule, we don't give isolated B vitamins without the whole package.
• 35:07
  SPEAKER_01: So I think that's also important.
• 35:09
  SPEAKER_01: But we did see that in the practitioner's survey where they were giving off-the-counter products that just had folate and iron in it, because that's the recommendation.
• 35:20
  SPEAKER_01: So I think the recommendations need to be broadened to say we do need multi-Bs in formulas.
• 35:28
  SPEAKER_01: Um, and when you look at those formulas on the shelf, the amount of B12 in there is absolutely pathetic, except for practitioner-only products, which they're really good.
• 35:39
  SPEAKER_01: I mean, you're talking six micrograms.
• 35:42
  SPEAKER_01: Like it's it's insane.
• 35:44
  SPEAKER_01: So I think there's, yeah, there's a lot of a lot of issues, but we're not gonna solve all those overnight.
• 35:50
  SPEAKER_01: But we can only try, can't we?
• 35:53
  SPEAKER_00: We're gonna need to clone you for the next generation, Carolyn.
• 35:56
  SPEAKER_00: So you've got the next we need more.
• 36:00
  SPEAKER_00: And and flowing on from that, what's next with your research?
• 36:03
  SPEAKER_00: What's happening now?
• 36:04
  SPEAKER_00: So um, okay, you'll have your PhD done hopefully by the end of 2025.
• 36:11
  SPEAKER_00: Um, what's it's Dr.
• 36:13
  SPEAKER_00: Carolyn Ludowski?
• 36:15
  SPEAKER_01: Oh, well, it's a really good question.
• 36:17
  SPEAKER_01: And I I'm not sure yet.
• 36:19
  SPEAKER_01: I would I like to do some teaching?
• 36:22
  SPEAKER_01: Yeah, I would.
• 36:23
  SPEAKER_01: I think I'd really like to teach the next generation of kids that, hey, this is a really important topic, and for us to understand that biochemistry and have the attitude that we need to be more individualized in our prescriptions.
• 36:37
  SPEAKER_01: I think that's really important.
• 36:40
  SPEAKER_01: There's so much research, and I'm I'm in the process now of writing the implications for future research, and there's so much future research around this whole thing.
• 36:51
  SPEAKER_01: Maybe supervising some other PhD students that can continue this work would be awesome.
• 36:58
  SPEAKER_01: Um, so I don't there's a lot of options.
• 37:01
  SPEAKER_01: I'm not sort of wedded to anything, or a book.
• 37:04
  SPEAKER_01: Yeah, absolutely.
• 37:06
  SPEAKER_01: I do want to write a book next to you.
• 37:08
  SPEAKER_01: That's one of the things on my list.
• 37:10
  SPEAKER_01: Um, but it's there's a lot, and I think well, I've only looked at it from a recurrent pregnancy loss, but as I said in the very beginning, I think autism, I think definitely neurological disturbances across the board is a very, very big part of the picture.
• 37:31
  SPEAKER_01: And I think cardiovascular, there's so much.
• 37:35
  SPEAKER_01: Um, mental health, depression, anxiety, there's a lot that could be addressed through future research.
• 37:43
  SPEAKER_01: And I think I think, yeah, just I'd like to get to public department, you know, health departments to start presenting the results to at least open some conversations to say, hey, wouldn't it be great if we could be the first in the world to actually look at what excess means and how we define it and what we do?
• 38:07
  SPEAKER_01: I think that would be great.
• 38:09
  SPEAKER_00: I think, I think part of what you're asking, though, and uh we can only hope that somebody in authority within the healthcare system, within politics, the you know, that sort of echelon of our governance in Australia, um, whether it be medical or political, has the fortitude to change policy with regards to public health, that more is not better.
• 38:35
  SPEAKER_00: We got it wrong.
• 38:36
  SPEAKER_00: We need to change.
• 38:37
  SPEAKER_00: We've we've we've done it before.
• 38:40
  SPEAKER_00: I don't think they're gonna say we got it wrong.
• 38:42
  SPEAKER_01: No, I don't think, but but I do think the first step could absolutely be we're not changing our policy.
• 38:51
  SPEAKER_01: We're just saying that we believe that 400 micrograms is the upper limit.
• 38:56
  SPEAKER_01: So we're gonna restrict supplements, we need to tamper, we're gonna reassess voluntary fortification, and by the way, we're gonna acknowledge that there is a subset of the population, like those having recurrent pregnancy loss, that we might look at changing what we give.
• 39:12
  unknown: Yeah.
• 39:13
  SPEAKER_01: If we could do those three things, that would be major.
• 39:18
  SPEAKER_00: Yeah, but not just with those women that are losing the baby with their partners who are give donating the DNA.
• 39:26
  SPEAKER_00: Yeah.
• 39:26
  SPEAKER_01: Absolutely.
• 39:27
  SPEAKER_01: I think that would be absolutely phenomenal if those three things could at least be started to say, okay, we acknowledge there's an upper limit.
• 39:37
  SPEAKER_01: We don't know what it is yet, but let's let's just stick to the worldwide recommendation, which is four or five hundred micrograms.
• 39:44
  SPEAKER_01: Let's not allow any supplement to have above that.
• 39:48
  SPEAKER_01: And by the way, yeah, we think the people are probably getting too much.
• 39:53
  SPEAKER_01: So let's cut out a voluntary fortification and just stick to our mandatory.
• 39:59
  SPEAKER_01: That would be major if we could do that.
• 40:01
  SPEAKER_00: I I am so impressed by your your incredible focus, but also your care because it's not just care about the topic, because you're a clinician, you care for patients, you care for women and men who are suffering issues, not just pregnancy and loss and things like that, but neurological issues you have done for decades.
• 40:21
  SPEAKER_00: Um, I'm so impressed that you are finalizing your PhD now because it's going to give you that extra piece of credential to say, no, no, I've really looked into this.
• 40:31
  SPEAKER_00: You know, um, you really, you really have a message that's worthy of being listened to.
• 40:36
  SPEAKER_00: I just I thank you so much for the work that you've done, not just for patients, but for future practitioners and the care of their patients.
• 40:44
  SPEAKER_00: Well done to you, Carolyn Ludowski.
• 40:46
  SPEAKER_00: And I will I will preempt this by saying, uh, what do we say?
• 40:50
  SPEAKER_00: PhD candidate, but you know, I can't wait for the day where I'm able to say Dr.
• 40:54
  SPEAKER_00: Carolyn Ludowski.
• 40:56
  SPEAKER_01: Oh, thank you.
• 40:57
  SPEAKER_01: That's really kind of you.
• 40:58
  SPEAKER_01: Yeah, it is look, it is exciting.
• 41:00
  SPEAKER_01: And as you said, I I've been passionate about this for 15 years, but I it was just something that I was determined.
• 41:10
  SPEAKER_01: That was part of the reason I I did the research.
• 41:12
  SPEAKER_01: One, I found, and it's sad, uh, but I did find as a naturopath, I didn't have a voice in this area.
• 41:20
  SPEAKER_01: I and I really needed to have a voice.
• 41:23
  SPEAKER_01: I needed to basically try and get other people to see what I could see in clinic.
• 41:30
  SPEAKER_01: And so that was the real move behind doing the doctorate, was to not only get research we didn't have, but also have a voice at the end of it that I could say, yeah, I have the credentials to be able to say to you, I think we've got a problem.
• 41:50
  SPEAKER_01: And so if that means then that I have to do 500,000 presentations next year, I'll do it.
• 41:56
  SPEAKER_01: But it just means that we've got to open some doors.
• 41:59
  SPEAKER_01: And I think as a doctor, I've got more chance of opening doors where I couldn't open a door before.
• 42:08
  SPEAKER_01: And it's really sad to say that.
• 42:10
  SPEAKER_01: But I think what comes with the doctorate is people say, Well, you've got to know your topic.
• 42:16
  SPEAKER_00: Yeah.
• 42:17
  SPEAKER_00: Yeah.
• 42:18
  SPEAKER_00: And I can see that you'll be in demand the world over.
• 42:20
  SPEAKER_00: Well done, Carolina Ludowski.
• 42:22
  SPEAKER_00: It's been great chatting with you again.
• 42:24
  SPEAKER_00: Yeah, and thank you so much for sharing.
• 42:26
  SPEAKER_00: This is like it's such important work that you're doing.
• 42:28
  SPEAKER_00: So well done, seriously, for what you've done.
• 42:31
  SPEAKER_00: Beautiful.
• 42:31
  SPEAKER_00: Thank you.
• 42:33
  SPEAKER_00: And thank you, everyone, for joining us today.
• 42:35
  SPEAKER_00: Of course, we will put up as much as we can with Carolyn's research.
• 42:39
  SPEAKER_00: There will be some that we can't that will be embargoed until it's published, but um, watch this space.
• 42:44
  SPEAKER_00: We'll put up the relevant details for when they become available.
• 42:48
  SPEAKER_00: And of course, you can watch the other podcasts on the Designs for Health website.
• 42:52
  SPEAKER_00: I'm Andrew Whitfield Cook, and this is Wellness by Designs.