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High Alcohol, Low Folate:
A Bad Mix For Women

by Jennifer Wider, MD

(Washington DC, 12/05/03):†Heavy alcohol consumption may put women at high risk for several chronic diseases if they do not supplement their diets with folic acid, according to a new study published in the American Journal of Epidemiology.†

Researchers from the Harvard School of Public Health in Boston, Mass., analyzed data from the Nurses' Heath Study cohort to examine the relationship between alcohol and folic acid intakewith the risk of major chronic diseases.† The study included more than 80,000 women aged 34-59 who disclosed data about their diets.† The authors documented more than 10,000 new cases of major chronic disease during sixteen years of follow-up.† They defined chronic diseases as fatal or nonfatalheart disease, cancer or other non-traumatic death.

Folic acid, also known as folate, is a water-soluble B vitamin that plays a key role in producing and maintaining new cells.† Folate occurs naturally in food, while folic acid is the synthetic version in supplements and fortified foods.

According to the National Institutes of Health (NIH), folic acid is required to make DNA and RNA, the building blocks of cells. Folate is especially important during periods of rapid cell division and growth such as infancy and pregnancy.† Folate also protects DNA from changes that could lead to cancer and other diseases.

Women with folate deficiency who become pregnant are more likely to give birth to low birth weight and premature infants, and infants with birth defects in the brain or spinal cord.

Alcohol can interfere with folic acid metabolism and increase a woman's chance of getting heart disease or cancer, according to the study's results.

†"Alcohol has a strong anti-folate effect," according to Ed Giovannucci, M.D., S.C.D., an epidemiologist at the Harvard School of Public Health and one of the study's researchers.† Consuming an excess of alcohol may counter the positive effects of folic acid, leaving a person vulnerable to diseases.† Women who drink heavily with low folic acid levels are at highest risk, the study said.

Alcohol seems to affect women differently than men.† "A given amount of alcohol may produce higher blood levels in women," Giovannucci said.† According to the NIH publication Alcohol Alert, women seem to be more vulnerable to the negative side effects of alcohol when compared with men.† For example, women become more impaired than men after drinking equal amounts of alcohol, which suggests that they attain higher blood alcohol levels. † The female hormonal axis may also play a role in the interaction between alcohol and folate.† According to Giovannucci, "there is some evidence that estrogens may increase the folate requirement."† Women may need to raise their levels of folic acid intake due to the presence of estrogen in their bodies, but more studies are needed to explore this relationship.

"Folate appears to be important both for cardiovascular disease as well as cancer," Giovannucci said.† Therefore, folate deficiency may be a risk factor for these chronic diseases.† Women, especially those who consume large amounts of alcohol, need to monitor their folate intake.† The possible combined effects of estrogen and higher blood alcohol levels make women more vulnerable.

"Excessive drinking should be avoided and a diet high in folate is important," Giovannucci said.† Green leafy vegetables and liver are rich in folate, as are many fortified cereals and grains.† A multivitamin that contains folic acid is important for everyone, especially heavy drinkers.† But Giovannucci cautions consumers to "avoid very high intake of vitamins, well over the recommended daily allowance, as there could be adverse effects."


National Center for Health Statistics, Alcohol reports, 2002.

National Institutes of Health, Facts about Folate, 2002.

Jiang R, Hu F, Giovannucci, et al.† Joint Association of Alcohol and Folate Intake with Risk of Major Chronic Disease in Women. Am J Epidemiol 2003; 158:760-771.

The Society for Women's Health Research is the nation's only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Dr. Donnica Moore has been a member of the Society since 1990 and is a past member of its Board of Directors.

Created: 12/5/2003  -  Jennifer Wider, M.D.
Reviewed: 12/5/2003  -  Donnica Moore, M.D.

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