From: "Dr. D. Kossove" <doctordee@telkomsa.net>
Subject: !bmj diet editorial folate
Date: Saturday, January 24, 2004 10:57 AM

http://bmj.bmjjournals.com/cgi/content/full/328/7433/0-g?etoc

Home Help Search/Archive Feedback Table of Contents 

--------------------------------------------------------------------------------
BMJ  2004;328 (24 January), doi:10.1136/bmj.328.7433.0-g 
PDF of this article  
Email this article to a friend  
Respond to this article  
Read responses to this article  
Related editorials in BMJ  
Other related articles in BMJ  
Download to Citation Manager  
Search Medline for articles by: 
 Smith, R.  
Alert me when: 
 New articles cite this article
 
 
Editor's choice
"Let food be thy medicine..." 
Mark Lucock ends his review of the science of folic acid by quoting Hippocrates: "Let food be thy medicine and medicine be thy food" (p 211). Although many patients are convinced of the importance of food in both causing and relieving their problems, many doctors' knowledge of nutrition is rudimentary. Most feel much more comfortable with drugs than foods, and the "food as medicine" philosophy of Hippocrates has been largely neglected. That may be about to change. Concern about obesity is rocketing up political agendas, and a growing interest in the science of functional foods is opening up many therapeutic possibilities (p 180). 
It was in 1931 that Lucy Wills described how yeast extract could be effective in preventing tropical macrocytic anaemia of late pregnancy. Folate was shown to be the crucial factor. In the 1980s a series of studies showed how periconceptional folate could prevent spina bifida. Then in 1995 came a meta-analysis that established that high homocysteine concentrations were a risk factor for atherosclerosis. Dietary folate reduces homocysteine, raising the possibility that a vitamin might prevent vascular disease. Next, several nucleotide polymorphisms were found to be related to folate, meaning that folate levels might influence the chance of developing cancer. 

These discoveries are not surprising as folate metabolism is involved in many of the fundamental processes of life. Lucock describes, for example, how it is important for nucleotide biosynthesis. Thymidylate synthase, an enzyme that helps synthesise DNA, depends on a folate derivative. Low levels of folate may thus lead to breaks in DNA, predisposing to cancer. There are many other ways in which folate can affect gene function, and so folate is central to nutrigenomicsthe study of the links between nutrition and gene function. 

Folate may thus be a leading contender for panacea of the 21st century. Addition of folate to foods might reduce birth defects, vascular disease, and heart diseaseand the Americans favour fortifying bread with folate. But folate being involved in so many of life's fundamental processes not only leads to its possibilities as a panacea but also to the prospect that "messing around with folate" could do extensive harm. The folate used in food fortification is not a natural co-enzyme, and nobody knows the long term effects of exposing whole populations to the unnatural folate. 

There is thus great potential for good, some possibility of harm, and much uncertainty. The question of fortifying foods inevitably becomes highly political, and the politics of nutrition are just as complex as the science. Owen Dyer tells how the United States governmentlobbied by food manufacturersis trying to undermine a report by the World Health Organization on Diet, Nutrition, and the Prevention of Chronic Disease (p 185). My unadventurous prediction is that we will be hearing much more about the science, medicine, and politics of food. Hippocrates would be pleased. 

Richard Smith, editor 

(rsmith@bmj.com) 




--------------------------------------------------------------------------------
To receive Editor's choice by email each week subscribe via our website: bmj.com/cgi/customalert 



Rapid Responses:
Read all Rapid Responses 

First remove the sugar and have a glass of wine 
Nicholas D Moore 
bmj.com, 23 Jan 2004 [Full text] 
Promises in Nutrition 
Ned Hoke 
bmj.com, 23 Jan 2004 [Full text] 
Related editorials in BMJ:
Health claims for functional foods. 
Martijn B Katan
BMJ 2004 328: 180-181. [Full text]   

Other related articles in BMJ:
News
Claim of human reproductive cloning provokes calls for international ban. 
Susan Mayor
BMJ 2004 328: 185. [Full text]   

Clinical review
Is folic acid the ultimate functional food component for disease prevention?. 
Mark Lucock
BMJ 2004 328: 211-214. [Full text]   



PDF of this article  
Email this article to a friend  
Respond to this article  
Read responses to this article  
Related editorials in BMJ  
Other related articles in BMJ  
Download to Citation Manager  
Search Medline for articles by: 
 Smith, R.  
Alert me when: 
 New articles cite this article
 
 




--------------------------------------------------------------------------------
Home Help Search/Archive Feedback Table of Contents 

 2004 BMJ Publishing Group Ltd 
 