folic acid and tongue tie

[Guest guest]

Hi, Everyone!

A few months ago, we had some conversations with conjectures about what might be causing the increase in tongue ties that we all seem to be seeing. Folic acid use to prevent neural tube defects came up as a possible cause. Is there any research to support this theory? Or is theory all we have at this point?

Thanks for any information.

Dee Kassing

[Guest guest]

Thanks so much for this timeline about possible posterior tongue tie, Ann! May I have your permission to share this information with the LLL Leader who was asking me about this?

Dee Kassing

Subject: Re: Folic acid and tongue tieTo: Date: Tuesday, January 17, 2012, 11:41 AM

Dear Dee,

I was part of that thread. Yes, it was put forth as a hypothetical reason for TT and other midline defects.

One variation of the folate/folic acid hypothesis is that we are actually overconsuming folate/folic acid, also mentioned in the article below, from Wikipedia. I know, I know: not the most rigorous source of information.

However, I felt it did not fly.

Here is my thinking:

Folic Acid fortification was begun in 1996:

The United States Public Health Service recommends an extra 0.4 mg/day for newly pregnant women, which can be taken as a pill. However, many researchers believe supplementation in this way can never work effectively enough, since about half of all pregnancies in the U.S. are unplanned, and not all women will comply with the recommendation. Approximately 53% of the US population uses dietary supplements and 35% uses dietary supplements containing folic acid.[112] Men consume more folate (in dietary folate

equivalents) than women, and non-Hispanic whites have higher folate intakes than Mexican Americans and non-Hispanic blacks.[112] Twenty nine percent of black women have inadequate intakes of folate.[112] The age group consuming the most folate and folic acid is the >50 group.[112] Only 5% of the

population exceeds the Tolerable Upper Intake Level.[112]

In 1996, the United States Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products.[113][114] This ruling took effect on January 1, 1998, and was specifically targeted to reduce the risk of neural tube birth

defects in newborns.[115] There are concerns that the amount of folate added is insufficient .[116] In October 2006, the Australian press claimed that U.S. regulations requiring fortification of grain products were being interpreted as disallowing fortification in non-grain products, specifically Vegemite (an Australian yeast extract containing folate). The FDA later said the report was inaccurate, and no ban or other action was being taken against Vegemite.[117]

As a result of the folic acid fortification program, fortified foods have become a major source of folic acid in the American diet. The Centers for Disease Control and Prevention in Atlanta, Georgia used data from 23 birth defect registries covering about half of United States births, and extrapolated their findings to the rest of the country. These data indicate since the addition of folic acid in grain-based foods as mandated by the FDA, the rate of neural tube defects dropped by 25% in the United States.[118] The results of folic acid fortification on the rate of neural tube defects in Canada have also been positive, showing a 46% reduction in prevalence of NTDs;[119] the magnitude of reduction was proportional to the prefortification rate of NTDs, essentially removing geographical variations in rates of NTDs seen in Canada before fortification.

When the U.S. Food and Drug Administration set the folic acid fortification regulation in 1996, the projected increase in folic acid intake was 100 µg/d.[120] Data from a study with 1480 subjects showed that folic acid intake increased by 190 µg/d and total folate intake increased by 323 µg dietary folate equivalents (DFE)/d.[120] Folic acid intake above the upper tolerable intake level (1000 µg folic acid/d) increased only among those individuals consuming folic

acid supplements as well as folic acid found in fortified grain products.[120] Taken together, folic acid fortification has led to a bigger increase in folic acid intake than first projected.

However, I believe posterior tongue ties existed prior to the US folic acid fortification being mandated.

In 1997, Joanne Burke Snyder of the Lactation Institute, published in JHL her article, Bubble palate and failure to thrive: A case report.

We know that variations in infant palate (VIPs) were being found at the LI prior to the publication of that article, possibly predating the article by several years. Depending on how long the approval process for the article takes, it could have been written several years before publication. We also know that VIPs frequently accompany ATTs and PTTs.

In addition, in several editions of the Womanly Art of Breastfeeding there were pages devoted to nursing styles. When I looked back on them and looked through my old copies of the WAB, I was struck by the description of the "Nip and Napper" nursing style.

In addtion, one of the most consistent hallmarks of a PTT is not always pain, not always LMP, not always poor weight gain, but always long feeds and falling asleep before achieving satiety.

So, I hypothesize that Nip and Nappers may have been PTTed infants. If so, then they existed long before folic acid/folate fortification was inaugurated.

I doesn't appear in the 1963 (blue book) edition, but first appears in 1981:

The nip and napper

The nip and napper has much in common with the leisurely diner, although he tends to drop off to sleep (nap) after a few minutes of nursing (nip) and repeats the sequence very often.

1987 The nip and napper:

The nip and napper has much in common with the leisurely diner, although he tends to drop off to sleep (nap) after a few minutes of nursing (nip) and repeat this sequence rather often.

This is another instance when switch nursing can encourage more efficiency. As soon as baby starts to doze, switch him to the other breast. If he's really sleeping soundly, but you know he hasn't nursed long enough to be full, try burping him or changing his diaper before switching to the other breast.

A baby who spends too much time sleeping at the breast instead of sucking well could be headed for a problem with slow weight gain. You'll want to work at encouraging him to suck well and watch for wet and soiled diapers to be sure he's getting enough to eat. (See the information in the next section under "Is Baby Getting Enough?")

1991 The nip and napper

The above, 1987, edition is repeated verbatim

1997 The nip and napper

Again repeated verbatim

This is all purely speculation and hypothesis on my part, so I welcome discussion...

Ann