The Folic Acid Paradox and the Importance of Vitamin Balancing

In this blog post, Kelly Dorfman, MS, LND, explains the folic acid paradox and what can be done about it.

Folic acid (or folate) is one of the most deficient and problematic nutrients in the American diet. While small amounts are in orange juice, folic acid is found mainly in dark green “foliage,” from which its name derives.

Many children with developmental and attentional issues – and most children with sensory issues – seem particularly repelled by green food. Typically, picky eaters reject their desperate parents’ attempts to provide a balanced diet.  Nonetheless, if a child is on the growth chart despite limited eating habits, physicians tend to discount parental concerns.

Persistent parents and conscientious doctors have sometimes tested blood nutrient levels in a child’s plasma to assure that all is well. Generally, the testing reveals nothing unusual, with one exception. Folic acid, a B vitamin, is sometimes found in high amounts in ostensibly malnourished children.

Some professionals may mistakenly suggest that the child is not only sufficient in nutrients, but is close to toxicity and should, therefore, avoid added nutrients.This advice is based on the dubious, but common, medical practice of treating a test instead of a patient.

High folic acid levels in a child who consumes a limited diet are highly suspicious. Furthermore, high levels are puzzling because folate (like all B vitamins) is water soluble and does not tend to accumulate in the blood, even when extra is taken. Something else must account for the paradoxical findings.

Vitamin B1

Dr. Derrick Lonsdale, a pediatrician in Westlake, Ohio, and the world’s leading expert on vitamin B1, may have stumbled on an explanation. He discovered high folic acid levels in the blood of a child with a rare lymphatic condition. Confused, he consulted a biochemist hoping to find a plausible reason.

The chemist explained that vitamin B1 is a co-factor in utilizing folate. Perhaps, if B1 were deficient, the underutilized folic acid would back up in the blood. Dr. Lonsdale confirmed the theory by prescribing a large dose of B1, along with a B-complex vitamin. Not only were the youngster’s folic acid levels normal upon retesting, but also his lymphatic condition significantly improved.


In 1980, Dr. Lonsdale showed a relationship between low vitamin B1 and behavior problems in children. He discovered this relationship not by measuring B1 (or thiamine) levels in the blood, but by monitoring an enzyme that depends on thiamine to function. Checking enzymes (in this case, red blood cell transketolase) that vitamins regulate is more accurate than trying to catch individual B vitamins themselves because they work together.

Thus, a problem with one can distort the assessment of another. Indeed, assessing vitamin sufficiency by measuring blood levels is analogous to judging factory efficiency by counting workers, rather than looking at product output.

Balancing B Vitamins

While Dr. Lonsdale has a particular interest in B1, he emphasizes that B vitamins must be balanced. They interact in ways that we have yet to understand. The application of this insight is two-fold.

  • If your poor eater is coming up high in nutrient testing, rule out unusual food sources of the vitamin (after all, you know he is not eating broccoli) and consider, instead, a related nutrient deficiency. A knowledgeable nutritionist or biochemist can help.
  • If you give your child vitamin B6 or another B vitamin as part of nutritional therapy, DO NOT GIVE IT ALONE. Vitamin B6, for example, may cause imbalances in vitamin B2 (riboflavin) if given in large and unopposed amounts. It is neither necessary nor desirable to give equal amounts of all B vitamins, but there should be enough of all the other Bs to support a huge dose of one.

B vitamins are not dangerous. We must simply respect the way they work in nature, which is together, in balance.

Vitamin E

Many other vitamins and minerals work in teams, too. Vitamin E, for example, is a complex of mixed tocopherols and tocotrienols. The inexpensive versions available at many drug stores are often synthetic and represent only one piece of the known complex. Gamma-tocopherol, which is not present in synthetic vitamin E, is now believed to be a factor responsible for protecting against heart disease. Those taking synthetic E (dl-alpha-tocopherol) may not be getting the benefits they seek.

Therefore, study findings may disagree (depending on what exact kind of vitamin E the test subjects use.

About Kelly Dorfman MS LND

Kelly Dorfman is one of the world’s foremost experts on using nutrition therapeutically to improve brain function, energy and mood. Kelly’s special talent for integrating information from many sources and finding practical solutions has made her a popular speaker and workshop leader. She lectures extensively and is a member of Platform (formerly the National Speakers Association) and has been featured on numerous television programs including CNN’s American Morning.

Kelly’s award winning book, Cure Your Child With Food: The Hidden Connection Between Nutrition and Childhood Ailments (formerly known as What’s Eating Your Child) was given rave reviews by Publishers Weekly and the Washington Post.

As a go-to expert on nutrition issues, Kelly is frequently interviewed and quoted in the media. She has been featured in articles in The Wall Street Journal, Parade, Bethesda magazine, Living Without magazine, and the Huffington Post.

Kelly holds a master’s degree in nutrition/biology and is a licensed nutrition dietitian. She is a co-founder of Developmental Delay Resources, which has merged with Epidemic Answers. You can find out more about Kelly and her practice at

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