Potential for elimination of folate and vitamin B₁₂deficiency in India using vitamin-fortified tea: a preliminary study

Abstract

IntroductionThe majority of Indian women have a poor dietary folate and vitamin B12 intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea—the second most common beverage worldwide (after water)—is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B12, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India.MethodsWomen (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate pluseither 0.1 mg vitamin B12 (Group-1, n=19) or 0.5 mg vitamin B12 (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared.ResultsMost women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B12 levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p<0.05) and 6.69 ng/mL (95% CI 3.93 to 9.44, p<0.05), respectively; however, Group-0 experienced an insignificant rise of 1.26 ng/mL (95% CI –4.08 to 0.16). In addition, over one-half and two-thirds of women in Group-1 and Group-2, respectively, exhibited increases in serum vitamin B12 levels over 300 pg/mL. There was also a significant post-interventional increase in the mean haemoglobin concentration in Group-1 of 1.45 g/dL (95% CI 0.64 to 2.26, p=0.002) and Group-2 of 0.79 g/dL (95% CI 0.11 to 1.42, p=0.027), which reflected a bona fide clinical response.ConclusionTea is an outstanding scalable vehicle for fortification with folate and vitamin B12 in India, and has potential to help eliminate haematological and neurological complications arising from inadequate dietary consumption or absorption of folate and vitamin B12.

The Unresolved Tragedy of Neural-Tube Defects in India

“…We had confirmed that nearly all 60 young women (who were nursing students at a college in Sangli, India) had low-folate status and nearly two-thirds had a low-Vitamin-B 12 status, similar to that of women in the nearby city of Pune. [ 26 ] Accordingly, in another group of 43 young Indian women (nursing and homeopathy students in Sangli) with borderline or low-vitamin stores,[ 26 ] we determined if consumption of a single daily cup of tea prepared from teabags that were individually fortified with both these water-soluble vitamins could lead to a rise in serum folate and Vitamin B 12 within 2 months. The “experimental group” was divided into two subgroups to receive tea from teabags fortified with two strengths of vitamins: 1-mg folate plus either 0.1-mg or 0.5-mg Vitamin B 12 per teabag (containing 2 g of tea); one teabag was used per cup of tea.…”

“…We subsequently documented that daily use of vitamin-fortified tea for 2 months led to significant rises in their serum folate and Vitamin-B 12 levels, and hemoglobin concentration, which signified a clinical response; by contrast, there were insignificant changes in women using daily unfortified tea. [ 26 ]…”

“…As noted above, the key to prevention of over three-quarters of NTDs lies in raising the serum folate and Vitamin-B 12 level of Indian women prior to conception. Therefore, the fact that vitamin-fortified tea raised the serum folate level in 34 of 36 women in 2 months,[ 26 ] and also improved Vitamin-B 12 levels in a dose-dependent manner, suggests that tea is an efficacious vehicle to rapidly replenish folate and Vitamin B 12 in Indian women of childbearing age. In practical terms, a recent study has suggested that folate replenishment could ultimately help prevent over 115,000 babies with NTD in India each year.…”

“…[ 18 ] Moreover, with a reduction of folate- and Vitamin-B 12 - deficiency-induced anemia in Indian women, and additional evidence highlighting the importance of folate for fetal brain development, this could ensure long-lasting benefits on improved social interactions and scholastic achievement in their children; this coupled with other robust data showing the benefits of sufficient folate (and Vitamin B 12 ) in preventing strokes and Alzheimer's disease promises additional benefits to all adult Indians. ([ 26 ] and References therein)…”

Role of Vitamin B12 and Folate in Metabolic Syndrome

“…In a study directed at isolating strains of lactobacilli synthesizing the highest folate concentration by milk fermentation, it was found that Lactobacillus fermentum (from kefir granules), Lactobacillus plantarum (from salted mustard), and Lactobacillus rhamnosus (from breast milk) produced the highest concentrations of folic acid in the absence of pre-existing folate in milk [33]. An interventional study conducted in India to estimate the potentiality of tea as a scalable vehicle for fortification with vitamins B9 and B12 successfully showed that the daily consumption of a cup of vitamin-fortified tea for two months could benefit women of reproductive age [34]. Investigations on the dietary value of freshwater living green unicellular algae Chlorella species proved the presence of large amounts of folate.…”