Can Folic Acid Supplementation Reverse Precancerous Changes in the Stomach?
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According to a recent meta-analysis, folic acid supplementation may improve gastric mucosal atrophy and intestinal metaplasia and other precancerous lesions that can occur in the stomach.
NOTE: Folate, found in foods as vitamin B9, supports cell growth and plays a role in DNA repair. Its synthetic form, folic acid, is recommended by doctors as a supplement before and during pregnancy to support the baby’s brain function. However, adults taking high-dose folic acid supplements without appropriate guidance may develop problems such as nerve damage. Consulting a doctor before taking folic acid supplements helps ensure an appropriate dose. Folate obtained from food does not harm the body. Examples of the Best Sources of Folate: pulses such as chickpeas, lentils and beans, nuts and green leafy vegetables are among the best sources.
Treating Gastric Lesions With Folic Acid
Jinhao Zeng, the lead investigator of this study conducted in China, said, "We believe that doctors could try using folic acid to halt or reverse the progression of gastric precancerous conditions, thereby reducing the incidence of stomach cancer."
The study was published online in BMC Gastroenterology.
However, Zeng cautioned that the number of relevant studies available for the meta-analysis was "relatively insufficient and the results should be interpreted carefully".
What Is a Meta-analysis? A meta-analysis is a comprehensive type of research that combines the results of several independent studies on a particular topic and statistically analyses their findings. Meta-analysis results represent the strongest scientific evidence.
Results That Require Careful Interpretation
This is believed to be the first meta-analysis examining the preventive and therapeutic effects of folic acid in patients with gastric precancerous lesions. It included 13 randomised controlled trials involving a total of 1252 adults with such lesions living in China.
NOTE: Gastric precancerous lesions include gastric dysplasia, gastric adenoma, gastric atrophy, intestinal metaplasia and dysplasia. These changes usually arise from chronic infection with Helicobacter pylori bacteria.
According to Zeng and colleagues, a meta-analysis of five studies showed a statistically significant positive therapeutic effect of folic acid supplementation on gastric mucosal atrophy (1.61-fold relative risk reduction; 95% CI: 1.07–2.41).
They also found that a meta-analysis of two studies showed a statistically significant effect of folic acid on the reversal of intestinal metaplasia (1.77-fold risk reduction; 95% CI: 1.32–2.37).
The researchers wrote, "Our study shows that 20-30 mg of folic acid daily for 3-6 months has a beneficial effect in treating precancerous changes in the stomach."
However, folic acid supplementation did not appear effective in relieving the signs and symptoms associated with these changes.
The authors say that, in a separate analysis, they confirmed that folic acid may inhibit gastric mucosal carcinogenesis by influencing gastrin and pepsinogen levels.
More Studies Are Needed
Earlier studies assessed whether folic acid supplementation was associated with a lower risk of stomach cancer, but their results were "mixed and inconclusive".
Although previous meta-analyses have examined folic acid and stomach cancer, this study is notable for assessing its effects on precancerous lesions for which no medical treatment is currently available.
At present, treatment guidelines do not recommend folic acid supplementation to prevent or treat gastric precancerous conditions or stomach cancer. Its potential protective role against DNA damage has generated interest in folic acid as a chemopreventive agent, but randomised controlled trials have not yet confirmed these benefits.
Given the small size of the study and its restriction to a Chinese population with a higher incidence of precancerous lesions and stomach cancer than the general Western population, folic acid supplementation solely to prevent gastric precancerous lesions cannot currently be recommended, particularly in view of possible adverse effects.
Nevertheless, this meta-analysis supports the need for larger randomised controlled clinical trials to investigate the relationship further.
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