The continued increase in diabetes has created urgency within the scientific community not only to develop new medications to manage the disease, but also to identify the reason why the number of people diagnosed continues to rise. The autoimmune origin of type 1 diabetes (T1D) has long been recognized, and thus efforts have focused on examining factors influencing the immune system.

One specific dietary factor has gained recent attention and was reported by the Diabetic Research Institute Foundation in March 2018 as a “factor of interest.” The research, published in Frontiers in Endocrinology, identifies the fortification of flour in the United States as a potential culprit. Dr. Chris Fraker, research assistant professor of surgery and cell transplantation at the Diabetes Research Institute and coauthor of the study, together with coauthor Dr. Allison Bayer, highlights an action taken by the FDA as the potential precipitating factor in this alarming epidemic: the agency’s requirement that flour, bread, pasta, cereal, and other products made from grain be enriched with folic acid (vitamin B9). 

“We believe that this metabolic factor may actually be causing a general weakening in people’s immune systems that, in a person that has a genetic susceptibility, may lead to the development of not only diabetes but other autoimmune conditions as well,” said Dr. Fraker. The Flour Fortification Initiative was launched decades ago to promote vital nutrients that support many functions in the body, and folic acid was added to help prevent worldwide birth defects.

Scientists have found that the powerful immune-system modulation action of the synthetic version of folic acid significantly slows the metabolic processes, resulting in cellular dysfunction and damage when compared to effects of naturally occurring dietary folate. The researchers have proposed that this metabolic impact increases one’s vulnerability to viruses and autoimmune diseases, including but not limited to, diabetes. The researchers also hypothesized that any potential damage already done because of the dietary ingestion of synthetic vitamin B9 is likely not reversible, so future efforts may be more productively directed at reducing or eliminating this exposure.

“For correcting this condition, I don’t think there is a simple fix because if it is related to folic acid and you’ve consumed this food, you may have already done the damage to the immune system. Viruses can be reactivated within your body, and it’s very difficult to get those under control,” Dr. Fraker said.

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