It is with a deep and heartfelt apology that I write to you all.

I have made a mistake that I am deeply sorry for. In my latest book, What am I Supposed to Eat? I used a word to describe Down Syndrome that I thought was a current medically used word.

It has since been brought to my attention it is a word that is used in a derogatory way and I am very, very sorry to have caused anyone any distress through this error, particularly children with Down Syndrome and their families.

We have begun the process of recalling the book from sale and arranging a reprint and the word will not appear in any future publications.

The lovely people of Mongolia have also reached out to me and kindly explained the challenging impact that this medical term has had on their community. I am truly sorry for any hurt this may have caused their country.

Please accept my deepest apology, I am so very sorry for any distress I have caused.

Libby

 

I just want to reiterate my apology for using a derogatory word in my books. I am so deeply sorry for the distress this has caused, particularly to children with Down syndrome and their families.

I have also been asked by numerous people about how I drew the link between folate status and an increased risk of Down syndrome and I share with you below some of the science that shows a potential link and also some that doesn’t. Please know that never for a moment did I want to elicit guilt or suggest that Down syndrome occurs due to poor folate status, as this is not true. My intention was to bring awareness to folate’s critical role in the body, particularly in the pre-conception period, given the key role it plays in normal cell division and DNA synthesis.

Please also know that in any future publications of my books I am not replacing the derogatory word with ‘Down syndrome’ and therefore any suggestion of a link between folate status and Down syndrome will be removed from my work.

To my knowledge, a potential link between the birth of a child with Down syndrome and maternal polymorphisms of genes involved in folate metabolism has been the subject of scientific research since the late 90’s.

The nature and ethics of human research and the complexity of the human body means that we can very rarely prove causality. Most human studies in the nutrition field are therefore designed to detect an association or link between risk factors and developing a certain condition. An association does not equal causality and it does not mean that it is the only risk factor involved in any said condition.

Scientists and evidence-based health professionals formulate an opinion based on the body of scientific evidence that is available at the time, and my approach is no different. There have been a number of meta-analyses published on this topic, and this type of research is considered high quality.

My book Beauty From the Inside Out was published in 2013 and at this point in time, I based my opinion on the potential link of maternal folate status to risk of Down syndrome on the following scientific research:

In 2007, a meta-analysis of 11 studies was published in the Journal of Human Genetics. This investigated the following gene polymorphisms: MTHFR C677T, MTHFR A1298C and MTRR A66. The authors concluded that more research was needed to claim or deny an association between maternal gene polymorphisms and risk of Down syndrome.

In 2013, a meta-analysis based on 28 studies was published in the European Journal of Obstetrics & Gynaecology & Reproductive Biology, which found a significant association between the MTHFR C677T genotype and increased risk of Down syndrome. There was no association with MTHFR A1298C.

In 2013, another meta-analysis was published in Mutagenesis Journal, based on 32 articles. There was no significant association between risk of Down syndrome and the MTHFR A1298C, MTR 12756G and CBS 844ins68 polymorphisms, however an association was observed for MTHFR C677T, MTRR A66G and RFC-1 A80G.

In 2013, another meta-analysis of 9 studies was published in Nutrients Journal. The authors concluded that the RFC-1 80G polymorphism was associated with increased risk.

Considering that two meta-analyses reported a significant association between risk of Down syndrome and the MTHFR C677T gene polymorphism and RFC-1 A80G polymorphism, I considered this to be sufficient evidence to suggest that folate status may play a role. I certainly am not claiming that it is the only factor involved.

In the time since Beauty From the Inside Out and my latest book What Am I Supposed To Eat? was released, more research has been published:

In 2014, a meta-analysis of 17 studies published in Disease Markers Journal was published. It reported evidence for an association between the MTRR c.66A>G (rs1801394) and MTHFD1 c.1958G>A (rs2236225) polymorphisms and maternal risk for DS, but no associations for the MTR c.2756A>G (rs1805087), TC2 c.776C>G (rs1801198), and CBS c.844ins68 polymorphisms.

In 2016, a meta-analysis was published in the Journal of Genetics. The authors analysed 37 studies and found that MTHFR 677 C-T was associated with increased risk for the birth of a child with Down syndrome.

In 2017, a meta-analysis was published in the Molecular & Clinical Oncology Journal. It included 15 studies. The authors of this paper reported that the RFC-1 A80G polymorphism may be a maternal genetic risk for DS. There was no association found for the MTR A2756G and CBS 844ins68 polymorphism.

Based on this, it appears that the research suggests that some maternal gene polymorphisms to which folate contributes, may play a role in risk of Down syndrome, while other polymorphisms don’t.

My intention in including this in my books was not to suggest that poor folate status causes Down syndrome. It was simply to bring awareness to folate’s critical role in the body, particularly in the pre-conception period, given the key role it plays in normal cell division and DNA synthesis.

Again, I am so sorry for any hurt I have caused.

With warmth,

Libby

 

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