Folate Fortification Not Without Controversy

Women's Health |

Folic acid, a B vitamin, is known to be protective against certain birth defects — neural tube defects (NTDs) — that develop early in pregnancy. A new study published in the August 1999 issue of The American Journal of Clinical Nutrition confirms that folic acid fortification significantly raises the folate levels of women and suggests that only an extra 100 micrograms (mcg) of folic acid a day could benefit women in their childbearing years. Folic-acid-fortified products include breakfast cereals, all enriched breads, pasta, all enriched flours, and other food products.

Among the common NTDs are anencephaly and spina bifida. In spina bifida, the spinal column fails to close and is exposed, while anencephaly means that most or all of the baby’s brain is missing. The Food and Drug Administration (FDA) recommends that women who are pregnant or capable of getting pregnant consume 400 to 600 mcgs of folic acid before and during pregnancy.

Researchers from the University of Ulster, Northern Ireland, and Trinity College, Ireland, investigated the impact of products fortified with little amounts of folic acid on folate levels and whether their elimination from the diet would have a negative effect on those who normally consumed them.

Fifty-one women between the ages of 17 and 40 who were neither pregnant nor scheduling a pregnancy were instructed to eliminate folic acid-fortified products from their diet for 12 weeks. The researchers designated the 21 women who usually ate folic-acid-fortified foods at least once a week “consumers.” The 30 “nonconsumers” ate such foods less than once a week. All the subjects had an initial folate status within the normal range, which was assessed by measuring red-blood-cell (RBC) folate concentrations.

The exclusion of fortified foods (primarily breakfast cereals) resulted in a significant decrease in the average total folate intakes and RBC folate concentrations in consumers, but not in the nonconsumers. Past research has shown that the higher the RBC folate concentration, the lower the risk for NTDs. The findings seem to validate the fortification of breakfast cereals, since such products were the only folic-acid-fortified foods the subjects consumed before participating in the study. When fortified cereals were removed from “consumer’s” diets, their total folate intakes and RBC concentrations dropped significantly.

The report also showed that those who regularly consume foods fortified even at low levels will have considerably higher intakes than those who eat them less frequently. The researchers found that the women who ate folic acid fortified foods at least once a week had on average a 35 percent higher intake of the vitamin.

Folic acid fortification became mandatory in 1998. The FDA requires that 140 mcgs of folic acid be added to every 100 grams (about 3 1/2 ounces) of enriched grain product.

But folic acid fortification is not without controversy. While folate fortification may help prevent neural tube defects (NTDs), there is also the possibility that symptoms of vitamin B12 deficiency may be masked, which may prevent its early detection. Many older people and others who are genetically predisposed may not absorb adequate amounts of B12 from their food. Raising the levels of folate fortification too high could create a serious problem in that population.

It is because of the potential detriment to the elderly that Dr. Victor Herbert of the Bronx Veterans Administration Medical Center opposes the current folic acid fortification policy. Although the actions taken by the FDA are considered by many as promising in the fight against NTDs, Dr. Herbert states: “Folate fortification alone helps a few but harms many. Whenever there is fortification with folic acid, foods should also be fortified with vitamin B-12.”