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Folic Acid Supplements Still Advised

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WebMD Health News

May 10, 2000 -- While experts debate the pros and cons of folic acid-enriched foods, most agree that women who could become pregnant should be taking a supplement containing folic acid to reduce their chances of conceiving a child with spina bifida or other serious birth defects that can be caused by a deficiency of the compound.

Spina bifida, a birth defect in which the spinal cord does not fuse properly before birth, occurs in about one of every 1,000 births. These children may suffer brain damage from fluid that can collect in the brain, and may be unable to walk because of weakness in their legs.

Since Jan. 1, 1998, the FDA has required that certain grain products be fortified with folic acid to reduce the number of children born with these birth defects. It's too early to tell if there has been a benefit, however.

The decision requiring folic acid to be added to certain foods was controversial because some, including officials with the CDC, wanted a required level of folic acid that was four times higher than what was approved.

But at that time, some experts -- including James L. Mills, MD, chief of pediatric epidemiology at the National Institute of Child Health and Human Development -- warned about the impact of folic acid on people who may have a vitamin B-12 deficiency. Folic acid can mask the anemia or low blood counts associated with B-12 deficiency.

Now the debate has fired up anew. Mills wrote an article in the May 11 issue of The New England Journal of Medicine, arguing that the current levels of fortification should remain in place until more research is available.

Studies have shown a dramatic increase in the levels of folic acid in older adults who do not use supplements, and that some foods contain much more folic acid than their labels suggest, according to Mills.

He says that since folic acid fortification exposes 274 million people to folic acid to prevent only 2,000 potential birth defects per year, "it is surprising that public health officials have not demanded a higher standard of proof that the current level of fortification is safe and effective. Who will perform the studies to document the safety of fortification in children and the elderly?" writes Mills.

"Women should be cautioned that half of all pregnancies are unplanned and that folic acid must be taken before conception to be effective. Taking supplements is the safest and most effective way" to prevent the birth defects associated with folic acid deficiency," he concludes.

Mills tells WebMD he wrote the article because "there has been a lot of politicking to increase the amount [of folic acid]" in enriched flour. The dose for most women who could become pregnant is 400 mcg per day, and 4,000 mcg per day is recommended for women who have already had a child with a birth defect associated with low folic acid, Mills says.

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