Folic Acid Supplements Still Advised
The results of the current folic acid enrichment program are not expected to
be available until sometime later this summer, says J. David Erickson, PhD,
chief of the branch of birth defects and genetic diseases at the CDC.
"Our best guess at this was that you might see a 50% drop [in these
birth defects]," Erickson says. "That would be our hope; that's what
one would hope to achieve with fortification. The projections by the FDA at the
time were that women would consume an extra 100 mcg a day [with fortification].
That is one-fourth the recommended amount."
Mills provoked an impassioned response from Godfrey Oakley, MD, who likened
Mills' article to "yelling fire in a crowd." Until two years ago,
Oakley was the director of the CDC's Division of Birth Defects and
"My view is that, from everything we know up this point, the amount of
fortification is not enough," Oakley tells WebMD. "You would have to
eat a loaf of bread" made with folic acid-fortified or enriched flour to
reach the recommended level, says Oakley. He is currently a visiting professor
of epidemiology at Emory University in Atlanta.
"What gets missed is [that] this is not about what is the dose at which
you can start to see some protective effect," he says. "That is not
what you are after. It is about what is the least dose that will give you the
most protective effect. It takes 400 mcg to do the whole job. We should have no
child with folic acid-preventable [birth] defects. I agree that until
fortification is fixed, we need to be teaching as many women as we can ... to
take a multivitamin." However, this is an ineffective solution, he notes,
because "no more than 50% of women will take vitamin supplements."
While many will take them once they realize they are pregnant, it's too late
by then. "This birth defect occurs before most women know they are
pregnant," says Oakley.
Lynn B. Bailey, PhD, a professor of human nutrition at the University of
Florida, reviewed Mills' article for WebMD, and she agrees with Mills that more
research is needed. She served on the FDA panel that made the fortification
recommendations and supports the March of Dimes recommendation that a woman
capable of becoming pregnant consume 400 mcg of folic acid from foods or
"Folate is not widespread in the food supply," says Bailey.
"It's really not enough to say, 'consume five servings of fruits and
vegetables.'" But it can be found in larger concentrations in orange juice,
green leafy vegetables, strawberries, beans, and nuts, she says.
- In 1998, the government required certain foods to be fortified with folic
acid, because of its ability to prevent serious birth defects.
- While many women take supplements once they become pregnant, folic acid
must be taken before conception to be effective.
- Some experts argue that the level of folic acid fortification is not high
enough, while others say that there is not enough evidence that the current
level is safe and effective.