Researchers have called on the U.K., as well as other countries, to look at mandatory fortification of flour with folic acid to curb spina bifida cases and other neural tube defects (NTDs). The study, which was published in Public Health, explained that an earlier report used to determine a daily upper limit for folic acid consumption – set at one milligram per day – was based on a “flawed interpretation of data.”

• Neural tube defects like anencephaly and spina bifida are two of the most severe birth defects known all over the world. Unfortunately, it’s also one of the most common: NTDs affect one in every 500 to 1,000 pregnancies.
• Folic acid is a synthetic compound for folate. While it doesn’t naturally occur in food, it can still become biologically active after metabolic reduction. For the study, researchers proposed fortifying foods using folic acid because it is more stable and twice as bioavailable as folate.
• An earlier randomized double-blind trial conducted by the Medical Research Council demonstrated that increasing the intake of folic acid to 4 mg per day before and during the early stages of pregnancy arrested the prevalence of NTDs by 80 percent.
• In 2014, a cross-sectional study of 500,000 women in England found out that only 31 percent of women took folic acid supplements immediately before their pregnancy. While 62 percent took supplements during pregnancy, these were taken at a time where NTDs were already too late to be prevented.
• The upper limit for folate comes from a study made by the Institute of Medicine which concluded that treating cases of vitamin B12 deficiency with higher doses of folic acid were more likely to have neurological damage. This was revisited in the current study, with the results indicating that folic acid did not cause the damage; rather, it was because B12 deficiency was not treated with vitamin B12.

With these outcomes, the researchers opined that flour should be fortified with folic acid to increase intake to at least 0.2 mg a day and reduce the incidence of NTDs.

Find the full text at this link.

Journal Reference:

Wald NJ, Morris JK, Blakemore C. PUBLIC HEALTH FAILURE IN THE PREVENTION OF NEURAL TUBE DEFECTS: TIME TO ABANDON THE TOLERABLE UPPER INTAKE LEVEL OF FOLATE. Public Health Reviews. 2018;39(1). DOI: doi.org/10.1186/s40985-018-0079-6