What is Folate/Folic Acid?
Folate is a water soluble B vitamin that is naturally present in some foods and added to others in it’s synthetic version, folic acid. Sources of dietary folate include green leafy vegetables such as spinach, broccoli and brussel sprouts. Other sources include liver, some fruits/vegetables, nuts and dairy, however our main intake comes in the form of foods fortified with folic acid.
Like many vitamins and minerals it serves several vital functions in the body which promote optimal health and well-being.
This post is going to relate to it’s role in the development of the foetus in pregnant women.
Why Is It Important?
In this case folate levels are important as it can help prevent birth defects in children such as neural tube defects (these happen when the tube doesn't close properly). Folate is important for cell growth and differentiation and this has a huge impact on a developing foetus - specifically embryonic development. The regular formation of the brain, spine and spinal cord in embryonic development has been shown to be affected by folate levels.
The two most common neural tube defects are spina bifida and anencephaly.
Spina bifida is a condition that affects the spine and causes physical and intellectual disabilities that can range from mild to severe.
Anencephaly is a birth defect where the baby is born without parts of the brain and skull.
The neural tube develops in the first 3-4 weeks of pregnancy and it's closure usually happens around 28 days after conception. Because of this it’s important to be aware of folate levels, folic acid, and supplementation guidelines before finding out you are pregnant. Another consideration is that many pregnancies are unplanned, and someone who has low levels of folate runs the risk of neural tube defects in their child.
Any further detail on the specifics of NTD's is outside my scope of knowledge. If you are interested in looking into it a little more I would highly recommend this excellent video from Armando Husadungan (11 minutes long).
What Does The Evidence Show?
Mandatory folic acid fortification was introduced in the USA and Canada in 1998 (guidelines had been set out for daily supplementation in 1991). The U.S began it’s fortification program in January of that year and required manufacturers to add 140 micrograms/100 grams to breads, cereals, flours and other grain products specifically with the aim to reduce the risk of neural tube defects.
A follow up study (1) in 2002 estimated that mean folic acid intake increased by 190 micrograms per day in the following years, twice as much as was predicted.
Studies in the United States, using various methodologies, have shown decreases of 19%–32% in the prevalence of NTDs overall since the implementation of folic acid fortification in 1998 (2).
Canada, South Africa, Costa Rica, Chile, and Brazil also have reported declines in NTDs (19%–55%) since the initiation of folic acid food fortification.
The UK have had the issue raised in parliament earlier this year (this has happened several times over the past decade +) and a consultation process is to begin early in 2019 which will decide whether or not mandatory fortification of food will go ahead in the future.
Many food products in Ireland are fortified by manufacturers but levels can fluctuate as there are no set guidelines.
As of 2018 no EU countries have mandatory fortification.
How Much Should I Supplement*?
*ALWAYS consult your doctor first.
Here are some of the institutions who recommend 400 micrograms per day for women who are planning pregnancy and pregnant women up until 12 weeks of pregnancy (the guidelines are also in many instances recommended for any woman of child bearing age to take into account unplanned pregnancies).
The World Health Organisation.
The U.S National Institutes of Health.
The U.S CDC (Centers for Disease Control and Prevention)
The FSAI (Food Safety Authority of Ireland)
National Institute for Health and Care Excellence (NICE)
Add to that approximately 85 countries throughout the world have mandatory folic acid fortification, including the United States and Canada, who have done so since 1998.
The evidence over the past 20 years overwhelmingly points toward that the recommended supplemental level of folic acid – 400 micrograms per day – is likely to vastly reduce the likelihood of a child being born with a neural tube defect.
Ireland’s own Food Safety Authority has highlighted the importance of optimal folate as being of worldwide importance, not just in Ireland. Evidence from other countries shows that a problem with supplementation guidelines is it requires widespread knowledge across all socio-economic boundaries for it to be successful hence the push for mandatory fortification and a public health drive.
It is important to note there is no large body of evidence yet to show that there is harmful effect from a country introducing mandatory folic acid intake aside from potentially masking vitamin b12 deficiency.
Folic acid can be purchased as a supplement on it's own but many multi-vitamins also carry the recommended dose of 400 micrograms (levels do vary from supplement to supplement).
MTHFR Polymorphism is a condition that can potentially affect the way a person processes folate. For more information click below.
I hope this short article has highlighted a light a particularly important area you may not have been aware of. It's not something I knew about before doing Mac-Nutrition, and more recently I had to do an assignment on the subject as part of my Masters which meant looking at it in more detail.
Thanks for reading.
The National Institutes of Health – U.S Department of Health and Human Services
The U.S Centers for Disease Control and Prevention (CDC)
Armando Hasadungan – YouTube
The U.S National Library of Medicine Website