Overwhelming evidence to support the claim that folic acid fortification to wheat flour is advisable for women of childbearing age.
Today the BBC reported that latest research, published in Public Health Reviews, claims evidence for limiting intake of folic acid to no more than 1mg a day is out-of-date and flawed. The new re-analysis of the data finds no relationship between higher levels of folic acid and harm, although some say there is still not enough proof to say fortification is entirely safe. Research had previously suggested that high doses of folic acid could cause symptoms such as diarrhoea, cramps, sleep disorders, confusion, nausea and seizures.It can also cover up the symptoms of vitamin B12 deficiency, which is a particular concern in older people. Prof David Smith, an expert in pharmacology at the University of Oxford, said: "The matter has not been resolved. "However, Prof Tom Sanders, nutrition expert at King's College London, said there was "overwhelming" evidence in support of the case for folic acid fortification to prevent neural tube defects.
Lead author of the study, Prof Sir Nicholas Wald, of the Wolfson Institute of Preventative Medicine, said: "Fortification would be a major saving."Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it." Flour is already fortified with calcium, iron, and some vitamins.
Since 1998, when the policy to fortify wheat and cereal products with folic acid was introduced, the US has seen a 23% fall in pregnancies with neural tube defects (spina bifida and anencephaly).
The current recommendation for folic acids is 400 micrograms prior to conceiving and throughout the first trimester of pregnancy. Women can aim to eat sufficient amounts of folate rich foods but only about 1/3 of British women do. Supplementation is recommended by midwives at the first antenatal visit. If the pregnancy is unplanned and the mom hasn't been intentionally consuming folate, the risk of neural tube defects is even higher than for those who are trying to conceive (as those women typically take a daily pre-natal vitamin). About 1 in 1000 pregnancies result in neural tube defects.
Rich sources of folic acids are:
spinach, kale, Brussels sprouts, cabbage, broccoli
beans and legumes (e.g. peas, blackeye beans)
yeast and beef extracts
oranges and orange juice
wheat bran and other whole grain foods
poultry, pork, shellfish and liver
fortified foods (e.g. some brands of breakfast cereals - check the label).
If you have additional questions about antenatal nutrition and how to have a healthy pregnancy, as always, contact me!