Filling your folic acid void

Vegetarian Times, Dec, 1996 by Tony Jaros

What is folate, and why does the government say it has to be added to my cereal?--N. T., St. George, Utah

As a child, you probably were told countless times not to play with your food. But the folks over at the U.S. Food and Drug Administration (FDA) apparently didn't have such persnickety parents--through the process of fortification, they've been playing with their food--and yours--for years.

The latest focal point on the fortification front is folic acid, or folate. For years, researchers have known the watersoluble B vitamin plays a vital role in the prevention of birth defects if taken in proper levels by mothers both before and during the first few weeks of their pregnancy, also known as the periconceptional period. Other studies also have been released claiming folic acid can play a role in the prevention of both heart disease and various cancers.

Low folic acid intake has been linked to serious neural tube defects (NTDs) such as spine bifida and anencephaly in fetuses. With spine bifida, the spinal cord does not close entirely, leading to varying degrees of paralysis and other medical problems. The results of anencephaly are even more damaging; as a result of the top of the neural tube not closing, most or all of the brain is left undeveloped, leading to stillbirth or death after just a few days. According to information published by the Washington, D.C.-based Spina Bifida Association of America, 4,000 babies a year are affected by NTDs.

A 1992 report by the U.S. Public Health Service (PHS) stated women should be getting about 400 micrograms of folic acid daily; the U.S. Department of Agriculture has subsequently reported the average American woman gets a little more than half that amount. The PHS recommended three remedies. As usual, Americans first were implored to improve their eating habits. Barring that miracle, the PHS recommended taking a daily supplement containing folic acid and finally fortifying the food supply with the vitamin.

So, following more than three years of haggling over exactly which foods to fortify and at what amount, in late February of this year, the guidelines were released. By January I, 1998, the FDA ordered that cereal grain foods including enriched bread and buns; enriched flour; corn grits and cornmeal; enriched farina and rice; and all enriched macaroni and noodle products be fortified with folic acid at levels that range from .43 milligrams (mg.) to 1.4 ma. per pound of product. On average, this will mean a person would get about 10 percent of the recommended intake level per serving of bread. Manufacturers will be directly responsible for the accurate fortification of their products.

For the most part, response to the FDA plan has been positive. "Once a woman knows she is pregnant, it is too late to start a vitamin supplementation program; the neural tube has closed already," says Dr. Jess Gregory, professor of food science and human nutrition at the University of Florida in Gainesville. "This makes it almost essential that there is a food fortification program."

Health organizations echo Gregory's sentiment. "We've worked closely with the FDA to get this passed," says Andrea Ziltzer, manager of media relations for the White Plains, N.Y.-based March of Dimes. She says the 400-microgram (mcg.) level the FDA settled on is even below what they believe women should be taking in. "We're still recommending that women take a supplement on top of eating the fortified foods," she says.

The FDA had its reasons for settling on what some groups call a "conservative" recommended amount for folic acid. The PHS has recommended that persons keep their total daily folate intake under 1 mg.; higher intake may mask the symptoms of pernicious anemia, a form of vitamin [B.sub.12] deficiency. If a patient does not have the anemic symptoms, a [B.sub.12] deficiency may be harder to diagnose. Vegans and the elderly are the most susceptible to [B.sub.12] deficiency, which can lead to permanent and severe nerve damage if not treated.

Dr. Beth Yetley, director of the FDA's Office of Special Nutritionals, says even with this warning, people shouldn't be concerned that the new law will lead to the overfortification of some people's diets. "We've done countless studies of how the U.S. population eats to make sure our recommendation falls within nearly everyone's range," she says. "It is highly unlikely that anyone will be negatively affected." Gregory, though, believes that the [B.sub.12] issue is one to be reckoned with in the future. "Maybe the next step is to look at fortifying foods with [B.sub.12]," he says. "The question is, of course, how to add it and how to monitor it, but there are many experts who support looking into it."

Worries also have cropped up in the past regarding manufacturers' ability to carry off accurate fortification of foods on a mass basis. For example, the fortification of milk with vitamin D came under extreme scrutiny after a June 1991 outbreak of vitamin D poisoning in Massachusetts in which one person died and many others fell ill after a local milk manufacturer oversupplemented its milk with vitamin D by more than 600 percent.