Birth defects can be avoided with folic acid supplements or enriched flour

- and the upper safe limit makes no sense

There really is no need to have an upper safe intake limit for folic acid, and we ought to enrich flour with this nutrient to prevent children from being born with potentially disabling or life-threatening brain or spinal cord defects. This is part of the conclusion of a new study from Queen Mary University of London, and it supports an earlier study from Aarhus University in Denmark. Folic acid deficiencies, which are rather common, may lead to fatigue, poor memory, dementia, and a number of other health problems later in life. It is therefore important that we focus on this essential nutrient.

There is no need to be afraid of enriching selected foods with folic acid. According to a new study from Queen Mary University of London, the current one milligram daily upper safe intake level for folic acid is based on outdated data. Accordingly, the scientists behind the new study believe that in the near future, the health authorities should introduce folic acid enrichment of flour to prevent the birth of children with potentially disabling or life-threatening defects of the central nervous system.
The neural tube of a fetus normally closes within a month of conception. Afterwards, it develops into the brain and spinal cord. If the neural tube fails to close properly, it may lead to imperfect brain development and spina bifida, which may cause severe disabilities, heart defect, and stillbirth. For that reason alone, it is vital for pregnant women to get enough folic acid.

Folic acid enrichment of grain can prevent neural tube defects

In Europe, around 10 out of every 10,000 children are born with spina bifida. A randomized study from 1991, which was conducted by scientists from Medical Research Council, showed that an increased intake of folic acid just before and into the early stage of pregnancy helped prevent of spina bifida and accompanying complications. As a result of this study, 81 countries including the United States and Canada, introduced compulsory folic acid enrichment of grain around the beginning of the 1990s. This has reduced the number of children with spina bifida, and it has lowered the related health costs by up to 50 percent.

The upper safe intake level for folic is based in misleading science

Despite these success stories, mandatory folic acid enrichment of flour has not been introduced in countries like England and Denmark. One of the arguments against this measure is the fear that people may exceed the current safe upper intake level of one mg per day and get too much folic acid. This intake limit is based on an analysis from the US Institute of Medicine (IOM) that dates back about 50 years. However, according to a recent study that is published in Public Health Reviews, the IOM analysis is misleading. In brief, the scientists behind this analysis mistook vitamin B12 deficiencies for folic acid deficiencies and erroneously treated the vitamin B12 deficiencies with folic acid. If you treat a vitamin B12 deficiency with anything but vitamin B12, the deficiency symptoms will only grow worse, needless to say, especially as vitamin B12 is important for the central nervous system.

There is no upper limit for most B vitamins

B vitamins are water-soluble and not stored in fat, which is why we need to consume them on a daily basis. Excess B vitamins are excreted in the sweat and urine, and it is very difficult to overdose on these vitamins. According to the new study from Public Health Reviews, there is no need for an upper safe intake level for folic acid. Also, there is no need for a limit for vitamins B1, B2, B5 and B12.

Researcher: Add folic acid to the food now

Nicolas Wald, a professor with the Wolfson Institute of Preventive Medicine at the Queen Mary University of London, does not see any scientific or medical reason not to introduce mandatory folic acid enrichment of foods in Great Britain and other countries that have not yet implemented it.
In fact, Professor Wald compares the lacking food enrichment with having a polio vaccine and not using it. After all, we know that folic acid prevents neural tube defects and other diseases in the central nervous system. According to Professor Joan Morris, who is affiliated with the same institute as Wald, one could have prevented 3,000 cases of neural tube defect in Great Britain in the period between 1998 to 2017 simply by introducing mandatory folic acid enrichment of flour like in the United States.

Women lack folic acid and forget to take supplements

Good sources of folic acid are fresh (uncooked) leafy greens, cabbage and other vegetables, liver, nuts, and fruit. However, many European women have too little folic acid in their blood.
Adults are recommended to get at least 200 micrograms of folic acid daily, and pregnant women should get at least 400 micrograms of folic acid daily until their 12th week of pregnancy in order to reduce the risk of having a baby with spina bifida or similar birth defects. It is generally a good idea for a woman to start taking folic acid, as soon as she thinks of becoming pregnant. However, not all pregnancies are planned, and many pregnant women don’t take the recommended folic acid supplements because of ignorance, forgetfulness or other reasons.

Lack of folic acid has many serious costs

It has serious human and financial costs that so many children are born with spina bifida and other defects of the central nervous system. Later in life, the widespread lack of folic acid may lead to fatigue, poor memory, insomnia, dementia, and many other health problems that are often treated with medicine, but where the underlying cause is not addressed.
According to the researchers behind an earlier study from Aarhus University in Denmark, Europeans should consider adding folic acid to staples like flour like they have done in the United States and Canada. Even though foods are enriched with folic acid, however, pregnant women should continue taking supplements, the scientists believe. This may help reduce the risk of having a baby with spina bifida and other potentially disabling and life-threatening problems.

References

Queen Mary University of London. Upper intake of folate is invalid: Government urged to fortify flour with folic acid.
https://www.sciencedaily.com/releases/2018/01/180131085830.htm

Wang G, el al. Associations of maternal pregnancy BMI and plasma folate concentrations with child metabolic health. JAMA Pediatrics. 2016

Kristian Sjøgren. Forskere: Put folinsyre i danske dagligvarer. Videnskab.dk 2015
https://videnskab.dk/krop-sundhed/forskere-put-folinsyre-i-danske-dagligvarer

Ernæringsrådet. Folsyre til kvinder, der planlægger graviditet – kun få følger anbefalingerne
https://www.sst.dk/publ/mer/2003/Folsyre_til_kvinder_der_planlaegger_graviditet-kun_faa_foelger_anbefalingen2003.pdf