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Folic Acid:
How to Make Sure the Right People Get Enough

Fruit and vegetables are our best sources of vitamins in the diet, but they are found in very small quantities. That is why dietary recommendations always stress several servings of fruit and vegetables each day. There is always a concern that many consumers are not getting enough vitamins. Now we have fortified foods and row upon row of pills and capsules of supplements in the pharmacy and health food stores.

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Recently folic acid has received a lot of attention because of the link that has been found between poor folic acid status of the mother during the first days of pregnancy and the increased risk of neural-tube defects. Dr. James L. Mills estimated that daily folic acid supplemention could prevent 50% of all neural-tube defects. But what is the best way to ensure that pregnant women in particular are getting enough folic acid in their diet? The United States Food and Drug Administration decided that grain products sold in the US have to be fortified with folic acid as a way of getting more folic into the diet. But this raises several questions and concerns.

Is fortification of specific foods helpful or can it be dangerous? Adding folic acid to grain products does not help pregnant women if they don`t eat grain products. And fortification may be increasing the folic acid in others in the population who don`t need it. One concern is that because of their close metabolic functions in the body, high levels of folic acid could mask a deficiency of vitamin B12. It has been suggested that other foods be fortified with folic acid to ensure that the target group i.e. pregnant women receive adequate levels. But this will only put more at risk without necessarily solving the problem.

According to Dr. Mills fortification of additional foods in not the solution. Educating women who are of child bearing age to have adequate intakes of folic acid is a first and important step. It should be emphasized that the beneficial effects of folic acid occur in the very first days of pregnancy. Increasing folic intake after a confirmed pregnancy is often too late. Supplements and not food fortification are the best way to protect the target group without subjecting others to possible harmful effects.

Table 1:
FoodFolic Acid Content (ug/100 g portion)
apple2.8
potato, baked9
tomato, raw15
beans, green snap, cooked33
spinach, boiled145
bread, soft, white95
orange juice18
  1. Reference
  2. Mills, J.L. Fortification of foods with folic acid--how much is enough? New England Journal of Medicine2 342: 1442-1445 (2000)

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