Since so many foods are fortified with folic acid, are supplements still necessary for women who are trying to get pregnant?
Obviously, this is a question a woman needs to discuss with her doctor, but in general, all women of childbearing age are still encouraged to take a multi-vitamin or a supplement with at least 400 micrograms (mcg) of folic acid every day. Doing so can prevent neural tube defects, such as spina bifida and anencephaly, as well as some heart defects.
First, some background: Folic acid is a synthetic B vitamin. The natural form is called folate. Foods that contain folate naturally include dark green leafy vegetables, dried beans and peas, citrus fruits and juices, most kinds of berries, and whole grains.
But most people don’t get enough folate from those foods. Because brain and spine defects develop in the very early stages of pregnancy, often before a woman knows she is pregnant, and because about half of all pregnancies in the U.S. are unplanned, it’s important for all women of childbearing age to get enough folate.
In 1998, the Food and Drug Administration mandated the fortification of cereal-grain products with folic acid, including flour, bread, pasta, breakfast cereal and white rice.
The strategy appears to have had an effect. The Centers for Disease Control and Prevention recently reported that folate deficiency has dropped to less than 1 percent; before fortification, about 12 percent of women of childbearing age were low in folate.
Still, about 2,500 infants are born each year with a neural tube defect. It’s estimated about half are due to a folic acid deficiency. That’s why supplements are still recommended.
However, overloading on folic acid is a concern for one reason: It can mask problems if you happen to have a vitamin B12 deficiency. How does that work? Well, the most obvious sign of a vitamin B12 deficiency is anemia. A folic acid intake over 1,000 mcg a day -- the “upper intake level” -- prevents anemia, but not another, even more serious problem related to vitamin B12 deficiency: nerve damage. If a vitamin B12 deficiency isn’t diagnosed and treated, nerve damage can become permanent.
People over 50 and those who don’t eat meat or animal products are most at risk for a vitamin B12 deficiency. If you fall into those groups, ask your doctor to check your vitamin B12 status if you take a folic acid supplement.
For more information on folic acid, see http://1.usa.gov/folic_acid.
Chow Line is a service of Ohio State University Extension and the Ohio Agricultural Research and Development Center. Send questions to Chow Line, c/o Martha Filipic, 2021 Coffey Road, Columbus, OH, 43210-1044, or firstname.lastname@example.org.
Editor: This column was reviewed by Dan Remley, field specialist for Ohio State University Extension in family nutrition and wellness.