Let them eat cake ... and bread
and pasta too

Neurological birth defects have dropped dramatically thanks to folate-fortified flour

By Katherine Addleman

Food fortified with folic acid may be the next best thing since sliced bread, which coincidentally is exactly where you can find these supplements. Manufacturers have been slipping folic acid into flour-based goods for five years now at the behest of Health Canada and the results have been very gratifying. The occurrence of neural tube defects (NTDs), anencephaly, and other neurobiological injuries linked to folic acid deficiency in pregnancy has plummeted thanks to the new laws. One study carried out at Dalhousie University in Halifax found that NTDs declined by 54% after grain flour began to be fortified. Another report noted a 32% reduction. Yet another reason to get off the Atkins diet has emerged.

Folic acid deficiency is now recognized as a cause of incomplete development of the central nervous system in the first trimester fetus. In spina bifida, the neural tube fails to close completely at the posterior end, causing problems like paralysis, and bowel and bladder incontinence. Anencephaly � incomplete development or absence of the brain � is caused by incomplete neural tube closure at the anterior end. Incidence of NTDs now only affects about 0.1-0.2% of live births in this country, with the highest rates occurring in Atlantic Canada. According to the Halifax researchers: "The lifetime medical and financial costs of a patient with spina bifida are very high and the effect on the family is incalculable."

For years, national medical associations like the Society of Obstetricians and Gynecologists of Canada and the Canadian College of Family Physicians of Canada have been running public awareness campaigns about the benefits of folic acid. And it's working. Dr Fay Weisberg an Ob/Gyn at the University of Toronto Medical School and Women's College Hospital in Toronto says "Most Canadian family doctors make sure their patients know about folic acid. At this point, the level of public awareness is very impressive."

Women of childbearing age should get a daily dose of at least 400g of folic acid, either through diet or vitamin supplements. For adequate prevention, Health Canada recommends that women should start taking it three months before they get pregnant. Since so many pregnancies are a surprise, and since the neural tube closes very early � even before many women realize they have a bun in the oven � it's recommended that all women of childbearing age should be topping up routinely. And women who've had a pregnancy affected by an NTD need to start taking 4mg of folic acid every day one month before the planned conception, and continue this dose to the end of the first trimester, under their doctor's supervision. Others at higher risk of having an affected baby include women suffering from diabetes, obesity or seizure disorders. Dr Weisberg says, "Personally, I tell my patients to start on a prenatal vitamin preparation or 1mg of folic acid when they're about to stop using contraception. By the time a woman is six weeks pregnant, it's too late to make a difference."

Not all babies are as fortunate as Canadian infants. There's still a global epidemic of NTDs afflicting more than 200,000 newborns annually. Australia and other countries have announced that they're planning to follow our lead in the near future and fortify their flour as well. Yet even in Canada, some researchers insist that the numbers could drop another 70% if flour were fortified with a little more punch.

Of course, it's not only pregnant women who benefit from folic acid. It's also known to zap homocysteine, a risk factor for stroke and myocardial infarction. Some research has also demonstrated reductions in cervical, colon and breast cancer rates.