Food has folic acid
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Folic Acid in Food: Benefits and Considerations
Introduction to Folic Acid and Folate
Folic acid is the synthetic form of folate, a water-soluble B vitamin (vitamin B9) essential for DNA synthesis, methylation, and cellular division. Folate naturally occurs in various foods, including dark leafy greens, asparagus, broccoli, citrus fruits, legumes, and liver2 4 5. Folic acid is often added to foods to enhance their nutritional value, particularly in staple foods like cereal, wheat flour, cornmeal, rice, and bread5.
Fortification of Staple Foods with Folic Acid
Wheat and Maize Flour Fortification
Fortification of wheat and maize flour with folic acid has been implemented in over 80 countries to prevent neural tube defects (NTDs) and improve overall folate status in populations1. Studies have shown that folic acid fortification can significantly increase erythrocyte and plasma folate concentrations, which is crucial for preventing NTDs and other health issues1. For instance, pregnant women consuming folic acid-fortified maize porridge had significantly higher erythrocyte and plasma folate levels compared to those who did not1.
Impact on Neural Tube Defects
The primary motivation for folic acid fortification is the prevention of NTDs. Evidence suggests that folic acid supplementation can reduce the risk of NTD pregnancies significantly7 8. For example, one non-randomized controlled trial (non-RCT) found that wheat flour fortified with folic acid and other micronutrients was associated with a significantly lower occurrence of total NTDs, spina bifida, and encephalocele1.
Bioavailability of Food Folates vs. Folic Acid
The bioavailability of natural food folates is approximately 80% of that of synthetic folic acid3. This means that while natural folates from fruits, vegetables, and liver are beneficial, folic acid from fortified foods is more efficiently absorbed and utilized by the body3. Therefore, fortification programs are an effective strategy to ensure adequate folate intake across populations.
Health Benefits Beyond Neural Tube Defects
Cardiovascular Health
Folic acid supplementation has been linked to a reduction in ischemic heart disease and strokes. This is due to its role in lowering homocysteine levels, a risk factor for cardiovascular diseases7. Some studies suggest that proper doses of folic acid could potentially reduce ischemic heart disease by up to 40%7.
Cancer Prevention
There is also evidence to suggest that folic acid may help reduce the incidence of certain cancers, such as colon cancer7. However, the relationship between folic acid and cancer is complex, as high folic acid intake may also facilitate the progression of pre-existing preneoplastic cells4.
Potential Risks and Concerns
Overconsumption and Health Risks
While folic acid fortification has clear benefits, there are concerns about the potential risks of overconsumption. High levels of folic acid intake can lead to elevated blood concentrations of unmetabolized folic acid, which may be associated with decreased natural killer cell cytotoxicity and reduced efficacy of antifolate drugs used against conditions like malaria and cancer4. Additionally, in the elderly, high folate levels combined with low vitamin B-12 status may increase the risk of cognitive impairment and anemia4.
Epigenetic Effects
Recent studies have also explored the epigenetic effects of folic acid, particularly during pregnancy. Continued folic acid supplementation beyond the first trimester has been linked to changes in DNA methylation in genes involved in brain development, with potential sex-specific differences9. These findings highlight the need for careful consideration of folic acid supplementation protocols during pregnancy.
Conclusion
Folic acid fortification of staple foods like wheat and maize flour has proven to be an effective public health strategy to prevent neural tube defects and improve folate status in populations. However, the potential risks associated with high folic acid intake, such as its impact on cancer progression and epigenetic changes, underscore the importance of ongoing research and careful monitoring of fortification programs. Balancing the benefits and risks of folic acid intake is crucial for developing optimal public health policies.
Sources and full results
Most relevant research papers on this topic
Fortification of wheat and maize flour with folic acid for population health outcomes.
Folic acid fortification of wheat and maize flour, alone or in combination with other micronutrients, may improve folate status and overall health outcomes in the general population.
Meta-Analysis
Very Rigorous JournalFolic Acid Supplementation and Cancer Risk: Point
Folic acid supplementation may reduce the risk of developing certain types of cancer.
Highly CitedBioavailability of food folates is 80% of that of folic acid.
Food folates from fruit, vegetables, and liver have a bioavailability of approximately 80% of synthetic folic acid, making a diet rich in food folate more efficient for improving folate status than previously thought.
RCTVery Rigorous JournalHighly CitedIs folic acid good for everyone?
High folic acid intake may be harmful for some people, and nations considering fortification should carefully research its effects before implementing it.
Very Rigorous JournalHighly CitedFolic Acid
Folic acid is a lab-made form of vitamin folate (vitamin B9), necessary for maintaining healthy cells in the body.
Effect of food fortification on folic acid intake in the United States.
Folic acid fortification in US foods has resulted in higher folic acid intake than initially predicted, with a need for careful assessment of the impact of this higher level of fortification.
Highly CitedFortifying Food with Folic Acid
Fortifying flour with folic acid can help prevent neural tube defect pregnancies, ischemic heart disease, and possibly colon cancer, with proper doses needed to prevent these disorders.
Folic Acid Food Fortification—Its History, Effect, Concerns, and Future Directions
Folic acid food fortification programs have reduced the prevalence of neural tube birth defects, but ongoing monitoring is crucial to address concerns and address uncertainties.
Rigorous JournalHighly CitedFolic acid throughout pregnancy: too much?
Increasing folic acid intake during pregnancy may not be necessary, as it may lead to altered DNA methylation in offspring, potentially affecting brain development.
Very Rigorous JournalKnowledge gaps in understanding the metabolic and clinical effects of excess folates/folic acid: a summary, and perspectives, from an NIH workshop.
Excess folic acid intake and elevated folate status may have adverse effects on health, but current evidence is inconclusive and more research is needed to clarify these issues and bridge knowledge gaps.
Very Rigorous JournalHighly Cited