Some Scientists Questioning Folic Acid Fortification, Baltimore Sun Reports

Some scientists are questioning whether a 1998 FDA requirement to fortify flour, bread and pasta with folic acid in an effort to prevent birth defects has had "unforeseen trade-offs," including an increase in colon and prostate cancer cases and an increase in cognitive impairment among seniors, the Baltimore Sun reports. However, proponents of folic acid fortification say the benefits -- including a decrease in birth defects and possible prevention of some cancers and cardiovascular disease -- are proven and argue that "potential downsides" to fortification are unproven (Desmon, Baltimore Sun, 1/27).

According to CDC, the fortification requirement and an effort launched in 1992 to encourage women to take daily vitamins containing folic acid has contributed to a decline of about one-third in the rate of infants born from spina bifida and anencephaly from 1991 to 2005. March of Dimes, the American Medical Association and several pediatric groups in the last two years have called on FDA to double the amount of folic acid required in fortification (Daily Women's Health Policy Report, 1/23).

According to the Sun, scientists are uncertain how folic acid works, but many believe it assists in forming DNA, stimulating cell growth, preventing damage and helping DNA replicate. Folic acid also helps cells divide in normal tissues but can have the same effect in precancerous tissue, causing cancer cells to reproduce quickly, the Sun reports.

A report published last summer by Joel Mason -- director of the Vitamins and Carcinogenesis Laboratory at Tufts University -- and colleagues found a possible link between folic acid fortification in the U.S. and Canada, and colorectal cancer rates, which are not declining as quickly as they were prior to fortification. According to the study, folic acid fortification has lead to as many as 15,000 additional colorectal cancer cases in the U.S. annually and 1,500 in Canada. Mason said that although his study is not definitive, the U.S. cannot "afford" a 10% chance that it is valid. Mason does not recommend that the U.S. stop fortification until more data are collected, but he does believe that the United Kingdom, which is currently considering fortification requirements, should wait until more data is available.

Walter Willett, chair of the department of nutrition at the Harvard School of Public Health, said that it will take about 10 years until the impact of fortification is known. "I think we've done something that overall is beneficial, and we won't know the full balance of benefits or possible adverse effects for many years," he said, adding that "overall the picture looks good" (Baltimore Sun, 1/27).

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