For an individual to achieve the required amount of 400 micrograms per day and to reach this target is by consuming a highly fortified breakfast cereal, as it would contain between 100-400 micrograms of folic acid per serving.
Pregnant women who do not eat cereals would have great difficulty in reaching the recommended amount of 400 micrograms. Therefore are advised to consume a supplement of the vitamin. The rest of the population i.e. adult men, women and children who are not of the reproductive age should consume 200 micrograms.
People who smoke and consume alcohol their folate levels are greatly disturbed. They then need to increase the amount of folic acid needed to function properly. This is because they need to obtain the same plasma levels, as non smokers. 650 micrograms is the RDA for a smoker.
Lengthy cooking can destroy the folates in food so the amount that is thought to be consumed is actually reduced. Eating fresh vegetables and fruits or microwaving can reduce the folate loss.
WHY FOLIC ACID IS IMPORTANT
Research has proved that folic acid can greatly reduce the chance of giving birth to a baby with neural tube defects (NTD’s), such as spina bifida and anencephaly. It is needed for cell growth and the development of the embryo. Folic acid is needed for the production of DNA, and essential for cell duplication necessary for rapid cell growth needed to make foetal tissues and organs in early pregnancy. A vital role is the production of red blood cells and cell growth.
Recent research shows that if you consume the recommended daily allowance of folic acid the amount of homocysteine is significantly lowered. Homocysteine is an amino acid which in high levels is related to heart diseases, and strokes.
Another important reason for consumption of folic acid is to protect is to protect against cervical cancer. There was also evidence that it protects against colorectal and lung cancer, limb reduction defects and urinary tract defects. It may also prevent babies from developing cancer so it is of great importance especially for childbearing women. Children who have a lack of folic acid in their diet are at a great the risk of becoming anaemic.
RISKS OF HAVING FOLIC ACID DEFICIENCY
People with poor eating habits or severe dieting like anorexics and bulimics, do not get adequate amounts of folic acid in their diets.
Smokers and alcoholics do not have well balanced diets and therefore have lower levels of folic in their bodies’ as well.
Drug abusers and people taking birth control pills reduce the amount of folic acid in their body. People in these categories should take multi vitamin tablets.
DEFICIENCY
All individuals described above are prone to be more deficient in folic acid and have more chances in developing a form of anemia called megaloblastic anemia.
The plasma homocysteine concentrations are markers of folate deficiency. In order for pregnant or lactating women to not be deficient they should take supplementations of folic acid, as it is critical in the fetal development.
A growing fetus utilises Folates from its mother’s blood, which in turn creates a shortage in the mother. If insufficient levels are consumed then this is when neural tube defects occur.
NEURAL TUBE DEFECTS AND HOW THEY CAN BE PREVENTED
NTD’s are birth defects and involve incomplete development of the neural tube. The neural tube is what develops into the spinal cord and brain. There are many types of NTD’s one of the NTD’s is spina bifida and this is when the spinal cord is no completely surrounded by bone sometimes referred to as open spine. Spina bifida occurs as two major forms. Spina occulta (hidden) is a small gap in the spine. This is hard for people to acknowledge, as it has no symptoms. The more worrying type is spina bifida aperta. It produces a noticeable sack on the back called meningocele.
The picture below illustrates spina bifida aperta.
Anencephalaly is another birth defect where babies are born with underdeveloped brains and deformed skulls. This condition is critical and death may occur in a few hours. These two defects make up 90% of all NTD’s.
Encephalocele makes the remaining 10%. This defect is distinguished by a whole in the skull revealing the brain tissue, which results in mental disabilities the occurrence of the defect is usually between the 17th and 30th day after conception. Although folic acid deficiency is not the sole factor for NTD occurrence it still plays a major role but the environment and genetic factors may have a little affect and this should be recognised.
Prevention of oral and facial birth defects such as cleft palate occurring is also done by folic acid. These problems may be mild but there is no limit to or extent to the extremity of each defect. Precautions are always the better option. Women who take the B vitamin (folic acid) before and during the first two weeks of pregnancy can reduce the chances of getting an NTD drastically.
The three main ways that maybe necessary to consume the correct level of folic acid are
balance diets, folic acid supplements and fortification.
FORTIFICATION
Fortification and enrichment has been an extremely effective way to prevent diseases since the 1940’s. It was in 1993 that the Food and Drug Administration (FDA) proposed the regulation that required manufacturers to add folic acid to wheat products such as flour bread and other grains. This was approved in 1996 but limited the range of fortification to stay within safe limits for heavy consumers of grain products. This became mandatory in 1998. Wheat products were chosen and seemed a prime target for fortifying, as they are staple products. Also they had a long history of being successful for improving nutritional standards and reducing the risks of classic nutrient deficiency.
To reach the RDA, six meals containing the fortified amounts need to be consumed. An example of a perfect requirement for a pregnant woman would be 3 types of bread totaling 81 micrograms, 1 cup of pasta, which is around 120 micrograms and a fortified breakfast cereal with at least 200 micrograms.
Fortification of grain products will not exceed 1000 micrograms as this value should not be reached from the total daily intake of all folic acid. It would only range from around 40- 50 micrograms per 100 grams of wheat product so people consuming folic acid in other food products will still be in the safe amount.
SHOULD FORTIFICATION BE MADE COMPULSORY
A campaign set in Virginia iniated by the region prenatal coordinating council worked well to increase awareness therefore promoting behavioral changes concerning folic acid intake. It was low budget and only advertised on TV, radio and newspapers. Its effectiveness was measured through pre and post surveys via the telephone.
Evaluation was 25% increased awareness, 20% increased knowledge and benefits and 11% increased in folic acid consumption overall in the year on a target population.
The purpose of folic acid addition to wheat is to eliminate deficiencies. It prevents women from worrying about whether or not they have taken enough and it is also time efficient as it saves time trying to search through food labels looking g for the essential vitamins. However as stated previously too much intake (over 1000 micrograms) could be harmful in the elderly as it covers up anemia or vitamin B12 deficiency. This over consumption may be a reason against making wheat fortification compulsory but the argument for it is that over consumption is rare as levels of enrichment are not very high. This also leads to another problem, which is that it is difficult to estimate what people eat and the amount so whether or not childbearing women are reaching the 400 micrograms requirement is questionable.
Vitamin supplements need to be additional but only educating people will really ensure their diets are satisfactory as it is difficult for a behavioral change without the understanding behind it.
Wheat fortification in the USA has proved to regulate levels of homocysteine, which has implications with heart conditions as well as reducing NTD’s although some may still happen due to genetic reasons or environmental factors.
"I've seen the trauma of neural tube defects. It's a very stressful situation for a family," says Joseph Mulinare, M.D., a paediatrician and medical epidemiologist at CDC. As a member of CDC's working group on folic acid, Mulinare and his colleagues would like to see FDA require two and a half times more folic acid in breads than it is considering.
Research in to how happy people in the populations it will affect are to have their food tampered with could be a possible ethical issue open for discussion. Previous findings into this have shown more then 50% of the population to agree with the regulation. This figure would increase in the future as children are our future and their health and welfare need to be considered. Doing our best to ensure this means sacrificing a little and adjusting to the food fortification to prevent these neural tube defects.
CONCLUSION
The fortification of wheat products with the vitamin folic acid is a good idea and although it would be beneficial to make it compulsory the amount at which it is fortified with should perhaps be reviewed.
In order to keep everyone satisfied by being certain that folic acid levels will not exceed 1000 micrograms in especially the elderly to whom it may cause most damage. The effects are not critical but may mask anemia or vitamin B12 deficiency. As the elderly are already prone to many health problems another does not need to be added.
Wheat is definitely a good choice of food to fortify as it is classed as a staple food, which is affordable by all.
It should be made mandatory that all pregnant women take some sort of folic acid supplements as it clearly does make a big difference.
Educating the younger generation about NTD’s is also important as it will involve great behavioral changes within many populations of the world and if there is an educated understanding then it is more likely to take a positive effect.
The advantages of making this fortification compulsory strongly outweigh the disadvantages. However it should be remembered that folic acid is important through out life and should be consumed as part of a regular diet and not just during time of pregnancy.
Bibliography
Understanding Biology, fourth edition.
Total health for children
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Vitamin deficiencies and toxicities lecture notes by Professor Sanders.
Pregnancy and lactation lecture notes by Dr. Patterson.
References
David Elliman, Helen Bedford, (1999), total health for children, London, Marshall publishing.
Glenn and Susan Toole, (1999), understanding biology for advanced level, fourth edition, Cheltenham, Hutchinson Education.
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