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Women need folate found
in beans and leafy greensA wonderful announcement was made recently about progress in preventing birth defects. The Centers for Disease Control and Prevention published an analysis of blood data showing substantial increases in women's levels of the vitamin folate, also known as folic acid. This is likely a result of 1998 government regulations requiring the addition of folic acid to enriched breads, flours and other grain products.
At the same time, organizations such as the March of Dimes and the Spina Bifida Association of America launched campaigns to increase women's awareness of the importance of folic acid.
Question: Why is this fortification important?
Answer: It is well-established that inadequate intake of folic acid increases a woman's risk of giving birth to a child with neural tube defects (the neural tube in a fetus grows into the brain and spinal cord). These defects can cause permanent and serious disabilities, even death.
Folic acid also is thought to protect against heart disease and certain types of cancer.
Q: What did the CDC find?
A: The data was collected as part of the National Health and Nutrition Examination Surveys conducted before fortification (1988 to 1994) and after (1999 to 2000). Substantial increases in blood folate were found in all groups of women, with Mexican-American and white women reaching the national goals set for 2010.
More progress is needed. Black women as a group, along with more than 25 percent of all women in the study, were still below the 2010 goal.
Q: Have similar improvements occurred in Hawaii?
A: Similar data is not available for Hawaii. However, there is information for the incidence of neural tube defects.
The national incidence of these defects has dropped almost 20 percent since the initiation of folic acid fortification, but in Hawaii there has been no change. Hawaii's rates are fairly low compared to national standards, but it is somewhat surprising that no change in incidence has been apparent.
Q: Why hasn't there been a decline in neural tube defects?
A: There is no way to know for sure. But one contributing factor could be the misconception that all rice is a good source of folic acid. It is not.
This confusion seems to stem from food composition data for various forms of rice that are not carefully described in databases. A cup of cooked, unenriched, medium-grain white rice has only about 4 micrograms of folate. Brown rice has about 8. Most rice sold and prepared in Hawaii is not fortified with folic acid. Only fortified rice, such as Uncle Ben's Converted rice, has 80 micrograms per cup of cooked rice.
To put this into perspective, it takes 100 cups of "local"-style white rice to provide the adult RDA for folate.
Foods high in folate include liver, beans, lentils, green leafy vegetables and orange juice. For those who enjoy more processed foods, the good news is that the folic acid added to supplements, cereals, bread and pasta is absorbed about twice as efficiently as the folate naturally present in foods.
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Alan Titchenal, Ph.D., C.N.S., is a sports nutritionist in the
Department of Human Nutrition, Food and Animal Science,
University of Hawaii-Manoa.Joannie Dobbs, Ph.D., C.N.S., is a food and nutrition consultant
and owner of Exploring New Concepts, a nutritional consulting firm.
She is also responsible for the nutritional analyses
indicated by an asterisk in this section.