The discovery in 1991 that about 70 percent of neural tube defects, a group of serious birth defects, could be prevented by the consumption of synthetic folic acid led to a major health promotion campaign in many Western countries, by governments, and those in healthcare and industry. The objective would be for women to take 400 micrograms (mcg) of synthetic folic acid daily before getting pregnant. Authors of a just published study (Andrew Boilson and colleagues in Am J Clin Nutr;96) state that “This campaign largely failed in its objective, in part because more than half of all pregnancies are unplanned.”
For decades before this time, synthetic folic acid was a part of most dietary supplements sold in drug and health stores, and in prescription forms. Often, they are labeled as “natural” even though they are not.
By 1998, pharmaceutical companies, the manufacturers of synthetic folic acid, increased their business when governments mandated that processed flour be fortified with this chemical. As of 2007, 52 countries worldwide had national regulations mandating folic-acid fortification. This strategy, along with the popular recommendation for women of childbearing age to take folic acid continued. Boilson and colleagues conclude that, “After 20 years, the risks and/or benefits associated with either of these strategies remains unclear, and the debate continues.”
Part of the debate is that some scientists and health authorities are changing their minds. The United Kingdom suspended its fortification program upon discovery of an increase in cancer rates attributable to the addition of folic acid. Ireland recently stopped its program as well.
Researchers also noticed that rates of colorectal cancer went up in North America around the same time that fortification began. They estimate that excess folic acid consumption may cause an additional 15,000 cases of colorectal cancer each year in the U.S. and Canada. By comparison, fortification prevents an estimated 2,000 to 3,000 cases of neural tube defects in both countries.
Another study showed the same problem in Chile after fortification began there in 2000, rates of colorectal cancer increased.
The latest concern is an increased risk of prostate cancer. So it’s not any one specific cancer, but quite possibly any form. Folic acid can speed up cancers for the same reason it can prevent neural tube defects — the body uses more folate for rapid cell growth, something shared in the fetus and tumors.
Over 50 years ago, research showed that synthetic folic acid supplements accelerated leukemia in children. (Such studies helped lead to a class of antifolate drugs that are among today’s most common cancer treatments.)
Recent studies have been demonstrating the potential ill effects of long-term synthetic folic acid intake. Part of the problem is that too many people are getting too much because so many processed foods are fortified with this chemical. In fact, current levels of synthetic folic acid are in excess by as much as twice the target set for fortification.
When reading the ingredient list on a food package, if it states “folic acid,” it’s the synthetic version.
There have always been safety issues surrounding the use of this synthetic vitamin. In addition to leukemia, one of the first concerns was related to the masking effect of folic acid on vitamin B12 deficiency, the cause of pernicious anemia. The lack of adequate B12 can come from poor diet (not consuming animal foods) or poor absorption from the intestines (due to stress or disease). This form of anemia can occur at any age, although symptoms don’t usually appear until after age 30, there is a higher prevalence in those over 60.
Untreated pernicious anemia can produce little or no symptoms in many patients. In others it can cause fatigue, shortness of breath, poor concentration, and depression. It can also be fatal in some cases. That’s because this form of anemia can severely affect the brain.
It’s not likely that the U.S. will suspend fortification of processed foods with synthetic folic acid. The business of selling these and other synthetic vitamins, whether for fortification or pills, is booming.
Xinfa Pharmaceuticals, a Chinese manufacturer of folic acid, produces in excess of 1,200 tons per year, with probably most finding its way to U.S. retail shelves. Turned into tablets, that amount of folic acid can produce more than 4 trillion pills. I don’t have data on how much of this folic acid goes to the fortification program. But the dietary supplement industry in the U.S. is a multi-billion dollar business alone. As is well known, the pharmaceutical industry has thousands of lobbyists in Washington, D.C., who try to influence Congress. The non-partisan Center for Public Integrity reported that the pharmaceutical industry spent $855 million on lobbying activities between 1998 and 2006.
The primary problem is nothing more than the fact that too many people are not eating well. Governments have not helped, allowing — actually encouraging — industry to sweet-talk entire populations into avoiding the consumption of healthy food by offering easy, cheap and unhealthy alternatives. Typical government and healthcare recommendations are to consume large amount of carbohydrates, which usually means people eat a lot of refined flour that’s fortified with synthetic vitamins. By not eating fresh fruits and vegetables, for example, the primary sources of adequate natural folates, along with legumes, millions of people are choosing junk food instead, void of essential natural nutrients.
