In 1998, the Canadian government mandated folic acid fortification of certain food products in Canada – namely, all white flour and enriched grain products. This, in theory, is fantastic. Folic acid (a synthetic form of the B-vitamin folate) is necessary for proper neural tube development, which occurs early after conception when most women are still unaware they’re pregnant. Subsequent data, 11 years onwards, shows seemingly successful results: since fortification became mandatory, neural tube defects (such as spinal bifida) have declined in Canada by approximately 50% (Canadian Journal of Public Health, 2009).

Now, one would think that when introducing such a large-scale, population level intervention, one would do their homework. Such questions as, ‘Is there a risk if one has too much folic acid? How will folic acid quantities be regulated once in the food supply? Who will be responsible for such regulation?’ come to mind. What is fairly disturbing is that, until recently, the actual amount of folate in Canadian food has been unknown. A recent report (Shakur et al, 2009) published in the Canadian Journal of Public Health is, as far as the researchers are aware, the first direct assessment of actual folate amounts in the Canadian food supply. It found that label values did not accurately reflect actual amounts of folate in foods – and were on average 50% higher than the stated value. This wouldn’t be such a concern if having too much folic acid didn’t pose a health risk. Problem is – a growing body of literature seems to suggest it may. Consuming high levels of folic acid has been found to mask Vitamin B12 deficiency, increase cognitive impairment in seniors, and increase insulin resistance in unborn children. A recent report in the Globe and Mail cited some new research suggesting high levels of folic acid may accelerate cancer growth in at-risk individuals.

As concerning as these findings are, what’s even more troubling is the current call in Canada to increase the level of folic acid fortification, with the aim of reducing neural tube defects a further 25%, without any further research into potential health risks.

Compare the Canadian government’s approach to fortification with that of England’s, who currently do not mandate folic acid fortification: recently confronted with calls to institute mandatory fortification, England’s Chief Medical Officer has delayed making a final decision until the risks and the benefits have been carefully researched and weighed.

Undeniably, folic acid is incredibly important for proper neural tube development in unborn children. And, as this occurs very early in pregnancy, it does make sense to fortify the general food supply with it in order to ensure women who may not be taking supplements or getting adequate amounts do. However, the Canadian government has the responsibility to research and weigh all of the risks and benefits of instituting such a large-scale intervention before it is introduced, and properly monitor levels in a timely, scheduled, and scientifically sound manner.

In Health,
Michelle Amy Burtnyk

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