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Folate, folic acid and fortification

What is folate?

Folate is a B vitamin that is vital for healthy growth and development of blood cells and nerve tissue. Folate is found naturally in food, especially green vegetables and grains.

Why we need folate

Folate is important for everyone for cell growth and reproduction. Folate deficiency can result in a type of anaemia called ‘megaloblastic anaemia’. Megaloblastic anaemia is a blood disorder characterised by the presence of enlarged immature red blood cells (megaloblasts).

How much folate is recommended?

It is recommended that New Zealand adults consume around 400 micrograms of folate from food each day. Adults get about 200 micrograms (µg) of folate from food each day, well below the recommended intake.

What are good sources of folate?

Foods that are naturally high in folate are vegetables, especially green vegetables such as broccoli, spinach, salad greens; citrus fruit eg, oranges; wholegrain breads and breakfast cereals. Chick peas, nuts, dried beans and peas are also high in folate, although cooking reduces this level.

What is folic acid?

Folic acid is the synthetic form of folate which may be added to manufactured foods and drinks, or taken as a vitamin supplement.

Folic acid and pregnancy

Women who don’t get enough folate and folic acid before and during pregnancy have a higher risk of their baby developing abnormalities known as neural tube defects (NTDs). The neural tube is the nerve centre of the foetus which grows into the spinal cord. The most common NTDs are spina bifida and anencephaly.

New Zealand’s current policy recommends that women capable of, or planning a pregnancy, take at least 400 micrograms of folic acid daily for at least four weeks before and 12 weeks after conception. As well as consuming foods rich in folate and folic acid-fortified foods. Folic acid is more readily absorbed by the body than naturally occurring folate.

During pregnancy it is difficult to get enough folate from food alone – it would mean eating about one kilogram of cooked spinach or raw broccoli each day!

If you find out that you are pregnant and you have not been taking folic acid vitamin supplements, you should start taking these as soon as possible. It is recommended that you take a 400 microgram folic acid vitamin supplement daily until 12 weeks after conception.

If you have a family history of NTDs like spina bifida an even higher dose of folic acid may be necessary – particularly for women who have had a child with an NTD and are planning subsequent pregnancies.

Folic acid vitamin supplements can be purchased over the counter at the pharmacy or on prescription from your doctor or midwife. Check with your doctor or midwife to find out what is best for you.

What is fortification?

Fortification is when extra nutrients (such as folic acid) are added to food and drinks during the manufacturing process.

Some manufacturers voluntarily fortify their products with folic acid. These products include some breakfast cereals, juices and food drinks (such as liquid meal supplements).

Mandatory fortification is when manufacturers are legally required to add extra nutrients to a particular food to meet a significant health-need in the population.

Mandatory fortification of bread with folic acid

Recently, the New Zealand Government passed a standard requiring all bread manufacturers to fortify bread with folic acid. Mandatory fortification is expected to increase folic acid intake in the target population (women 16-44 years) by an average of 140 micrograms per day and reduce the number of pregnancies affected by neural tube defects.

Bread manufacturers have been given two years to start adding folic acid to bread. From September 2009, most bread in New Zealand will be legally required to contain folic acid. Fortified bread will contain around 135 micrograms of folic acid for every 100g of bread, that’s about 2-3 slices.

Organic bread will be exempt from mandatory fortification with folic acid, providing consumers the option to purchase unfortified bread as well.

Is food that is fortified with folic acid labelled?

Yes. The food label will list the vitamins added (eg folic acid). These can be found in the ingredients list and sometimes in the Nutrition Information Panel (NIP). The total amount of folate in the NIP includes the natural folate as well as the amount of folic acid that has been added.

Do any other countries fortify bread with folic acid?

Yes. In the USA and Canada, mandatory folic acid fortification of flour since 1998 has successfully reduced the number of babies born with a neural tube defect. Australia, like New Zealand, introduced fortification with folic acid in 2007, requiring most bread to contain folic acid by September 2009.

Are there any risks of taking folic acid?

Based on current scientific evidence, there is no apparent risk to public health and safety from the estimated increase in folic acid intake as a result of mandatory fortification.

NZFSA and the Ministry of Health will be monitoring the effect of mandatory fortification of bread with folic acid. After two years of monitoring the information will be reviewed to consider the population health impacts and benefits.

NZFSA will also be monitoring the progress and development from those countries (eg, USA and Canada) that have previously implemented folic acid fortification, as well as emerging scientific research in this area.

Related links

Detailed information on the decision to fortify bread with folic acid [Food Safety Australia New Zealand]

Food safety in pregnancy

Folate, folic acid, and health [Ministry of Health]