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Folic Acid Fortification
Interest in adding micronutrients to foods has substantially increased due to malnutrition. Humans require such micronutrients to provide for the essential growth and maintenance of life. In order to counter micronutrient malnutrition, practices of food fortification are necessary. This process allows for vitamins and trace elements to be added to foods to ensure that even lowest dietary requirements are met. Such methods prevent deficiency diseases and lead to balanced diets with adequate nutrients.

Food fortification takes many forms and uses a variety of micronutrients and vitamins. Folic acid, the synthetic form of vitamin B9 or folate, is one common micronutrient used to supplement the folate that naturally occurs in foods. [1]

In particularly the US as well as many other countries, flour and grain products are fortified with folic acid. Folic acid provides forms of Vitamin B9 and is vital to the body in many ways. Folate is extremely essential for human reproduction and other biological roles. It plays an important role in biological reactions, pregnancy, and infancy by assisting with cell division and cell growth. [2] Folate is a vital part in the reproduction and growth of cells, such that it helps with DNA synthesis and prevents any changes that could cause harm to DNA. The early stages of birth and childhood require folate so cell division and synthesis aren’t interrupted or hindered. [2] [3]

Neural Tube Defects
Neural tube defects (NTDs) are greatly impacted by folic acid fortification. Pregnant women and infants with a shortage of folate suffer from congenital deformations, spina bifida, anencephaly, cleft lips, preterm delivery, and other malformations. [2] [3] However, due to folate deficiency, the most notable defects were NTDs.

Trials were conducted to evaluate the influence of folic acid fortification. From these studies a daily intake of 400 μg of folic acid during early pregnancy can reduce the prevalence of NTDs. A survey taken in 1998 showed that only 29% of the US women actually followed the recommendation of a daily folic acid consumption of 400 μg back in 1992. [2] After noticing the decrease of NTD birth prevalence of 19% from experiments, in January 1998 the US Food and Drug Administration (FDA) demanded that enriched grain products be fortified with folic acid. [2]

Anemia
Both children and adults need folic acid to produce healthy red blood cells and prevent anemia. [4] Without red blood cells or hemoglobin, oxygen cannot be transferred from the lungs to the tissues. Lack of oxygen may lead to weakness, fatigue, or lack of concentration. More than a third of the world’s population suffers from anemia due to the increasing number of micronutrient deficiencies over the world. While millions of children under the age of 59 months suffer from anemia, almost half are affected specifically by iron deficiency anemia. [4] Despite the strong influence of iron deficiency, other micronutrients also contribute to the prevention of anemia. One example was seen Mexico where 30% of the anemic population did not react to iron fortification. [4]

Experiments were conducted to seek out possible strategies of treating anemia in children. One trial was carried out by randomly dividing a group of 266 children into 5 treatment groups. The different groups were treated with: iron supplement (IS), iron and folic acid supplement (IFS), multiple micronutrient supplement (MMS), micronutrient-fortified complementary food as porridge powder (FCF), and zinc and iron and ascorbic acid fortified water (FW). [4]

The MMS, IS, and IFS groups were shown to have an increase of hemoglobin and total iron more significantly than the FCF did. [4] Supplemented treatments with micronutrients and folic acid proved more effective in the reduction of anemia presence. Therefore fortified foods, such as IFS and MMS, are more viable to children than other supplements in treating anemia.

Possible Risks
Low levels of folic acid in one’s diet can lead to a build up of homocysteine, which is related to cardiovascular diseases. However, it is uncertain whether high levels may cause any harm. Experiments were conducted to test the effect of long-term folic acid intervention and its dosage amounts. [5] An unsystematically dose-finding trial was conducted with participants randomly assigned to take doses of either placebo or folic acid at 0.2, 0.4, 0.8 mg/day for 26 weeks. [5] The results showed that using doses as low as 0.2 mg/day over a longer period of time is equivalent to using a higher dose of 0.8 mg/day over a shorter term. If the two varying dosages were taken for the same amount of time, no risk of toxicity because any excess intake would be carried out through urine. [5]

Because folate is a water-soluble vitamin, it is constantly being expelled from the body through urine, putting it at a fairly low risk of harm. Almost no downfalls have been detected for this type of supplement. Folic acid has not yet been proven to be detrimental to humans’ diets.

Future Prospects
Uncertainties have been revolving around the adverse effects of increased folic acid consumption. Today, countries all over the world are researching the side effects of excess folic acid. Studies are being conducted to directly and indirectly evaluate this impact. Much research has gone into exploring the efficacy of folate treatments, but information on how it reacts with antifolate treatments is more ideal. Obtaining details on how folate interferes with antifolate treatments is extremely helpful for treating cancer patients. With people constantly suffering from micronutrient malnutrition, it is encouraged that the uncertainties of folic acid be learned to benefit the world.