Folic Acid is Not the Only Nutrient needed to Prevent Birth Defects

Original Article September 2012
Copyright Jaine Kirtley

Folic acid has once again been in the news as The Minister of Food Safety has recently decided to change the proposed mandatory fortification of bread with folic acid  to a voluntary fortification of bread.[1]
Many women quite rightly follow recommendations to take Folic Acid before pregnancy and during pregnancy to prevent the Neural Tube Defects (NTD) in babies. Folic acid is a synthetic vitamin. The natural forms of folic acid are a group of nutrients called folates. An inadequate level of Folic Acid (or folates) is one of many aspects of the diet which increase risk of Neural Tube Defects, such as Spina Bifida. 
Folic acid alone may not prevent Neural Tube Defects approximately 30% of NTD affected pregnancies are not related to a lack of folates or folic acid[1]. Many other nutrients are important in pregnancy and prior to conception (by both men and women) [2], not only in the prevention of NTD but also other health problems at birth.
Pre-conception diets low in Choline even with supplemental folic acid, and dietary folate, increase NTD [3-5] CHOLINE is high in foods such as Lecithin, Brewers Yeast, Legumes, Eggs-Yolk(best organic), Leafy Greens
Low zinc has also been associated with NTD [6] ZINC is high in Sunflower & pumpkin seeds, Seafood esp.
Oysters Mushrooms, Soybeans, Brewers yeast
Diets high in simple sugars which pose potential problems in glucose control are associated with NTD risk even among non-diabetic women.[7]
Obesity increases the risk of having a baby with NTD. [8].
Poverty and lack of knowledge of how to eat a nutritious diet effects the likelihood of NTD. Food Insecurity irrespective of folic acid or folate intake results in a high risk of cleft palate, spina bifida, and anencephaly [9].
So we see that the whole diet and the nutrients it contains and the damage a poor diet can cause all need to be taken into consideration in preventing NTDs. 
Fortification of bread with folic acid does not promote education of a health giving diet rich in green leafy vegetables, broccoli, whole grains, brown rice, chick peas, citrus fruit and yeast – all natural and well absorbed sources of folates. A reliance on either fortification or Folic acid supplements alone can in fact lead women into a false sense of security; so that they think they are doing all they can to prevent NTD but in fact could with a little knowledge do also much more.
Another concern with across the board fortification of folic acid is that it may lead to dietary imbalances or make it harder to identify vitamin B12 deficiency as the test to find Vitamin B12 levels is affected by the addition of  Folic acid. 
Another factor important to note is that Environmental toxins have also been shown to increase the risk of  NTDs[10, 11]
Folic acid supplementation for pregnant women, those of child bearing age or those women wishing to become pregnant is important. And one way of many to help decrease NTDs. 
Any woman wishing to become pregnant who has concerns over her nutritional status and any prospective father with similar concerns, regarding a healthy conception and pregnancy, should contact a naturopath for advice on healthy diet and supplementation.  
For more information contact us and read the NZ society of Naturopaths media release 
“New Zealand Society of Naturopaths Express Concern over Folate in Bread Media Release; November 2010 by Kirsten Johnstone” 

New Zealand Society of Naturopaths Express Concern over Folate in Bread Media Release; November 2010 by Kirsten Johnstone

1.    Wilkinson K: Folic Acid Fortification of Bread. In. Edited by Zealand MfFSN; 2012.
2.    Costello AMdL, Osrin D: Micronutrient Status during Pregnancy and Outcomes for Newborn Infants in Developing Countries. The Journal of Nutrition 2003, 133(5):1757S-1764S.
3.    Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM: Periconceptional Dietary Intake of Choline and Betaine and Neural Tube Defects in Offspring. American Journal of Epidemiology 2004, 160(2):102-109.
4.    Zeisel SH: Choline, homocysteine, and pregnancy. The American Journal of Clinical Nutrition 2005, 82(4):719-720.
5.    Velzing-Aarts FV, Holm PI, Fokkema MR, van der Dijs FP, Ueland PM, Muskiet FA: Plasma choline and betaine and their relation to plasma homocysteine in normal pregnancy. The American Journal of Clinical Nutrition 2005, 81(6):1383-1389.
6.    Velie EM, Block G, Shaw GM, Samuels SJ, Schaffer DM, Kulldorff M: Maternal Supplemental and Dietary Zinc Intake and the Occurrence of Neural Tube Defects in California. American Journal of Epidemiology 1999, 150(6):605-616.
7.    Shaw GM, Quach T, Nelson V, Carmichael SL, Schaffer DM, Selvin S, Yang W: Neural tube defects associated with maternal periconceptional dietary intake of simple sugars and glycemic index. The American Journal of Clinical Nutrition 2003, 78(5):972-978.
8.    Min of Health N: Food and Nutrition Guidelines for Healthy Pregnant and Breastfeeding Women. In. Edited by Min of Health N. Wellington; 2006 (revised 2008).
9.    Carmichael SL, Yang W, Herring A, Abrams B, Shaw GM: Maternal Food Insecurity Is Associated with Increased Risk of Certain Birth Defects. The Journal of Nutrition 2007, 137(9):2087-2092.
10.    Croen LA, Todoroff K, Shaw GM: Maternal Exposure to Nitrate from Drinking Water and Diet and Risk for Neural Tube Defects. American Journal of Epidemiology 2001, 153(4):325-331.
11.    Ren A, Qiu X, Jin L, Ma J, Li Z, Zhang L, Zhu H, Finnell RH, Zhu T: Association of selected persistent organic pollutants in the placenta with the risk of neural tube defects. Proceedings of the National Academy of Sciences 2011, 108(31):12770-12775.