The Importance of Folic Acid in Healthcare

 by Muhammed Sahil

Folic acid is the man made version of a vitamin called folate. Folate has an important function in our body by helping it to produce healthy red blood cells.

Folic acid has various uses including:

• To treat or prevent folate deficiency anaemia - Folate helps produce healthy red blood cells which are important as they carry oxygen around the body, having a low amount of this acid, can mean the body produces abnormally large red blood cells that don’t function successfully. Therefore this cause folate deficiency anemia.

• Plays a pivotal role in pregnancy as it helps an unborn baby’s brain, spinal cord and skull to develop properly to avoid neural tube defects such as spina bifida. The first 12 weeks of pregnancy consists of the baby’s body and organs being formed and taking folic acid ensures that this development occurs normally. At the time of pregnancy, women need up to 10 times more folate for the baby’s development.

• helps reduce side effects from Methotrexate which is a medicine used to treat Crohn's disease, severe arthritis and psoriasis.

Folic acid can be obtained on prescription and comes as tablets or as a liquid you swallow. It’s not suitable for everyone and there are many circumstances in which you should notify your GP before taking it such as if you have had a stent in your heart or if you have had an allergic reaction to Folic acid or any other medicine in the past. Like  all medications, folic acid can cause some side effects but for the majority of people there’s no side effects or only minor effects. 

It can also be combined with

• ferrous fumarate and ferrous sulphate as treatment for iron deficiency anaemia. 

• other minerals/vitamins as a multivitamin or  mineral supplement

Folic acid has now been added to UK flour as it helps prevent spinal birth defects in babies and so pregnant women are advised to take this vitamin as it can prevent spina bifida in unborn babies before and during pregnancy.  Spina bifida is a neural tube defect meaning that the spine of the baby develops abnormally. A baby’s neural tube starts developing in the first 4 weeks of pregnancy. 

Back in the 1980s, around 1 in 200 pregnancies resulted in a baby with a neural tube defect. But now since women have been advised to take Folic acid in early pregnancy, the risk has reduced to 1 in every 400.

In the UK, Neural tube defects, such as spina bifida and anencephaly which is a life-limiting condition affecting the brain, has an impact on around 1,000 pregnancies per year. Many babies diagnosed with spina bifida survive into adulthood but they will experience life long impairment. To reduce the risk, women are advised to take 400 micrograms of folic acid every day for at least a month before conception and up to the 12th week of pregnancy. Pregnant women would still be advised to take Folic acid tablets so the plan as said by the government would be to help women who don’t receive the message or for those women with unexpected pregnancies.

Adding folic acid to flour could prevent up to 200 birth defects per year with new rules only applying to non-wholemeal wheat flou. Both gluten-free foods/wholemeal flour are exempt.

Despite the UK just having introduced this, Folic acid has already been added to more than 80 countries due to its great benefit mainly for pregnant women. Furthermore a study in Australia has shown that the addition of Folic acid to bread had led to neural tube defects dropping by 14%, furthing supporting its addition to flour.

Concerns?

The mandatory fortification means that everyone who eats food such as bread will be getting more folic acid in their diets. Many concerns about any potential harmful health effects were raised such as covering up  a vitamin B12 deficiency or even increasing the risk of colon cancer. However, back in 2018 the Scientific Advisory Committee on Nutrition said that these concerns are not supported by the evidence. It’s taken years to mandatory fortify Folic acid into flour as the benefits need to be carefully weighed against any potential harm.

Another issue was that it was thought that for some people such as the elderly, an increase in folic acid may lead to harmful consequences such as covering up the symptoms of vitamin B12 deficiency. Despite the concerns, the government's independent advisory body had analysed all the evidence and were correct  to say that fortification is the right thing to do for the benefit of society. Boris Johnson said that this would be a “quick simple win” to enhance a baby’s development along with helping to improve the health of UK adults. The Health Secretary Sajid Javid has also expressed his support saying that preventing life-threatening health issue like spina bifida would ensure that  fewer people require hospital treatment.

Support also came from the charity, SHINE. Kate Steele is the chief executive of the charity and has been a campaigner for mandatory fortification of flour for over three decades. The charity provides specialist support for individuals affected by spina bifida/hydrocephalus (built up of fluid in the brain). She said that “the step will reduce the numbers of families who face the devastating news that their baby has anencephaly (birth defect in which a baby is born without parts of the brain and skull) and will not survive, It will also prevent some babies being affected by spina bifida, which can result in complex physical impairments and poor health.”

By making this simple adjustment to flour, many babies will be able to develop normally, which will also further reduce stress on parents, ensuring their child is born healthily.