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Since January 1998 the Food and Drug Administration has required that folic acid be added to cereals, breads, pastas, and other foods labeled "enriched." Key researchers, however, estimate that the current level of fortification will prevent only about 5 to 20 percent of folic acid-preventable birth defects of the brain and spinal cord. Dr. Godfrey P. Oakley, Jr., professor of epidemiology at Emory University in Atlanta is at the forefront of a crusade to implement a fully protective folic acid-fortification program (see "A Flaming Failure" SatEvePost Sept./Oct. 1999). The following editorial, written by Dr. Oakley, appeared in the November 11, 1999, New England Journal of Medicine:

"To the Editor: Researchers reported recently that 96 women from Maine had pregnancies, with estimated or actual dates of delivery between 1991 and 1996, in which open spina bifida or anencephaly developed in the fetuses. In addition, they found no decrease in the prevalence of these preventable birth defects.

"In 1991, the Medical Research Council Vitamin Study Research Group reported the results of a randomized, controlled trial that found that synthetic folic acid taken in the form of a pill prevents 72 percent of cases of spina bifida and anencephaly. Had an effective program of folic acid supplementation been implemented in Maine immediately after the publication of the results of the Medical Research Council vitamin study, most of the women in the study by Palomaki, et al., would not have had pregnancies affected by these birth defects. Had there been an effective national program, 20,000 pregnancies in the United States between 1992 and 1999 would not have been affected--more than the number of pregnancies affected by birth defects due to thalidomide 40 years ago in Europe.

"The failure to implement effective programs for protection against folic acid-preventable birth defects is causing a continuing public health emergency. Since 1991, approximately 64 children have lost their lives because of front-seat air bags. The 20,000 pregnancies unnecessarily affected by folic acid-preventable birth defects constitute an opportunity for prevention more than 300 times as great as the opportunity to control the number of deaths among children resulting from front-seat air bags.

"It is not surprising that the emergency continues. The Food and Drug Administration waited four years before requiring inadequate levels of folic acid fortification that result in the average woman's consuming only 25 percent of the amount of folic acid recommended by the Public Health Service in 1992 and the Institute of Medicine in 1998--a deficiency tantamount to marketing polio vaccine containing only the least common of the three vaccine strains. The current administration both permitted the inadequate fortification regulation to be formulated and failed to ask Congress to appropriate a single penny for the Centers for Disease Control and Prevention (CDC) to build an effective supplementation program. Congress appropriated only about $1 million for the effort, which, to be effective, would require about $100 million a year. Since the early 1990s, Congress has made approximately $100 million a year available for a CDC-sponsored program to prevent Haemophilus influenzae meningitis. We have nearly eliminated this killer and disabler of children--what a great public health success ! It is time for the President to implement a fully protective folic acid fortification program and, until that program is in place, for Congress to provide the CDC with the resources to teach women to consume vitamin supplements containing folic acid."

Copyright [C] 1999 Massachusetts Medical Society. All rights reserved.

Because we believe that folate lowers homocysteine levels and thus helps prevent heart disease, we would like to know if any mothers of spina bifida children would have their homocysteine levels tested the next time they have blood drawn. We would also be curious to know of any cases of heart attacks in women who have borne spina bifida babies.

If Dr. Kilmer McCully's hypothesis is correct, then women who have babies with birth defects preventable by folate might also be vulnerable for heart attacks and strokes unless they lowered their homocysteine levels with folic acid supplements.

Dr. Craig Venter convinced us that the new genome database is sure to reveal that the "one drug, or one vitamin dosage fits all" approach is very wrong. Some women obviously require more folate than others. Men would also be wise to determine their homocysteine levels, since it is so very easy and inexpensive to correct with folic acid supplements.

"People really need to understand that a simple, cheap, safe vitamin can keep children from dying and keep them out of wheelchairs," urges Dr. Godfrey Oakley. The Saturday Evening Post Society began writing about folic acid to prevent spina bifida in 1982 and pioneered an inexpensive heart-shaped folic acid tablet with [B.sub.12] and [B.sub.6] for prevention of spina bifida--and campaigned for its wide use. Today, 400- and 800-microgram folic acid tablets are readily available over the counter.
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Publication:Medical Update
Geographic Code:1USA
Date:Aug 1, 2000
Previous Article:BURNING FEET.

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