To “B” or Not to “B”

By Cindy Pearson

Usually, when we write an article in our “You Heard it Here First” series, we’re patting ourselves and our members on the back for being in the know. Because NWHN loves to dig deep into an issue, we are often able to figure out new information before it is widely known. This time, however, it wasn’t knowledge that we predicted -- it was controversy.

Over a decade ago, public health researchers recommended that folic acid (a B vitamin) be added to the U.S. food supply in order to prevent birth defects. Certain kinds of birth defects (“neural tube defects”, primarily spina bifida and anencephaly) are strongly associated with vitamin B deficiency and researchers argued that adding folic acid to wheat would be an easy, safe, and effective way to reduce the numbers of babies born with preventable birth defects.

Although certain public health researchers and pediatricians loved the idea, there were those who warned that the health of another group of people might be jeopardized by adding folic acid to wheat, and everything made with wheat, including bread. Geriatricians warned that many poor elderly -- the majority of whom are women -- eat lots of bread to fill up on something affordable, and could be exposed to too much folic acid if it were added into a wide variety of food products. Too much folic acid can mask symptoms of pernicious anemia, a vitamin B-12 deficiency, which can damage the brain if left untreated. Pernicious anemia is most commonly found in the elderly.

We were so intrigued by the controversy that we ran side-by-side articles arguing for and against folic acid supplementation in the January/February 1994 issue of The Network News. At the time, the Food and Drug Administration (FDA) was asked to give its advice on the issue, and eventually approved folic acid supplementation. We’ve all been eating foods, including bread and noodles, supplemented with folic acid since fortification became mandatory in 1998. By now, enough time has passed to assess the effect of this public health intervention -- were babies helped, were the elderly harmed?

All the evidence indicated that babies were helped by adding folic acid to our foods. The number of babies born with spina bifida and other neural tube defects has dropped, perhaps by as many as 1,000 a year. This evidence is so compelling that some advocates are arguing for increasing the level of fortification. The cautionary note comes from a new study looking at cancer rates, however, which found that colon cancer has stopped declining since folic acid fortification began. Colon cancer, like most cancers, is primarily a disease of the elderly. Although the study isn’t conclusive, the association of increased folic acid and more cancer is supported by clinical experience many years ago when cancer doctors tried treating leukemia patients with high doses of folic acid and saw the cancer grow rather than recede.

No one is arguing for removing folic acid from bread, but reasonable voices are calling for more research on this issue. Until then, the controversy will continue, and the NWHN will keep its ears attuned, listening for the latest.