The Story of Folic Acid Fortification


Dave Erickson: Folic acid is
a vitamin which can protect a developing baby
from getting a serious problem that can cause
difficulties walking. Spina bifida. Anencephaly. These are major birth
defects that are either fatal or have serious, long-term
consequences for the child. And, in contrast to polio,
where you only get motor- you only lose motor
function- with spina bifida, you lose both motor function
and sensory function. We estimate that about
300,000 babies are affected by neural tube defects
around the world. Joe Mulinare: Dave and
Godfrey Oakley had invited me to come to CDC to work on the Vietnam veterans
agent orange risk study for birth defects. And we analyzed that data
and published it and it was one of the first population based
studies that was done to show that folic acid in a multivitamin could reduce
the risk of neural tube defects. Dave Erickson: And it was
enough to prompt us to figure out whether this was really
an idea worth promoting on a public health scale
or whether it was something that was just a fluke. Godfrey Oakley:
June the 24th at 5 PM, 1991 was probably the most
marvelous professional moment of my life, when I got a call
from, now Sir Nicolas Wald, telling me that the randomized
control trial that he had done to find out if Folic Acid or a different vitamin
would prevent Spina Bifida, it had turned out to be
such a positive study. Godfrey Oakley:
It prevented 72% of spina bifida and anencephaly- And, it was in the
gold standard study that we call a randomized
control trial. And it meant that we
could bet the farm that Folic Acid prevented
spina bifida. So, you’re doing something
that prevents diseases and prevents conditions Margie Watkins:
with the result of not only saving
children’s lives, but improving their
quality of life. So the first thing we did was
make a recommendation for women who had previously
had an affected child with either anencephaly
or spina bifida, these two very severe
birth defects. Godfrey Oakley:
And that was one of the easiest policy things
I ever did at the CDC. Dave Erickson: This was
a special recommendation because it called for what we
really now call a high dose of folic acid, a pharmacological
dose of folic acid. If you can prevent
something like this, especially on the scale
of preventing thousands of these birth defects, then
this is a real accomplishment. Godfrey Oakley: How much
prevention you get depends on how bad off you are. The China study was really
public health at its best. At the time we did the
China Study, people didn’t know for certain whether
folic acid, by itself, would prevent neural
tube defects. We sent RJ off to China Godfrey Oakley: to do a
large community intervention. He wound up showing some
really fascinating things. We were asking folks in the
field- the health providers that were in the villages- to
take pictures of these babies in a way that we could then use
the picture to make a diagnosis. Godfrey Oakley: Among the
things that he showed was that how much prevention you
get depends upon how high the incidence is when you put the
Folic Acid into the population. And in parts of China it went
down almost ninety percent. And, the China Study was the
first and only study that showed that folic acid, by itself,
without other vitamins, prevents neural tube defects. Godfrey Oakley: And
from that moment on I knew that all we needed to do
to keep tens of thousands of kids each year out of wheel
chairs, was to get everyone with a reproductive
age 400 micrograms of Folic Acid every day. We have lots of
success stories about preventing spina bifida with Folic Acid fortification
programs. And the key is you
have to make it so that every manufacturer
has to do it. So, in the US, you know, it
was prohibited before February of ’96 and then it was required
twenty-one months later. And so beginning in January one 1998 all
enriched grains in the US had to have Folic Acid in it. Margie Watkins: So, once
the folic acid was added to cereal grain products,
added to the flour that goes into the bread that we eat and
other cereal grain products then you want to
count how many cases of neural tube defects
there were. Dave Erickson:
It has resulted in a substantive
reduction in the occurrence of neural tube defects
among babies who have been born
in the United States. Godfrey Oakley: There’re
roughly three hundred thousand cases of anencephaly and
spina bifida around the world and we’re preventing some place
around about fifteen percent of that, so some place on
the order of twenty thousand, thirty thousand a year. Godfrey Oakley:
And, it’s wonderful. I mean, thousands of kids
don’t have spina bifida and anencephaly. Joe Mulinare: To have
something so simple as folic acid in fortified
foods that can prevent fifty to seventy percent
of these children from having this condition,
and actually being born healthy to me is a success
story beyond belief. Smallpox is gone. Polio’s on the way
to being gone. I’d like for spina bifida
F to be the next one. And, that to me is
an exceptional thing to have happened and I
have had the opportunity to be a part of that. Tough not to be… …tough not to be an
evangelist for this, you know.

8 Replies to “The Story of Folic Acid Fortification”

  1. I was wondering how does this affect the mother of the child and other environmental issues currently?

  2. It was wonderful to hear from the scientists who were behind this change in public policy. Thank you!

  3. Outstanding story. Amazing to see how public policy (along with great research) saved lives and improved the quality of life for thousands. Thank you so much for sharing this information in a well prepared video! CDC – you rock!

  4. I have spina bifida and hydrocephalus. Thank you for helping me safeguard my twins from it. I had them in 1996.
    If these drs were English I'd demand they get an O.B.E

  5. Folic Acid is the synthetic form of Folate, they are not identical and do not work the same in the human body. A more ideal way to prevent neural tube defects would be to eat enough dark leafy greens and beans to get adequate folate naturally. If a supplement is needed, the natural form of folate, L-methylfolate aka 5-methyltetrahydrofolate, is preferable for many reasons. https://www.ncbi.nlm.nih.gov/pubmed/23482308
    https://nutritionfacts.org/video/can-folic-acid-be-harmful/

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