Frequently Asked Questions about Folic Acid
What are folate equivalents?
Folates in food and synthetically manufactured folic acid are ingested and converted in the body at differing rates. In order to take this different bioavailability into account, their levels are indicated internationally as folate equivalents: 1 microgram folate is equivalent to 1 microgram dietary folate or 0.5 microgram synthetic folic acid.
Can the recommended amount of folic acid be ingested from food?
The normal folic acid requirement can be covered by a balanced, rich diet with loads of vegetables, pulses and wholegrain products. Studies, however, show that only a small part of the population has a diet of this kind. This means that many people do not have a high enough folic acid intake.
Can food fortification improve folic acid intake?
Various foods like breakfast cereals, dairy products, salt and soft beverages are fortified with folic acid. Because eating habits and the reasons for choosing certain foods vary considerably, not all groups in the population benefit equally from this fortification.
In Germany and in other European countries there are also discussions about whether the targeted fortification of a staple food, which is consumed in predictable amounts by all echelons in the population, could be one way of improving the populationís folic acid intake. The USA and Canada already carry out this kind of fortification. Ireland will be the first European country to introduce the mandatory fortification of flour with folic acid.
Why should women wishing to start a family and women in the first three months of pregnancy take folic acid tablets as well?
The neural tube of the unborn baby closes in the first four weeks of pregnancy, a stage at which many women do not realise they are pregnant. In around one to two out of 1,000 pregnancies the spine does not close at all or not completely. This leads to a neural tube defect. The most well known is spina bifida, which is referred to popularly as "open back".
There are various causes for neural tube defects. Studies have shown that the incidence can be reduced by increasing folic acid intake during the critical phase of neural tube closure. For precautionary reasons intake should commence four weeks prior to conception and continue up to the end of the 12th week of pregnancy. Even now we still do not know how folic acid works. We simply know that it does.
Can too much folic acid cause damage?
Too much folic acid can mask the neurological changes caused by vitamin B12 deficiency. This mainly affects older people who are not able to ingest vitamin B12 effectively from their diet. However this effect only occurs at intakes of more than 1,000 micrograms synthetic folic acid.
It is still to be clarified whether the additional intake of folic acid increases the number of twins. Nor has it been fully clarified whether additional folic acid encourages the early stages of cancer, for instance in the colon.