At least that’s what Professor Nicholas Wald, one of the leading folic acid researchers says in his June 2022 publication-. (1) More than 30 years ago he was the leading scientist in the famous study which first proved that most neural tube defects (NTD) can be prevented by supplementing folic acid. (2)

It’s partly thanks to him that folic acid supplementation is recommended for pregnant women and that many countries have introduced enriching certain grains and flours with folic acid. (It’s used because it’s more thermostable and lasts longer than natural folates.)

We know the cause but can’t stop the problem

More than 30 years have passed since the discovery and to this day 300,000 children are born with NTD in the world, most of which would be preventable. In European countries women planning to have children are recommended to supplement 400 mcg folic acid daily even prior to becoming pregnant, but only one in three women take the recommendation and even some of them start usage too late.

According to Prof Nicholas Wald this is a very small amount since ten times this amount was used in the original study. Since then several studies have proved that such low dose decreases the occurrence of NTD only to a smaller degree. (3)

It’s important to start supplementing folic acid (or even better, methyl-folate) months before getting pregnant because the neural tube develops and closes in the first weeks of pregnancy, often before the woman knows she’s pregnant. If supplementation starts after that it’s too late.

That’s why folic acid enriched flours have been introduced in more than 80 countries since this increases almost every woman’s folic acid intake. In these countries the occurrence of NTD significantly lessened, as expected, however, the practice hasn’t spread worldwide because possible negative effects of larger dose folic acid consumption have arisen. We’ve discussed these in other, earlier articles. That’s where its daily 1 mg intake limit originates from. (4,5)

Is folic acid really dangerous?

The following concerns have arisen in relation to folic acid:

• In large doses it causes nerve damage.
• Reduces the symptoms of vitamin B12 deficiency so it’s only noticeable later
• It can increase the risk of certain tumorous diseases.

Nicholas Wald addresses these qualms in detail and has refuted them in his earlier publications.

• The presumed nerve damaging effects of folic acid stem form a statistical error, and in fact it’s non-existent. (6)
• Vitamin B12 deficiency can easily be detected using modern tests irrespective of folic acid consumption.
• The occurrence of colon cancer only correlates with folic acid enrichment because more effective screening was introduced at the same time, and as a result, more cases came to light. The number of colon cancer deaths didn’t grow. (7)

The connection of folate and tumorous diseases is rather complicated. High folate levels act as protection against certain types of tumours while it can indeed be harmful in some cases, but until we know more it’s better to be safe than sorry and avoid a daily intake exceeding 1 mg.

What’s the solution?

According to Prof Nicholas Wald the introduction of folic acid enrichment would be necessary in European countries as well, but much more folic acid would be needed than what’s being planned in England, for example. That amount would only prevent 1 in 10 NTD, while 1 in 8 could be prevented if women consumed 5mg/day on average.
Wald’s starting point is what’s the regulation that could help the most people even if they don’t enquire in the topic.

If people were well-informed, however, of course food wouldn’t need to be enriched with folic acid to provide adequate folate supplementation. Ideally everyone should consume enough folate, while those planning to have a baby could start supplementing folate months earlier.

Although folate is highly important, many other micronutrients are greatly needed during pregnancy, several of which affect the risk of NTD. Fat-soluble vitamins, other B vitamins, especially vitamin B12, choline, iron and iodine also contribute to avoiding the occurrence of problems during the child’s development.