Foods and ingredients fortified with folic acid such as rice and flour will easily find their way in stores and supermarket shelves once legislation is in place. This will provide more Filipina consumers with more amounts of a nutrient proven to help prevent the incidence of neural tube defects (NTDs) in their future children.

At a recent Roundtable Discussion on Folic Acid organized by the Department of Science and Technology-National Academy of Science and Technology (DOST-NAST), Food Fortification Initiative’s Executive Officer for Asia Dr. Karen Codling stressed the necessity of mandatory legislation to create an impact on public health.

“Eighty-one countries currently have mandatory legislation for the fortification of wheat flour,” Codling revealed. “All but five of these require fortification with folic acid. The Philippines is one of the five countries with mandatory fortification of wheat flour that does not include folic acid.”  

In the same discussion, NAST Academician and UP Manila Chancellor Carmencita D. Padilla shared that the Institute of Human Genetics of the National Institutes of Health is proposing a legislation to establish a comprehensive policy on achieving adequate folic acid intake via food fortification and supplementation. This proposed bill, said Padilla, will hopefully be submitted to the Senate and the House of Representatives by August 2015.

“We want to ensure that there is adequate supply of folic acid-fortified food and food products and folic acid tablets at an affordable price,” Padilla stated.

Naturally found in legumes, liver, fruits, and green, leafy vegetables, folic acid helps prevent NTDs which are birth defects of the brain, spine, or spinal cord. The neural tube is that part of an unborn baby which eventually develops into its brain and spinal cord. The onset of NTD occurs on the first month of pregnancy, when most women are still unaware that they are pregnant. Spina bifida in which the fetal spinal column doesn't close completely, and anencephaly in which much of the brain and skull do not develop, are the most common forms of NTDs which entail high cost of treatment.

However, women cannot get enough amounts of folate or folic acid naturally found in food, from these specific food items. First of all, Filipino women of reproductive age have been found to have a low one-day intake of legumes, fruits, and vegetables, according to data by the 2008 National Nutrition Survey.

Fortification of other foods with folic acid is one way of solving the problem.

Wheat flour as well as maize flour fortification have specifically been recommended by WHO as effective interventions against NTDs.

According to Codling, a review of 17 studies in 2012 comparing NTD prevalence before and after flour fortification indicated reductions in NTD incidence of 15.5% to 58%. Much of the evidence pointing to the efficacy of folic acid fortification was based on the use of wheat and maize flour. Wheat flour fortification, in particular, has been found to prevent 75% of folic acid-preventable NTDs at current levels of consumption.

National Nutrition Council’s Chief of Nutrition Policy and Planning Ma. Lourdes A. Vega disclosed during the NAST discussion that the local flour industry has expressed openness to the idea of mandatory folic acid fortification, which was recommended during the 2012 review of mandatory food fortification.

“We will request academe to resolve concerns on negative effects of mandatory folic acid fortification,” Vega added. Among these are safety concerns. However, Codling assured that there is no clear evidence pointing to folic acid as a cause of cancer, asthma, or cognitive impairment.