Every week in Australia, up to nine babies are born with a neural tube defect. The most common is spina bifida. It's a serious and permanent disability but the evidence shows that a diet rich in folate can prevent two-thirds of cases. Peta Newbold reports.
In 1998 it became compulsory for US manufacturers of flour and pasta to add a B group vitamin called folate. That was the result of more than 20 years of scientific evidence from around the world that proved that increased intake of folate by women of child bearing age leads to fewer babies born with neural tube defects (NTDs).
The results were dramatic. According to the National Centre of Birth Defects and Developmental Disabilities in Atlanta, Georgia, NTDs in the US have declined by 20 per cent.
"It's what I expected, but it's a pleasing finding," said Emeritus Professor Stewart Truswell, of the University of Sydney's Human Nutrition Unit. "This is nutrition in action and it proves that fortification works."
Professor Truswell was part of an expert panel from Australia's National Health and Medical Research Council (NHMRC) which also acted on the folate evidence. It didn't go quite as far as the American health experts though.
Instead it recommended that some food manufacturers be encouraged to add folate to foods such as cereals on a voluntary basis. That started in 1995 and Professor Truswell is certain is there's been a significant drop in NTDs in Australia since then. Unfortunately it's hard to quantify because foetal NTD detection has also improved and most of those pregnancies are now terminated.
The facts about NTDs:
In Australia 400-500 babies are affected each year.
Anencephaly, where the cranium has failed to close is responsible for around half of them.
All anencephallic children are stillborn or die within a few days of birth.
Around 50% have spina bifida, which means "split or divided spine". The spinal column doesn't close properly and the baby is born with exposed nerves and damaged vertebrae.
Children with spina bifida can face paralysis, problems with mobility, muscle control, co-ordination and learning.
Approximately 95 per cent of all NTDs occur with no prior that the woman was at risk of having an NTD affected pregnancy.
They occur in the first weeks of pregnancy when the brain and spinal cord are forming.
Seven out of 10 cases can be prevented.
And that's the good news. Quite simply it involves women of child-bearing age increasing their daily intake of a B group vitamin called folate.
What is folate?
Folate is a vitamin that occurs in foods like green leafy vegetables, nuts, fruit, and legumes.
The tablet form of the vitamin is called folic acid.
Folate is needed for all cell regeneration and proliferation processes in the body.
The demand for folate increases when cell proliferation is very active, such as in pregnancy and in leukemias and some other cancers.
How to increase folate intake:
By eating more leafy vegetables fruit such as citrus, berries and bananas, legumes, nuts and eggs. Yeast extract (Vegemite) is also a good source of dietary folate along with orange juice, bread, liver and kidney.
Microwaving, steaming or stir-frying are the best way to cook vegetables and still preserve their folate content.
Eat more folate-fortified foods. More than 20 breakfast cereals now have added folate.
Take a folic acid supplement but beware; multivitamin supplements contain only very small amounts of folic acid.
How much folate do we need?
Australia's National Health and Medical Research Council (NHMRC) recommends women take 400 mcg (0.4 mg) per day from at least one month before conception and for the first three months of pregnancy.
But I'm not planning to get pregnant...
It's pretty surprising in these days of sophisticated birth control, but as many 40 per cent of pregnancies may be unplanned. The neural tube closes in the very early weeks of the pregnancy, which means that by the time a woman realises she is pregnant, the damage may already have been done.
But there are other good reasons to increase folate intake. There is increasing evidence that folate may also protect against heart disease, breast cancer, and even Alzheimer's disease.
