Women's Folic Acid Levels Improving

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Their study also cites a "lack of data" on just how much folate is ideal to shield against neural tube defects, and how much is too much from a safety standpoint. Right now, experts recommend that young women in their childbearing years get about 400 micrograms per day of the nutrient, which is also found naturally in leafy green vegetables and citrus fruits.

The notion of an ideal folate dose remains controversial, said Dr. Michael Katz, senior vice-president for research and global programs at the March of Dimes. His organization, along with others, is advocating an increase in fortification levels.

According to Katz, there's been a decline in neural tube defects of about 45 percent in every country that has adopted a folic acid fortification program. That still falls well short of the 75 percent drop that experts had hoped to see, he said.

On the plus side, there's no danger of adverse effects from folate "at the levels currently used in the United States," Katz said.

"There has been absolutely no evidence that it has caused undesirable side effects," he said. "In areas where [fortification and consumption levels] are higher, such as Chile, the same obtains. So, we have absolutely no reason to believe that harm results."

Dr. Malika Shah, a neonatologist at Children's Memorial Hospital in Chicago, affirmed Katz's position, saying that women who have had one child with a neural tube defect now frequently are given "an incredible amount of folic acid, and we haven't seen any negative effects. It doesn't seem to have a downside."

One folate expert differed with those assessments, however. Initially, 4 milligrams daily was considered suitable, but a Hungarian study in the early 1990s found successful reductions in the occurrence of neural tube defects at a daily dose of only 0.8 milligrams, noted Dr. Tsunenobu Tamura, a professor of nutrition sciences at the University of Alabama, Birmingham.

"I don't think the 'more the better' idea is correct," he said. "We don't need to have more than enough. If we take too much, there is a kind of suggestive data trend in the research showing that we may promote cancer occurrence."