Folic Acid May Reduce Risk of Autism Spectrum Disorders

Another Reason to Include Fortified Wheat Foods:  Folic Acid May Reduce Risk of Autism Spectrum Disorders

by Michele Tuttle, MPH, RD

While the complex carbs in bread, rice, and other grain-based foods are known for providing essential fuel the body needs, here’s a new reason for women of childbearing age to make sure they are getting plenty of nutritious enriched grains – they are fortified with folic acid which may reduce the risk of autism spectrum disorders (ASD). A study of more than 85,000 children born in Norway between 2002 and 2008 indicates that folic acid supplementation four weeks before conception to eight weeks post-conception lowers the risk of the most severe types of ASD by 40%.  The women studied took folic acid supplements; Norway does not have a mandatory program of folic acid fortification of food products.  In 1998, the US began fortifying enriched flours, breads, rolls, buns, farina, rice, pasta and noodle products with folic acid after studies revealed that supplementation may reduce the risk of neural tube defects such as spina bifida by up to 70%.  (A small percentage of corn grits and cornmeal products are enriched but those that are must be fortified with folic acid). Approximately 1 in 3,000 children are born with a neural tube defect. Now it appears likely that folic acid may impact much more than just neural tube defects.  In 2008, nearly 1 in 88 children were born with ASD, a 78% increase since 2002.

 In the US, the fortification level is 0.7 mg folic acid per pound of flour, with enriched grains being the primary source of folic acid in Americans' diets. At this level, a slice of enriched bread will contain 37 μg and a half-cup of cooked pasta will have 60 μg. If consumers ate at least six ounces from the bread and grains group daily, this would enable them to reach the Daily Recommended Intake of 400 μg. For example, three ounces of bread (bagels, tortillas, English muffins, etc.) would total 81 μg; a cup of pasta, 120 μg; and a fortified breakfast cereal with at least 200 μg would fulfill the requirement for women of childbearing age.

The Centers for Disease Control and Prevention (CDC) named folic acid fortification of enriched grain products as one of the top 10 public health achievements in the first decade of 21st century, in recognition of its contribution to a remarkable 36% drop in neural tube defects from 1996-2006.

Folate, the form of folic acid that occurs naturally in foods, is found in whole wheat, dark leafy greens and beans (e.g., lentils, pinto beans).  The chart below shows the dietary folate equivalents of common foods. 

The bottom line:  its very, very important that all women of childbearing age consume folic acid or folate every day either through foods or supplements whether they are planning to become pregnant or not (up to 50% of pregnancies in the US are unplanned).

References:

Dietary Folate Equivalents of Common Foods

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