Anda di halaman 1dari 13

Vitamin B9 (Folic acid)

Overview:

Vitamin B9, also called folate or folic acid, is one of 8 B vitamins. All B vitamins help the body convert food (carbohydrates) into fuel (glucose), which is used to produce energy. These B vitamins, often referred to as B complex vitamins, also help the body use fats and protein. B complex vitamins are needed for healthy skin, hair, eyes, and liver. They also help the nervous system function properly. Folic acid is the synthetic form of B9, found in supplements and fortified foods, while folate occurs naturally in foods. All the B vitamins are water-soluble, meaning that the body does not store them. Folic acid is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body's genetic material, and is especially important when cells and tissues are growing rapidly, such as in infancy, adolescence, and pregnancy. Folic acid also works closely with vitamin B12 to help make red blood cells and help iron work properly in the body. Vitamin B9 works with vitamins B6 and B12 and other nutrients to control blood levels of the amino acid homocysteine. High levels of homocysteine are associated with heart disease. However, researchers aren't sure whether homocysteine is a cause of heart disease or just a marker that indicates someone may have heart disease. It' s fairly common to have low levels of folic acid. Alcoholism, inflammatory bowel disease, and celiac disease can cause folic acid deficiency. Also, certain medications may lower levels of folic acid in the body. Folic acid deficiency can cause poor growth, tongue inflammation, gingivitis, loss of appetite, shortness of breath, diarrhea, irritability, forgetfulness, and mental sluggishness. Pregnant women need more folic acid to lower the risk of neural tube birth defects, including cleft palate, spina bifida, and brain damage. Neural tube defects are birth defects caused by abnormal development of the neural tube, a structure that eventually gives rise to the brain and spinal cord. Since folic acid has been added to many grain foods in the U.S., such as bread and cereal, neural tube defects have decreased dramatically. Birth Defects

As mentioned, pregnant women who don' t get enough folic acid are more likely to have children with birth defects. Pregnant women should get 600 mcg of folic acid per day. Women who plan to become pregnant should make sure to get the recommended 400 mcg per day, since many neural tube defects can happen shortly after conception, before a woman even knows she is pregnant. Prenatal vitamins contain the needed amount of folic acid for pregnant women. Studies show that women who take folic acid supplements before conception and during the first trimester may reduce their risk of having children with neural tube defects by 72 - 100%. Folic acid may also help prevent miscarriage, although the evidence isn't clear. Heart Disease Folate may help protect the heart through several methods. First, there is some evidence that getting enough folic acid in your diet can reduce your risk of heart disease, although this evidence is based on population studies and not more definitive clinical trials. There is not yet any evidence that taking folic acid supplements would help. Also, many studies suggest that people with high levels of the amino acid homocysteine are roughly 1.7 times more likely to develop coronary artery disease and 2.5 times more likely to have a stroke than those with normal levels. B complex vitamins -- especially vitamins B9, B6, and B12 -- help lower homocysteine levels. However, so far there' s no evidence that high homocysteine levels actually cause heart disease. For most people who are concerned about heart disease, the goal should be getting enough B vitamins from healthy foods. In some cases, however, your doctor may recommend taking B vitamins to lower homocysteine levels. If you are worried about heart disease, ask your doctor whether taking a B vitamin supplement would be right for you. Age-related Hearing Loss One study suggests that folic acid supplements help slow the progression of age-related hearing loss in elderly people with high homocysteine levels and low folate in their diet. It isn't known whether healthy seniors would benefit. Age-Related Macular Degeneration

One large study found that women who took 2,500 mcg of folic acid along with 500 mg of vitamin B6 and 1,000 mcg of cyanocobalamin (vitamin B12) daily reduced their risk of developing AMD, an eye disease that can cause loss of vision. Depression The evidence about whether folic acid can help relieve depression is mixed. Some studies show that 15 - 38% of people with depression have low folate levels in their bodies, and those with very low levels tend to be the most depressed. And one study found that people who did not get better when taking antidepressants had low levels of folic acid. One double-blind, placebo-controlled study found that taking 500 mcg of folic acid daily helped the antidepressant Prozac work better in women, but maybe not men. But another study found that taking folic acid and vitamin B12 was no better than placebo in relieving depression in older people. Cancer Folic acid in the diet seems to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, cervical, pancreatic, and stomach. However, this evidence is based on population studies that show people who get enough folate in their diet have lower rates of these cancers. Researchers don' t know exactly how folate might help prevent cancer. Some think that folic acid keeps DNA healthy and prevents mutations that can lead to cancer. There is no evidence that taking folic acid supplements helps prevent cancer. The best course of action is to make sure you eat a balanced diet with enough folate, which will help protect you against a number of diseases. Low dietary intake of folate may increase the risk of developing breast cancer, particularly for women who drink alcohol. Regular use of alcohol -more than 1 to 2 glasses per day -- is associated with higher risk of breast cancer. One large study, involving over 50,000 women who were followed over time, suggests that adequate intake of folate may reduce the risk of breast cancer associated with alcohol.
Dietary Sources:

Rich sources of folate include spinach, dark leafy greens, asparagus, turnip, beets, and mustard greens, Brussels sprouts, lima beans, soybeans, beef liver, brewer's yeast, root vegetables, whole grains, wheat germ, bulgur wheat, kidney beans, white beans, lima beans, mung beans, salmon, orange

juice, avocado, and milk. In addition, all grain and cereal products in the U.S. are fortified with folic acid.
Available Forms:

Vitamin B9 is found in multivitamins, including children's chewable and liquid drops, and B complex vitamins, or is sold separately. It is a good idea to take folic acid as part of or along with a multivitamin because other B vitamins are needed for it to work. It is available in a variety of forms, including tablets, softgels, and lozenges.
How to Take It:

Most people (except pregnant women) should be able to get enough folic acid from their diet. Check with a knowledgeable health care provider before taking folic acid supplements or giving them to a child. Daily recommendations for dietary folic acid are listed below: Pediatric
y y y y y y

Infants 0 - 6 months: 65 mcg (adequate intake) Infants 7 - 12 months: 80 mcg (adequate intake) Children 1 - 3 years: 150 mcg (RDA) Children 4 - 8 years: 200 mcg (RDA) Children 9 - 13 years: 300 mcg (RDA) Teens 14 - 18 years: 400 mcg (RDA)

Adult
y y y

19 years and older: 400 mcg (RDA) Pregnant women: 600 mcg (RDA) Breastfeeding women: 500 mcg (RDA)

Amounts used in studies for heart disease range from 400 - 1,200 mcg. However, high levels of folate can hide a vitamin B12 deficiency, and should be taken only under a health care provider's supervision. If you are considering taking a folic acid supplement, ask your health care provider to help you determine the right dose for you.
Precautions:

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider. At the recommended daily allowance, side effects from folic acid are rare. Very high doses can cause stomach problems, sleep problems, skin reactions, and seizures. Talk to your doctor before taking more than 800 mcg of folic acid. Folic acid can hide the symptoms of an underlying vitamin B12 deficiency, which can cause permanent damage to the nervous system. Taking any one of the B vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, you may want to take a B complex vitamin, which includes all the B vitamins. People who are being treated for seizures or cancer should not take folic acid without talking to their doctors.
Possible Interactions:

If you are currently being treated with any of the following medications, you should not use folic acid supplements without first talking to your health care provider. Antibiotics, Tetracycline -- Folic acid should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Folic acid either alone or in combination with other B vitamins should be taken at different times from tetracycline. All vitamin B complex supplements act in this way and should be taken at different times from tetracycline. Phenytoin (Dilantin) -- Phenytoin, an anti-seizure medication, may lower levels of folate in the body. However, folic acid may interfere with the way phenytoin works, raising the risk of seizures. Ask your doctor before taking folic acid supplements. Pyrimethamine (Daraprim) -- Folic acid may make pyrimethamine, a drug used to prevent and treat malaria and to treat toxoplasmosis, less effective. Chemotherapy medications -- Folic acid may raise the amounts of 5fluorouracil and capecitabine (Xeloda) to dangerous levels in the body. If you are undergoing chemotherapy, ask your oncologist before taking any supplement or herb.

Drugs That Lower Levels of Folic Acid -- These drugs may interfere with the body's absorption of folate, and may mean you need to take a folic acid supplement. Talk to your doctor first.
y y y

y y y y y y y y

Antacids H2 blockers -- used to reduce stomach acid; include cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac) Proton pump inhibitors -- used to reduce stomach acid; include someprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), rabeprazole (Aciphex) Bile acid sequestrants -- used to lower cholesterol; include colestipol (Colestid), cholestyramine (Questran), and colsevelam (Welchol) Anti-seizure medications -- including phenobarbital, primidone (Mysoline), carbamazepine (Tegretol) Nonsteroidal anti-inflammatory drugs (NSAIDs) -- include ibuprofen (Advil, Motrin) and naproxed (Aleve) Sulfasalazine (Azulfidine) -- used to treat inflammatory bowel disease and rheumatoid arthritis Triamterene (Dyrenium) -- a diuretic (water pill) Cycloserine -- an antibiotic Pyrimethamine (Daraprim) -- used to prevent and treat malaria and to treat toxoplasmosis Trimethoprim -- an antibiotic used to treat urinary tract infections

When taken for long periods of time, these medications, as well as other anti-inflammatory medicines, can increase the body's need for folic acid. Methotrexate -- Methotrexate, a medication used to treat cancer, rheumatoid arthritis (RA), and psoriasis, reduces the amount of folic acid in the body. If you take methotrexate for RA or psoriasis, your doctor may prescribe a higher dose of folic acid, which helps reduce the side effects of methotrexate. People taking methotrexate for cancer, however, should not take folic acid supplements unless their doctor tells them to. Folic acid may interfere with methotrexate's effects on cancer.

Read more: http://www.umm.edu/altmed/articles/vitamin-b9000338.htm#ixzz1igoQdWAx

http://www.umm.edu/altmed/articles/vitamin-b9-000338.htm

B9 (Folic acid, Dihydrofolic acid, Folinic acid)


Vitamin B9 is commonly referred to as folic acid. Most individuals who have conceived are familiar with vitamin B9. Physicians often recommend vitamin B9 to females who are trying to conceive and who are pregnant. Studies have shown that vitamin B9 reduces the risks of birth defects in infants if consumed by the mother before and during pregnancy. Since neural tube development occurs during the first month, women should consume a considerable amount of folate during conception. Vitamin B9 is water soluble. The body utilizes folate to synthesize and repair DNA. Therefore, it plays a vital role in the cell division process. The vitamin also aids in the production of red blood cells and white blood cells. Vitamin B9 deficiencies may prompt a reduced production of white and red blood cells. A low blood cell count is referred to as anemia. Anemia manifests in the body as fatigue, weakness and inability to concentrate.

Recommended Daily Allowances


The recommended daily allowances for folic acid are 400 micrograms for men and women who are not pregnant or trying to conceive. Experts recommend 600 micrograms of folic acid for pregnant women.

Sources of Vitamin B9
While most pregnant mothers will receive folic acid through a supplement, individuals may also find vitamin B9 in a host of natural foods. Many experts recommend natural sources of vitamin B9 because it is easier for the body to absorb. Synthetic vitamins are more difficult to absorb.

Vitamin B9 is most commonly found in the following sources:


o o o o o o o o o o o o o o o o
Leafy Green Vegetables Spinach Asparagus Romaine Lettuce Dried or Fresh Beans Peas Beer Pasta Cereal Bread Sunflower Seeds range Juice Pineapple Juice Cantaloupe Honeydew melon Grapefruit Juice

o o o o o o o o o o o o

Banana Raspberry Grapefruit Strawberry Beets Broccoli Corn Tomato Juice Bok Choy Liver Bakers Yeast Dried Cereals

History of the Vitamin


Scientists, in the early 1900s, noticed that a deficiency of folate presented itself in the form of anemia. Dr. Lucy Wills demonstrated that anemia could be alleviated through the consumption of brewers yeast. She sought to prove this finding to eliminate anemia during pregnancy. In the 1940s, folate was isolated and extracted from spinach leaves. In the mid 1940s, folate was isolated in crystal form by scientist, Bob Stokstad, under the supervision of Dr. Yellapragada Subbarao. This research occurred at the Lederley Lab in Pearl River, NY. This research later led to the production of the anti-cancer drug known as antifolate Aminopterin. This research was conducted under the guidance of Dr. S. Farber in 1948. Scientists discovered the role of folate in neural tube development in the 1960s. In the 1990s, scientists pushed for inclusion of the vitamins in foods to assist individuals in meeting their daily allowances for defects. They accomplished this goal through the folic acid fortification program. Most of the fortification in the United States and other countries occurred through breads and cereals.

Health Benefits
o o o o o
Vitamin B9 plays a significant role in the neural tube development of an unborn fetus. The neural tube forms during the first 4 to 6 weeks of pregnancy. Pregnant mothers are recommended to consume between 600 to 800 micrograms to avoid neural damage and birth defects. Studies have shown that a diet consisting of 5 to 27 micrograms of folic acid per week will assist in the fight against rheumatoid arthritis. Patients suffering from diabetes mellitus typically have lower levels of folic acid present in the blood. These individuals may also benefit from folic acid supplements or foods fortified with folic acid. Folic acid may prove beneficial in fighting some cancers. Studies have shown benefits of folic acid in fighting colorectal cancers and breast cancers. The findings are inconclusive. More studies must be conducted to prove the findings conclusively. Vitamin B9 is also beneficial in fighting certain heart disease. Folic acid has been known to lower homocysteine levels. Elevated homocysteine levels indicate low vitamin B9 levels. Elevated levels may encourage blood cells to stick together and form clots. A blocked artery may cause a heart attack or stroke.

Ailments from Vitamin B9 Deficiencies


Several problems may occur if the body does not receive the daily allowance of vitamin B9. Deficiencies in Vitamin B9 can lead to the following health problems:

Birth Defects
Pregnant women who do not consume between 600 and 800 micrograms of folic acid per day put their unborn fetus at risk for improper development of the brain, skull, and spinal cord. Risk also increases for low infant birth rate, retardation of fetal growth, and pre-term delivery.

Additionally, when homocysteine levels rise in the blood due to low folate levels, pregnant women are more at risk for spontaneous abortion, placental abruption and preeclampsia. During the first four weeks of pregnancy, most women do not even realize that they are pregnant. Therefore, it is important to maintain a diet rich in folate if there is a possibility of conception. Neural tube defects will ultimately manifest as a spine defect in an infant. Spine defects are often referred to as spina bifida. Brain defects may also occur. The brain defects are referred to as anencephaly. Folic acid supplements also have been shown to reduce the risk of cleft lip, limb defects, urinary tract anomalies, and congenital heart defects. Women who take folic acid supplements reduce the risk of birth defects by 3.9 times. Alternatively, a recent study by University of Adelaide showed that pregnant mothers who consumed excessive amounts of folic acid during the last trimester of pregnancy may increase the chances of the child developing childhood asthma by 30 percent.

Cancer
A deficiency in Vitamin B9 may lead to problems during DNA synthesis. These problems may cause the DNA to accelerate the growth of cancerous cells instead of normal cells. Colon cancer or colorectal cancer is most often associated with folate intake. Folic acid intake appears to decrease the development of colorectal cancer. Folate accelerated prostate cancer by 67 percent in those individuals who had a progressive case of cancer. These findings were a result of a European study with 520,000 men participating. Another study showed that 1 mg of folic acid was found to increase the risks associated with prostate cancer. Scientists speculate that this phenomenon occurred because of folic acids role in nucleotide synthesis and promotion of cell growth and division. When cancer is present, folic acid may promote the division and growth of those cells as well. Folate receptors increase during cancer. Folic acid also plays a role in DNA methylation in cancer development. Folic acid deficiency inhibits the production of cytosine methylation in DNA. When the production ceases, proto-oncogenes become active and malignant cells begin to form in the body and more specifically, the prostate. The entire process increases the risk for cancer. More studies should be conducted before these findings are conclusive. Other studies show that diets high in folate also increased the risk for leukemia in children. More studies should be conducted to conclusively prove this finding. The findings for the effects of folic acid intake on breast cancer reduction are inconclusive. One Swedish study suggests that diets high in folate result in a decreased development of breast cancer. Other studies refute this finding. More studies must be conducted to prove the findings conclusively.

Heart Disease
Studies indicate that homocysteine levels are an indicator or risk factor of heart disease. Experts speculate that high levels of homocysteine may damage arteries or form blood clots that contribute to heart related problems. The data is not conclusive that vitamin B9 will lower homocysteine production and thus, reduce the risk of heart disease. However, the risks of heart disease decreased by 15 percent since the new folate regulations were introduced in the 1990s. Scientists estimate that 13,500 coronary-related deaths are associated with folate deficiencies.

Folate Deficiencies
Deficiencies in folic acid may lead to diarrhea, confusion, anemia, depression, and glossitis. Scientists suggest that increase homocysteine levels may indicate an anemia or decreased folic acid consumption. Individuals who have problems absorbing the vitamin may choose to take a supplement to replenish the presence of vitamin B9 in the body. Patients with celiac disease often have a problem with absorption and may develop a folate deficiency. Obese people who have a Body Mass Index (BMI) of 50 or more may also develop a folate deficiency.

Elderly Population

The results from studies regarding elderly populations and folic acid are mixed. One major concern is the ability of the vitamin B9 to mask a deficiency in vitamin B12 levels. Experts recommend consuming vitamin B9 in conjunction with vitamin B12 to avoid such masking issues. In a study of 747 elderly subjects, experts found that vitamin B9 reduced the risk of heart disease and lowered the homocysteine levels. Each of the subjects consumed 140 micrograms of folic acid per 100 grams of grain product. The subjects ranged in age from 67 to 96. Because of this study and similar studies, Canada fortifies its food supply with 150 micrograms of folic acid per 100 grams of grain. Much of their elderly population also consumes 400 micrograms. Experts recommend not consuming over the Recommended Daily Allowance (RDA).

Folic Acid Supplements and Vitamin B12 Masking


Experts are often concerned about the consumption of vitamin B9 without vitamin B12. The concern arises because vitamin B9 can alleviate anemia symptoms that are a result of a vitamin B12 deficiency. However, vitamin B9 does not address the deficiencies in the nervous system that result from a vitamin B12 deficiency. Experts grow concerned because although the patient may feel better after taking folic acid, they still may experience nerve damage from a vitamin B12 deficiency. Patients should not exceed 1000 micrograms or 1 mg of folic acid per day to avoid masking the symptoms associated with a vitamin B12 deficiency. Canadian studies show that no conclusive evidence indicates that high folic acid levels mask vitamin B9. However, more studies must be conducted to determine the effectiveness. In the elderly population, studies have shown that high folic acid levels in conjunction with low vitamin B12 levels promoted significant cognitive impairment. The elderly should consult with a physician prior to beginning a vitamin B9 or B12 regimen.

Bone Health
Elevated homocysteine levels related to a folic acid deficiency may lead to osteoporosis, reduction in Bone Mass Density (BMD) and bone fractures. The results are not conclusive and more studies must be done to prove the findings conclusively.

Menopause
Postmenopausal women who consume folic acid supplements may find relief from related symptoms, such as hot flashes. Folic acid is thought to interact with neurotransmitters in the brain, specifically norepinephrine and serotonin, to reduce the effects of hot flashes.

Infectious Disease
Folic acid deficiencies are linked to Plasmodium flaciparum malaria. This type of malaria is linked to anemia. Areas where malaria is endemic, such as Columbia, could benefit from folic acid consumption.

Depression
Some studies link folic acid to a reduction in depression. Studies are not conclusive. More data must be collected to prove this assumption.

Memory
In a study of over 800 people, scientists measured short term memory, mental agility and verbal fluency. During this study, scientists found improved concentration and memory in those individuals over the age of 50 who consumed 800 micrograms or more of folic acid daily. Folic acid is important for cells to divide. Cancer cells divide rapidly. Those who want to curb cancer growth should not consume high amounts of folic acid.

Obesity

Obese patients who consume folic acid may increase the presence of lipolysis in adipocytes. This process may prevent obesity and Type 2 diabetes. Folic acid may also play a role in lowering the accumulation of cholesterol in the liver and in the blood by increasing bile production.

Stroke
Studies have shown that patients at risk for a stroke have decreased their chances of having a stroke by consuming folic acid. Experts found that a folic acid supplement of 5 micrograms per day significantly reduced pulse pressure. Pulse pressure is an indicator of stroke risk.

Parkinsons Disease
Patients suffering from Parkinsons disease may benefit from a folic acid supplement. Studies have shown that folic acid lowers homocysteine levels. Elevated homocysteine levels contribute to bone loss and a host of other problems. Additionally, patients suffering from Parkinsons disease may take a drug known as levodopa. Levodopa is a psychoactive drug taken to treat Parkinsons disease. The drug may also decrease Bone Mass Density (BMD). Experts have cited improvements in femur bones and lumbar spine as a result of increased Vitamin B9 intake.

Renal Disease
Folic acid supplements have been found to reduce the risk of developing renal diseases in children. Microalbuminuria is a common childhood renal disease associated with a folic acid deficiency.

Macular Degeneration
Several studies have been conducted and documented in a journal article entitled, Womens Antioxident and Folic Acid Cardiovascular Study regarding folic acid and the developmental risks of age-related macular degeneration. These studies found that patients who consumed a folic acid supplement, along with pyridoxine and cyanocobalmin, reduced their risk of developing macular degeneration by 34 percent.

Antifolates
Experts recommend folic acid to promote cell growth and division. Cancer cells characteristically grow fast and divide rapidly. Cancer patients are given drugs to counteract folate metabolism. Antifolate methotrexate is a drug used to treat cancer. It is given to the patient to inhibit the production of the active for of THF from dihydrofolate. Methotrexate may become toxic to a persons body and produce undesirable side effects. Some of the most common side effects include inflammation of the colon, bone marrow depression and renal failure. Inflammation of the colon often makes it difficult to eat properly. While antifolates are designed to eliminate cancer dividing cells, folate intake will not counteract the drug. The folate supplement will be depleted rapidly by the cancerous cells. Methotrexate is used to treat lupus, rheumatoid arthritis, schleroderma, psoriasis, sarcoidosis, asthma, polymyositis, and inflammatory bowel disease.

Precautions when taking Vitamin B9


Consuming excessive amounts of folic acid daily may pose some serious side effects. The Recommended Daily Allowance (RDA) is 400 micrograms per day for non-pregnant individuals. Pregnant women should consume between 600 and 800 micrograms per day. An excessive amount translates between 5,000 to 10,000 micrograms per day. Consuming excessive amounts of B9 may mask a B12 deficiency. For this reason, some experts suggest consuming vitamin B12 in conjunction with vitamin B9. In 2007, scientists proved that vitamin B9 in excess makes the effects of a vitamin B12 deficiency worse by inhibiting its absorption rates. The excessive consumption may lead to nerve damage. These instances are rare. In most cases, the side effects are minimal. Consult a physician or go to an emergency room if the patient experiences negative side effects.

Vitamin B9 is water soluble; therefore, the vitamin is regularly excreted from the body through urine. Some research also suggests that folic acid consumed in excess may also interfere with anti-malarial treatments.

Allergic Reactions
Some individuals experience allergic reactions from folic acid intake. Individuals who are prone to allergic reactions should consult their physician prior to consuming folic acid.

Some of the symptoms may include the following:


o o o o o
Breathing difficulties Rash Itching Swelling Dizziness Individuals who experience these symptoms should seek the guidance of a physician if the problems become severe. One study involving 8083 subjects found that atopy, wheezing, and asthma were related to the dosage levels given to the patients. Folic acid taken after in vitro fertilization may improve chances of producing twins.

Role in Biological Processes


Biologically, the folic acid process in the body begins by forming tetrahydrofolate from folate. Folate reduces to dihydrofolate, which then forms tetrahydrofolate (THF). This process is catalyzed by dihydrofolate reductase. NADPH also assists in the synthesis. Methylene-Tetrahydrofolate (CH2FH4) is formed from THF by adding a methylene from a carbon donor. The carbon donor may be serine, glycine or formaldehyde. Vitamin B12 is the only acceptor of methyl-THF. Additionally, homocysteine is the only acceptor for methyl-B12. Since Vitamin B12 defiencies are often masked by vitamin B9, it is important to understand how homocysteine plays a role in the biological process of these vitamins.

Folic Acid Use Around the World

Australia
Australia and New Zealand have decided to fortify foods with folic acid. Folic acid has been included in the flour since 2009. The Food Standards Australia New Zealand regulates the process. The countries have agreed to add 0.135 mg of folic acid per 100 g of bread. The two countries debated over its inclusion before adding the beneficial vitamin.

Canada
Canada has fortified their food supply since 1998 with a synthetic form of folic acid called pteroylmonoglutamate. Canada includes 150 micrograms of folic acid per 100 grams of enriched flour or cereal. In 2003, the University of Toronto released a study indicating that the fortification movement has dramatically decrease neuroblastoma and congenital heart defects. After a study conducted by McGill University in 2009, experts noticed a 6.2 percent decrease per year in infants born with congenital heart defects.

New Zealand
Though New Zealand and Australia agreed jointly to include folic acid in a fortification plan in 2009, the country has since decided to wait until more research is conducted. New Zealand is against fortification citing it as mass medication. The country is afraid of overconsumption of folic acid and its effects.

United Kingdom
The United Kingdom is currently debating the inclusion of folic acid in bread and flour. The Food Standards Agency recommended the fortification, but the inclusion has not been mandated to date.

United States
According to the Center for Disease Control in Atlanta, GA, the number of neural tube defects has decrease 25 percent since the mandatory introduction of folic acid into the diet. Because the results remain positive, the United States Public Health Service is urging people to consume an extra 0.4 mg per day in supplement form. Since most of pregnancies are unplanned, this will reduce the risk of defects in infants.