Courtesy of Elaine Magee

I remember equating the vitamin, “folic acid” or “folate” with “foliage” when studying for a nutrition exam in college. That’s how I could remind myself that dark green plants were one of the great sources for this particular vitamin. You’ll notice, particularly for grain products, that folate, often referred to as "folic acid," is one of the token vitamins/minerals often listed at the bottom of the nutrition information label (along with vitamin A, vitamin C, calcium, and iron)—with a certain percent of the Daily Value per serving. That’s because some grain products and cereals have been fortified with folate since 1998.

This fortification mandate took place mainly because of the research suggesting additional folate in the diet will help prevent neural tube birth defects, which occur in one of every 1,000 pregnancies. It makes sense that folate in the diet early on in pregnancy has this positive effect because folate is needed in the development of the neural tube that encloses the spinal cord. (The neural tube is formed in the first month of pregnancy.)

The good news is that the National Center for Health Statistics reported a 25% reduction in neural tube birth defects between 1995-2002 related to folate fortification. Folate fortification may also be contributing to a decrease in stroke and ischemic heart disease, according the American Heart Association. Interestingly, there has indeed been a noticeable reduction in stroke deaths per year in people over the age of 40 since folate fortification.

Folate relates to heart disease via its close relationship to four other B vitamins (B1, B2, B6, and B12). These four vitamins may help prevent the buildup of homocysteine in the blood and elevated homocysteine levels have been strongly correlated to an elevated risk of coronary heart disease/stroke. Studies have shown that as intakes of folate, B6, and B12 increase, levels of homocysteine in the blood tend to decrease.

And the favorable reports for folate continue. Korean researchers tracking the development of dementia in 518 people over age 65, from 2001 to 2003, discovered that the onset of dementia was significantly more likely in the people whose serum folate levels fell further over the two-year study period. In fact, the people who were folate deficient (as detected in blood tests) at the start of the study period, were almost 3.5 times more likely to develop dementia.

But there could be some concerns on the horizon for folate fortification. Some new research from the Women’s Health Study raises some questions about a possible link between higher blood levels of folate and a higher risk of premenopausal breast tumors that respond to estrogen or progesterone. While we all wait for additional research on the role of folate in breast cancer development, it makes sense for women who are past the pregnancy stage of their lives to limit their intake of highly folate-fortified food products (like cereals, some white pasta, and white rice), especially if they take a multivitamin that also contributes folate.

Don’t get me wrong, though, naturally occurring folate, which isn’t absorbed into the body as readily as folic acid in fortified foods, is still highly desirable. Most of us need the folate that we are getting from foods like oranges, vegetables, and beans.