Diet-NutritionFolic AcidInfantsPregnancy

Caution on folic acid food fortification

Folate depletion is associated with an increased risk of colorectal cancer.

But research from the University of Chile, in Santiago suggests, “A folate fortification program could be associated with an additional risk of colon cancer.”

First, the details.

  • Cancer and cardiovascular hospital discharge rates before folic acid fortification (1992-96) were compared to discharge rates after a program of flour fortification with folic acid was established in Chile (2001-04).

And, the results.

  • The rate of colorectal cancer was higher after folate fortification.
  • Cancer risk increased 162% in people aged 45 to 64 and 190% in people aged 65 to 79.

The bottom line?
Overall, the evidence links folate deficiency in early pregnancy to increased risk of neural tube defects (NTD) in infants — most commonly spina bifida and anencephaly.

And the US has experienced declines in spina bifida and anencephaly cases since starting a folic acid fortification program. It’s estimated that approximately 920 fewer infants are born with these serious defects each year.

Dr. Joel Mason, at Tufts University, in Boston cautions, there might be differences in the natural and pharmaceutical form of folic acid. He adds, “In select circumstances in which an individual who harbors a pre-cancerous or cancerous tumor consumes too much folic acid, the additional amounts of folate may instead facilitate the promotion of cancer.”

Of course the change in colon cancer risk might have nothing to do with folate. The researchers from Chile acknowledge that another possible explanation for the rise in colon cancer they report might be increased obesity.

The pros and cons in the debate to fortify foods such as wheat and corn flour with folic acid are summarized here.

4/22/09 11:30 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.