Written by Greg Arnold, DC, CSCS. Non-pregnant Singaporean women who supplemented with fortified milk containing 400 mcg of folic acid for 2 weeks, significantly improved their levels of folate, vitamin D and vitamin B12.
In the United States, 3% of all babies (1 in every 33 babies) are born with a birth defect, yet they account for 20% of all infant deaths 1. Among the birth defects in the U.S., nearly 1,500 babies every year are born with spina bifida, a neural tube defect (when the spinal cord doesn’t completely close before birth).
Neural tube defects are a tremendous economic, social, and emotional cost to society, with a lifetime cost of $768,000 2. In the 1990’s, the U.S. Food and Drug Administration mandated folic acid fortification of milk and cereal products 3 which led to a 36% decrease in neural tube defects 4 and now saves an estimated $995 million each year in healthcare and family costs 2.
However, fortification programs have not been instituted across the world, including several countries in Asia. Eight countries in Southeast Asia (India, Sri Lanka, Thailand, Nepal, Indonesia, Bangladesh, Myanmar, and Bhutan) rank among those with the highest levels of birth defects 5, one of the most common of which is neural tube defects 6. A possible reason for the high rate of neural tube defects may be the poor digestion and intolerance of milk products among Asian populations 7 which “may be affecting the acceptance and consumption of these fortified milks in this population” 6.
Research in Singapore, however, suggests that milk supplementation may indeed be a way for Asian countries to increase their folic acid blood levels. A 2016 double-blinded placebo-controlled study 8, involved 70 non-pregnant women aged 21 to 35. They received either fortified milk powder providing 400 micrograms of folic acid (given as a 37.5-gram powder dose in 200 milliliters of water twice daily) or a placebo powder for 12 weeks. Blood samples were obtained before and after the study.
After 12 weeks, the following results were noted in the two groups:
| Folic Acid Powder | Placebo | p-value | |
|---|---|---|---|
| Folic acid blood levels (nanmoles/Liter) | 167% increase (27 to72) | 13.3% increase (30 to 34) | < 0.001 |
| Vitamin D blood levels (nmol/L) | 13% increase (46 to 52) | 2.1% increase (47 to 48) | < 0.001 |
| B-12 blood levels (nmol/L) | 20.8% increase (393 to 475) | 9.7% increase (337 to 370) | 0.01 |
What’s more, the milk powder was “well tolerated, did not increase body weight, and is effective at increasing [folic acid blood concentration] in Singaporean women to optimal levels by 12 weeks.” For the researchers, “we have shown that Singaporean women tolerated and complied with fortified milk in the ration of 75 grams of milk powder daily as 37.5 g powder in 200 ml water twice daily”, and that the fortified milk “also improved vitamin D and B-12 status in women”, though “consideration should be given to further increasing the amount of vitamin D in fortified milk.”
Source: Cheong, Magdalin, Huang Ying Xiao, Vicky Tay, Crystal D. Karakochuk, Yazheng Amy Liu, Sarah Harvey, Yvonne Lamers, Lisa A. Houghton, David D. Kitts, and Tim J. Green. “Folic acid fortified milk increases blood folate to concentrations associated with a very low risk of neural tube defects in Singaporean women of childbearing age.” Asia Pacific journal of clinical nutrition 25, no. 1 (2016): 62-70.
Posted October 31, 2016.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com.
References:
- CDC. Birth Defects: Data and Statistics. 2016; https://www.cdc.gov/ncbddd/birthdefects/data.html.
- Grosse SD, Berry RJ, Mick Tilford J, Kucik JE, Waitzman NJ. Retrospective Assessment of Cost Savings From Prevention: Folic Acid Fortification and Spina Bifida in the U.S. Am J Prev Med. 2016;50(5 Suppl 1):S74-s80.
- FDA. Food Standards: Amendment of Standards of Identity for Enriched Grain Products to Require Addition of Folic Acid. 1996; Food Standards: Amendment of Standards of Identity for Enriched Grain Products to Require Addition of Folic Acid; Correction.
- CDC. CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification. 2010; https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5931a2.htm.
- Thong-Ngam D, Suwangool P, Prempracha J, Tangkijvanich P, Vivatvekin B, Sriratanabun A. Lactose intolerance and intestinal villi morphology in Thai people. J Med Assoc Thai. 2001;84(8):1090-1096.
- Al-Sanae H, Saldanha W, Sugathan TN, Majid Molla A. Comparison of lactose intolerance in healthy Kuwaiti and Asian volunteers. Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2003;12(3):160-163.
- Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. The American journal of clinical nutrition. 1988;48(4):1142-1159.
- Cheong M, Xiao HY, Tay V, et al. Folic acid fortified milk increases blood folate to concentrations associated with a very low risk of neural tube defects in Singaporean women of childbearing age. Asia Pacific journal of clinical nutrition. 2016;25(1):62-70.
