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Research during the last 5 years has made it clear that people who do not take folic acid supplements are at increased risk for functional folate deficiency, which has been proven to cause spina bifida and anencephaly and also has been associated with a n increased risk for occlusive cardiovascular disease. The overriding folate policy issue is how to increase dramatically the folate consumption of 75% of the population who are not now consuming 0.4 mg of folic acid in a supplement. The most expeditious way to increase consumption is through fortification of a food staple. Public health programs are also needed to educate people about the vital importance of increased consumption of folic acid vitamin supplements and of foods rich in natural folates. It is urgent that fortification of cereal-grain products be implemented now. The level proposed by FDA would accomplish some prevention, but much more prevention would occur if the fortification were 2.5 times that level. Fortification at the higher level would prevent about 1000 spina bifida and anencephaly birth defects each year and perhaps as many as 50,000 premature deaths each year from coronary disease. Available data have not demonstrated that increasing consumption of folic acid by 0.1 to 0.25 mg of folic acid a day is harmful. If a policy needs to be established on the assumption that people who take vitamin supplements could be harmed, a good policy option is available: require that all folic acid vitamin supplements also contain 0.4 mg of vitamin B-12. INDEXING KEY WORDS: * folic acid * spina bifida prevention * neural tube defects * homocyst(e)ine * food fortification

The use of supplemental folic acid is urged to reduce the incidence of spina bifida and anencephaly. Folic acid vitamin supplements or food fortification can prevent at least half of the cases of these types of birth defects. The optimum public health strategy appears to be food fortification, but it should equal at least double the average red cell folate level in women, which is an extra 0.4 mg of folic acid daily. Total folic acid consumption among women of reproductive age should not exceed 1.0 mg daily because it could mask a vitamin B12 deficiency. This deficiency needs to be detected and treated in pregnancy to avoid possible neurological damage to the baby. Consumption of adequate folic acid is important for everyone. A folic acid deficiency also can cause occlusive cardiovascular disease.