Obviously, one ingredient missing from gluten free bread is the
gluten. But there's something else that
might be missing too - folic acid.
Folic acid is the synthetic form of folate, an essential B vitamin.[1] Inadequate folate intake can result in a particular type
of anemia, increased blood homocysteine levels (associated with increased risk
of heart disease), and - especially important to women in their child-bearing
years - increased risk of neural tube defects (NTDs) in newborns.[1] The U.S. RDA for adults is 400mcg, and
increases to 600mcg for women who are pregnant.[2]
Since 1998, folic acid fortification of "enriched
cereal-grains" has been mandatory in the US.[3],[4] The impetus of folate fortification was a
desire to "increase the folate intake of women of childbearing age to
assist them in reducing their risk of having a NTD-affected pregnancy."[3],[4] 61 Federal Register 151 (5 Mar. 1996), pp. 8782.
As a result, many products made from
refined grains, including flours, breads, crackers, pastas, and cereals, contain
added folic acid.[5]
But why fortification, as opposed to supplementation?
NTDs are defects in the brain, spine, and/or spinal cord.[4],[6] A fetus's brain, spine, and spinal cord develop
in the first few weeks of pregnancy, before most women are aware they are
pregnant.[4],[6] So by the time a pregnant
woman first sees her doctor to confirm her pregnancy, the NTD ship has
sailed. As stated in the regulations
regarding fortification,
"[f]ood
fortification...has the advantage of reaching a great number of women
in the
target population before conception and during early pregnancy. It also has the
advantage of providing folic
acid in a continuous and passive manner and, thus,
represents a potentially
effective means for improving the folate nutriture
of women throughout their childbearing
years."[4]
61 Federal Register 151 (5 Mar. 1996), pp. 8782.
Relying on supplementation to meet the same goal would
require significant educational efforts and could be prohibitively expensive for
some women.
So back to that missing ingredient. If you check out the ingredient list to that
gluten free bread in your pantry or freezer, you probably won't see folic
acid. Why? Because most gluten free products aren't
required to be fortified. This article
provides a fairly concise explanation as to why (so you don't need to resort to
reading the fortification regulations).
I took a quick survey of the gluten-free foods in my pantry,
and none (including bread, two brands each of crackers and pasta, corn
tortillas, and breadcrumbs) was folic acid fortified. In fact, the only folic acid fortified product
I've purchased in recent memory was white rice, which I typically eschew in
favor of whole grain brown rice.
Granted, folate is naturally present in foods other than fortified
breads and pastas, including leafy greens, fruits and fruit juices, nuts,
beans, grains, dairy, meat, seafood, and poultry.[1] Unfortunately, folate is less available to
our bodies than folic acid,[1] so just loading up on kale chips may not be
enough. In fact, a recent study by researchers
at Columbia University's Celiac Disease Center found that a group of patients following
a gluten free diet had significantly lower blood folate levels than a
comparison group.[7] The study focused on patients who did not have celiac disease,[7] which implies that the lowered folate levels were not the result of celiac disease's characteristic intestinal villi damage and, therefore, more likely tied to diet.
Whatever your personal stance on fortification (there are
those who advocate for less processing of our food, even when that processing involves
adding back nutrients), those of us in our child-bearing years would do well to
think about - and maybe talk to our doctors or dietitians about - whether we're
getting sufficient folate in our gluten free diets.
For more information about:
Folate generally, see
RDAs for folate, see
NTDs and Spina Bifida, and the link to folate, see
History of Folate Fortification in the U.S., see
Final Rule requiring folic acid fortification, see
