What do you do when the data from studies contradict each other? Let's tackle that question later and start by examining a recent example.
Health Sentinel reported on recent research that found the rate of spina bifida and anencephaly birth defects has fallen by more than one-third since the addition of folic acid to the nation's enriched flours, rice and pastas in 1998.
Good news, isn't it?
But wait - research published in the American Journal of Clinical Nutrition back in November 2003 found that higher rates of spina bifida and neural tube defects in infants whose mothers consumed higher levels of sugar and the highly refined carbohydrates found in potatoes, white bread and rice and many popular breakfast cereals. It is noteworthy that white bread, pasta and breakfast cereals in the United States are fortified with folic acid.
So what gives?
Well, apparently the glycemic load in the diet is as important as the level of folic acid or folate one ingests. In the recent study, the review was on overall incidence of neural tube defects, which have decreased. The earlier study specifically reviewed dietary habits of mothers who had a baby born with a neural tube defect and found those women ate a diet higher in sugars, refined foods and starchy selections. So each study approached the importance of folic acid from a different perspective and thus reached different conclusions.
The earlier study is very important - it underscores the importance of the overall diet a woman eats while she is pregnant...it is not enough to just eat foods fortified with folic acid, one must eat a nutrient-dense diet that is has few, if any, highly refined foods, even when those foods are fortified.
While the more recent data is being used to push for higher levels of fortification, it does not address the reality that the overall diet in America is poor. Adding higher levels of nutrients in the fortification process may sound like a solution but fails to address the real problem - poor dietary habits that include low intake of leafy green vegetables, legumes and other nutrient-rich non-strachy vegetables that provide excellent sources of folate naturally.
I was a bit shocked by the Heath Sentinel's sentence The natural form of the vitamin is found in green leafy vegetables, whole grains and citrus fruits, although it is less easily absorbed by the body.
Before fortification, how exactly did women get folate? Hello! They ate vegetables, whole grains and fruits - as part of their daily diet and did not depend on supplements or fortified foods! Have we actually forgotten that real food provides all the nutrients our bodies need if we eat a nutrient-dense diet?
While I understand that something must be done to prevent neural tube defects, and that folic acid is known to reduce the risk, I recognize we have a real problem when the solution offered up is more fortification and not education about eating right.
Which brings me back to my original question - what do you do when the data seems to conflict? You review more evidence and then bring the pieces together to form a more complete picture to make a decision. In this case, there is ample evidence to suggest that pregnant women must adjust their diet to include more whole foods and pass on the highly processed foods during the pregnancy.
Pregnant women must be told, in no uncertain terms, that what they eat while they are pregnant has a significant effect on the outcome of the pregnancy and strongly encouraged to eat a nutrient-rich diet filled with real, whole foods. Hey, it's only nine months of giving up the soda, cakes, cookies, french fries and other highly processed foods - a "sacrifice" that may have a lasting lifetime impact on the health of the child. Now isn't that worth it? Who knows, after the baby is born, mom may even find she prefers eating a better diet and will continue with it for years to come too!