Past Questions of the Month

This page is a collection of past "Question of the Month" entries from the homepage of this website. If you would like further information about anything you read, please contact us.

Q. I’ve heard that some countries have mandatory fortification programs for unplanned pregnancies. What are the benefits of this and why do other countries avoid introducing the same program?

Many countries have implemented a mandatory fortification program, including Canada and America. This program was implemented in Canada in 1998 with the intention to lower the risk of NTDs among pregnant women. About 150 mcg of synthetic folic acid was added to 100 g of Canadian cereal grains and this initiative is estimated to provide women with 0.1-0.2 mg of folic acid per day, provided they eat cereal grains.

One potential reason for the avoidance of introducing this program might be the possible risks associated with vitamin B12 deficiency. It has been suggested that having higher folic acid levels in your blood masks evidence of a vitamin B12 deficiency, especially in regards to the elderly. However there have been no formal studies performed on this topic and there is no evidence to support this claim.

Since the introduction of this mandatory fortification program, there has been a 50% reduction in the presence of NTDs among pregnant women, with little evidence of a reduction in vitamin B12 levels. Additional vitamin B12 fortification may be a topic to be considered in the future.


Q. How should I store Folic Acid?

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.


Q. Vitamin bottle labels are heard to read, how do I make sure I am buying a multivitamin with enough folic acid?

You are right, labels can be tricky to read. First, remember that folic acid and folate are the same thing, so whichever name you see in the ingredients list is ok. Also remember that 0.4mg is the same as 400mcg. mcg stands for micrograms, and there are 1000 mcg in 1 mg. As long as the multivitamin label says it contains 0.4mg or 400mcg, you are going to get enough folic acid. Also, remember that you can always ask a pharmacist for advice; they are there to help and may know a little more about specific products or brands that you can look at to ensure you are getting what you need.

Q. I’m on birth control pills and I’m not planning on getting pregnant at the moment – why should I take folic acid?

Folic acid should still be taken even while taking birth control pills because it is known that birth control is not 100% effective. Birth control pills or other methods are not 100% effective in preventing pregnancy. Research shows that 42% of women who used birth control remembered to take their pill daily. This shows that accidents can occur and thus, it is important that folic acid is consumed even while on birth control in order to reduce the risk of neural tube defects in your baby.

Q.How do I get folic acid from my food?

Eat a lot of different vegetables, fruits and grains.

The foods that have the most folic acid are green, leafy vegetables, fruits and fortified grains like cereal and bread.

It is hard to get enough folic acid from food, so all women should take a multivitamin with folic acid every day.

Q. I’m on anti-seizure medications because I have epilepsy – how will this affect the amount of folic acid I need and why?

A: Anti-seizure medications such as phenytoin (Dilantin, Phenytek), carbamazepine (Tegretol, Tegretol XR Carbatrol), Valproic Acid, and Phenobarbital decrease the amount of folic acid that the body can absorb, which lowers the benefits of folic acid. Doctors can increase the amount of folic acid consumption up to 5 mg by prescription for women that are on anti-seizure medications, so that folic acid consumption can be beneficial.

It is recommended for all high-risk women to take a daily dose of 5mg of folic acid, at least 3 months before conception, and up until the end of the third trimester. Note that if you are on phenytoin (Dilantin or Phenytek), your doctor should monitor you by checking the level of phenytoin in your blood because the increased folic acid consumption may deplete the phenytoin levels. The risk of having seizures is higher when there are low blood levels of phenytoin in your body.


Q. How do I choose a multivitamin with folic acid?

A: Read the Label: Be sure the multivitamin has at least 400 mcg of folic acid. Women at risk (you, your child or a sibling has spina bifida) need at least 4,000 mcg of folic acid daily.

Avoid mega dose multivitamins

Name brands are not always better.

Avoid vitamins that contain extra ingredients like enzymes, herbs or amino acids: They cost more and are not better for your health.

Check the expiration date.


Q. By taking folic acid pills daily and eating folate-rich foods, is it 100% guaranteed that my baby will not be born with a neural tube defect?

A: It is not 100% guaranteed. Research shows that by taking 0.4 mg of folic acid daily in a multivitamin and eating folate-rich foods, you can decrease the chances of your baby being born with a neural tube defect by up to 70%.


Q: I am 23 years old and I heard that only older women who are trying to have a baby should take folic acid. Is this true?

A: False. All women of childbearing age should take a daily multivitamin with 0.4 mg of folic acid, along with increasing the amount of folate-rich foods in your diet, such as fortified grains, eggs, and spinach.


Q: I am clinically obese. How much folic acid should I take? Is it different from the regular recommended intake?

A: Yes, you are considered at high risk of having a baby with a defect of the brain and spine, called neural tube defects. It is recommended to take 4.0 mg of folic acid instead of 0.4 mg, which can be prescribed by your doctor, after consulting with them. You also need to eat folate-rich food, such as broccoli and fortified cereal.


Q: What's the best way to get the right amount of folic acid?

A: Before pregnancy, take a multivitamin that contains 400 micrograms (mcg) of folic acid every day. If women of childbearing age take 400 micrograms (0.4 mg) of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spin called neural tube defects (NTDs). Talk to your provider about taking a prenatal vitamin.


Q: I have insulin-dependent diabetes. How much folic acid should I take?

A:Some women, including those with insulin-dependent diabetes, have a higher risk of having a baby with a neural tube defect such as spina bifida. So, they need to take a daily multivitamin containing a larger dose of folic acid – 4.0 mg – after consulting with a doctor. They also need to eat folate-rich foods and take a higher dose of folic acid before and after conception. 


Q: What is "synthetic" folic acid?

A: Synthetic folic acid is the simple, man-made form of the B vitamin folate. Folic acid is found in most multivitamins and has been added in Canadian and in the U.S. to certain foods in order to enrich them; e.g., bread, pasta, rice and breakfast cereals. The terms “folic acid” and “synthetic folic acid” mean the same thing.

Q: Is it okay to just wait until I’m pregnant – or planning to get pregnant – to start taking folic acid?

A: Birth defects of the brain and spine (anencephaly and spina bifida) happen in the first few weeks of pregnancy; often before you find out you're pregnant. By the time you realize you’re pregnant, it might be too late to prevent those birth defects. Also, even if you intend to take a supplement containing folic acid 30 days before you plan to conceive, about half of all pregnancies are unplanned, so it may be too late. For these reasons, even if you aren’t planning a pregnancy anytime soon, it’s still important for you to get at least 0.4 mg of folic acid every day, or more if advised by your healthcare provider.


Q: I'm planning to get pregnant this month. Is it too late to start taking folic acid?

A: If you haven’t been taking folic acid, it doesn't necessarily mean that your baby will be born with birth defects. However, it’s recommended that women planning to get pregnant take a supplement containing 0.4 mg of folic acid every day, starting at least one month before getting pregnant and during the first trimester.

If you’re trying to get pregnant this month, or anytime soon, start taking 0.4 mg of folic acid right away to reduce the risk of neural tube defects.


Q: I already have a child with spina bifida. Should I do anything different to prepare for my next pregnancy?

A: Women who’ve had one pregnancy affected by a birth defect of the brain or spine may be at a higher risk for having another child with a neural tube disorder. You should talk to your healthcare provider about taking a higher dosage of folic acid – up to 4.0 mg each day – at least one month before getting pregnant and during your first trimester and do so only upon his or her medical advice. For more information, please see our section for High-Risk Women.


Q: Do I really need to take a folic acid supplement? Can’t I get enough folic acid by just eating a well-balanced and healthy diet?

A: It’s hard to eat a diet that has all the nutrients you need every day. Even with careful planning, you might not get all the vitamins you need from your diet alone. That’s why it’s important to take a vitamin with at least 0.4 mg of folic acid every day. Some foods are good sources of folic acid ; however, even if you track your daily consumption using a tool such as the VitaTrack Folate Tracker , you’ll likely find you’re not going to get enough folic acid to reduce the risk of neural tube defects without taking a supplement.


Q: I have trouble swallowing pills, so how can I make sure I get enough folic acid?

A: Some foods are good sources of folic acid. Check the labels on foods that have them, including breakfast cereals, to find out what percentage of the daily value (DV) of folate they contain. But remember that, even with careful planning, you might not get all the vitamins you need from your diet alone. The good news is that multivitamins containing folic acid now come in a variety of formats, including chewable tablets and liquids.


Q: How can I remember to take a vitamin with folic acid every day?

A: A simple way to remember is to take your vitamin at the same time every day, first thing in the morning or right before bed, for example. You can also try taking your vitamin when you brush your teeth, eat breakfast or lunch, finish your daily shower, or brush your hair. Leaving the vitamin bottle on the bathroom or kitchen counter in plain view can help you remember to take it, too. If you use a cell phone, you can program it to give you a daily reminder. If you have children, you can take your vitamin when they take theirs.


Q: Are there other health benefits of taking folic acid?

A: Folic acid may help prevent some other birth defects, such as cleft lip and palate and some heart abnormalities. Folic acid supplements may also be part of the recommended treatment for certain menstrual problems and leg ulcers, and there may be additional benefits – for both women and men. What’s more, folate deficiency may cause poor growth, graying hair, inflammation of the tongue (glossitis), mouth ulcers, peptic ulcer and diarrhea and/or result in hemolytic and megaloblastic anemias. Research is ongoing to confirm various health benefits. In the meantime, all adults should take 0.4 mg of folic acid every day.

Q: Is it better to take more than 0.4 mg of folic acid every day?

A: When taking supplements, more is not better. Women who can get pregnant (whether planning to or not) need just 0.4 mg of folic acid daily, and they can get this amount from vitamins or fortified foods. This is in addition to eating foods rich in folate. This amount may increase for high-risk women, whose healthcare providers may advise they take higher dosages for certain reasons.


Q: Can women get too much folic acid?

A: You can't get too much folic acid from foods that naturally contain it, but unless your doctor tells you otherwise, don’t consume more than 1 mg of folic acid a day. Consuming too much folic acid can hide signs that a person is lacking vitamin B12 (which can cause nerve damage), though lacking vitamin B12 is rare among women of childbearing age and most prenatal vitamins also contain B12 to help women get all they need. People at risk of not having enough vitamin B12 are mainly people 50 years and older and people who eat no animal products.


Q: What is folate and how is it different from folic acid?

A: Folate is a form of the B vitamin folic acid. Folate is found naturally in some foods, such as leafy, dark green vegetables, citrus fruits and juices, and beans. (For a longer list of food sources of folic acid, click here .) The body does’nt use folate as easily as folic acid. Currently, we can’t be sure that eating folate has the same benefits as consuming 0.4 mg of man-made (synthetic) folic acid each day. Women who can get pregnant should consume 0.4 mg of synthetic folic acid in addition to the natural food folate from a varied diet.


Q.I can’t swallow large pills. How can I take a vitamin with folic acid?

A. These days, multivitamins with folic acid come in chewable chocolate or fruit flavors, liquids, and large oval or smaller round pills. A single serving of many breakfast cereals also has the amount of folic acid that a woman needs each day. Check the label! Look for cereals that have 100% daily value (DV) of folic acid in a serving, which is 400 micrograms (mcg).