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.
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