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Folic acid might be losing its sheen


4 Star

Folic acid might be losing its sheen

Our Review Summary

 This story does a good job alerting readers to scientific debate about the benefits and harms of fortifying food with folic acid. It is a welcome contrast to stories that either adore or vilify vitamins.

The writer neatly lays out the historical points about supplementation of the grain supply in 1998, the benefits with regard to neural tube defect, and the newer concerns about colorectal and prostate cancer.  This is a nuanced discussion, and the reader comes away with a pretty good feeling for the problem at hand.

However, the story highlights the views of a single nutrition researcher in a way that blurs the distinction between his personal beliefs and the published evidence of potential links between folic acid fortification and certain cancers.

The story also fails to address apparent discrepancies between the cancer statistics quoted by the researcher (which seem to indicate colorectal cancer rates rose around the time folic acid fortification was introduced) and those published by the CDC (which highlight a decline in colorectal incidence over the years since fortification began.)


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

 The story includes one expert’s estimate of the cost of treating brain and spinal cord defects, but it does not discuss those costs may be affected by folic acid fortification or how the cost of fortification affects food prices. Though individuals don’t face a huge cost, the aggregate cost of fortification is substantial. The story could have mentioned this at least briefly.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


The story highlights the decline in birth defects that is attributed to folic acid supplementation. However, it does not include a source for the statement that “fortification with the vitamin prevents an estimated 2,000 to 3,000 brain and spinal cord defects in both countries.” By contrast, a CDC web page on folic acid supplementation states that each year in the U.S. “[a]n estimated 1,000 more babies are born healthy since fortification.”

Does the story adequately explain/quantify the harms of the intervention?


 The story performs a service by bringing attention to the complex and difficult balancing of benefits and harms that comes with decisions about adding supplements to food.

Does the story seem to grasp the quality of the evidence?


As mentioned above, the overall thrust of the story adequately captures the basic point that researchers are struggling to determine whether, what, and for whom folic acid supplementation may present potential harm. However, in some cases the comments of Dr. Mason portray a much stronger association between folic acid supplementation and cancer risk than even his own journal publications put forward. By intertwining the researcher’s personal statements with references to published trials and reviews, the story blurs the distinction between speculation and evidence.


Does the story commit disease-mongering?

Not Satisfactory

The story makes clear the complexity of and uncertainty surrounding possible associations between folic acid supplementation and cancer.

However, the story exaggerates what is known about potential cancer risk by highlighting comments supporting a potential link with folic acid supplementation, while failing to provide context or contrary information.

The story includes an estimate by Dr. Joel Mason that “excess folic acid consumption may cause an extra 15,000 cases of colorectal cancer each year in the U.S. and Canada.” But the story fails to define excess consumption, nor does it note that the are more than 160,000 new cases of colorectal cancer reported in the U.S. and Canada each year. And while the researcher may have told the reporter that he believes supplementation may be boosting cancer rates, a journal article Mason recently co-authored states that “Future studies need to explore whether a causal relationship exists between supraphysiological levels of folate intake and colorectal carcinogenesis.”

Also, while the story states that “researchers noticed that rates of colorectal cancer went up in North America around the same time that fortification began,” the reporter should have explained the apparent discrepancy with CDC statements that between 1998 (when mandatory folic acid supplementation began in the U.S.) and 2005 both colorectal cancer incidence and deaths declined.


Mason article:

Cancer stats:


Does the story use independent sources and identify conflicts of interest?


A story of this length on a subject that is hotly debated among nutrition researchers should include comments from more than one nutrition researcher. The story fails to note that according to a disclosure statement in one of his recent journal articles, Dr. Mason has been a paid consultant to Wyeth Consumer Healthcare, a manufacturer of multivitamins.


Disclosure statement with Joel B. Mason, Aaron Dickstein, Paul F. Jacques, Paul Haggarty, Jacob Selhub, Gerard Dallal, and Irwin H. Rosenberg

A Temporal Association between Folic Acid Fortification and an Increase in Colorectal Cancer Rates May Be Illuminating Important Biological Principles: A Hypothesis
Cancer Epidemiol. Biomarkers Prev. 2007 16: 1325-1329.

 However, because the story does touch on several aspects of the debate, we will give it the benefit of the doubt on this criterion even though we wish other sources had been named or that other nutrition experts had been quoted. 

Does the story compare the new approach with existing alternatives?


 The story points out the foods that are fortified with folic acid. However, there is no advice about how individuals could estimate their daily intake of folic acid or alter it, if they desired.

Does the story establish the availability of the treatment/test/product/procedure?


 The story points out that folic acid supplementation of flour has been required in the U.S. since 1998. It would have been helpful to also discuss whether and how consumers could reduce their intake of folic acid, if desired.

Does the story establish the true novelty of the approach?


 Questions about potential harms of folic acid supplementation are indeed a hot topic in nutrition research. However, most of the studies and other reports mentioned in this story were published more than two years ago, so the debate is not as new as the story implies.

Does the story appear to rely solely or largely on a news release?


Given the different aspects of the debate reflected in the story, we think it’s safe to assume this didn’t rely solely or largely on a news release – although we wonder why it relied so heavily on one nutrition expert’s perspectives.

Total Score: 8 of 10 Satisfactory


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