Turning flour mills into birth-defect prevention factories / Paige P. Parvin 96G
Godfrey Oakley remembers the precise moment he realized that ordinary flour could be turned into magic powder.
Oakley and his colleagues at the Centers for Disease Control and Prevention (CDC) had suspected for some time that folic acid could be the key to preventing spina bifida, a birth defect that damages the spine and causes paralysis. They were on the brink of conducting a randomized trial in China when, on June 24, 1991, at five o’clock in the evening, a telephone call came from a fellow researcher in the United Kingdom.
Studies done there had confirmed that women who took four hundred micrograms of folic acid daily before and during pregnancy showed a dramatic reduction in normal rates of spina bifida. The evidence was so conclusive there was little need for additional study.
“I knew when that telephone call came it was as if someone had handed me the polio vaccine in 1953,” Oakley says. “I knew it would prevent a problem that was as big as polio.”
Since that moment, Oakley, professor of epidemiology at Rollins School of Public Health, has been dedicated to ensuring that all large flour mills add folic acid and iron to their flour. Folic acid occurs naturally in foods such as citrus fruits and dark green leafy vegetables, but women who are pregnant or might become pregnant need more than food can offer; enriched flour provides a much-needed supplement. Women also are encouraged to take prenatal vitamins.
In response to a campaign by the CDC and the March of Dimes, the United States Public Health Service in 1992 recommended that all flour processed in U.S. mills be fortified; in 1996, the Food and Drug Administration issued regulations requiring folic acid fortification, and the program was implemented in the U.S. by 1998. But the rest of the world has been slower to catch on.
Oakley finds this especially frustrating because, he says, enriching flour with folic acid is an easy fix.
“The way you turn a flour mill into a birth-defect prevention factory,” he says, “is you put a cube of vitamins that has folic acid in this little gizmo called a feeder. Almost all flour is already enriched, and all flour mills that sell enriched flour have a feeder. So instead of ordering a cube of vitamins with no folic acid, you order a cube with folic acid.”
This changes the cost of a loaf of bread less than one-tenth of a percent, Oakley adds.
Spina bifida has been called the “Humpty Dumpty birth defect” because once it has been damaged, the spine cannot be put together again. The severity of paralysis depends on where upon the spine the damage occurs, but many children born with the disease are in wheelchairs or on crutches for life.
Jim Okula, CEO of the Spina Bifida Association of Georgia, works with some 1,800 children, adults, and their families affected by the disease. “Dr. Oakley has been a great supporter,” Okula
says. “He is a very important advocate for our work and our population. We call him the father of folic acid.”
Since the FDA regulation was established, there has been a 25 percent reduction of spina bifida in the U.S., where the condition occurs in some 1,300 births each year. Oakley estimates folic acid has saved the country about a billion dollars in health care costs. But the incidence is much higher worldwide. Only about 7 percent of the cases of spina bifida that could be prevented are being prevented, Oakley says. He spends much of his time visiting public health officials in other countries, trying to convince them of the benefits of fortifying their flour.
“I call it public health malpractice,” he says. “There is enormous bias against fortification. So until this gets done, it’s just an incredibly important area to work in. It’s a global mission.”