Clinical Review Science, medicine, and the future

Is folic acid the ultimate functional food component for disease prevention?

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7433.211 (Published 22 January 2004) Cite this as: BMJ 2004;328:211
  1. Mark Lucock (Mark.Lucock@newcastle.edu.au), lecturer1
  1. 1 Human Nutrition, School of Applied Sciences, University of Newcastle, Brush Road, Ourimbah, NSW 2258, Australia
  • Accepted 18 November 2003

We are entering a new era in preventive medicine, which focuses on diet as a means to health. Folate has received much attention as a vitamin that can protect against many diseases, but do we know enough about the long term effects of supplementation?

Introduction

Mankind has been relatively unsuccessful in the search for the ultimate panacea for all ills; however, in the field of functional foods, few nutritional components have so many fundamental and diverse biological properties as folic acid and related B group vitamins. Moreover, few nutrients can claim to modulate, if not overtly benefit, such a wide array of clinical conditions.

Around 2500 years ago Hippocrates first espoused the “food as medicine” philosophy, which fell into obscurity by the 19th century. The first 50 years of the 20th century saw the discovery of the essential elements and vitamins, particularly in the context of deficiency diseases. Indeed, by 1912 Casimir Funk had put forward the “vitamine theory,” proposing four different “vitamines” that would cure scurvy, pellagra, beri-beri, and rickets. During the 1970s the shift in emphasis from undernutrition to overnutrition and disease led to a flood of public health guidelines on optimising nutritional parameters. By the 1990s, with an ageing health conscious population, scientists from academia and the commercial world coalesced their thinking to create the trend we now know as functional foods.

Enrichment of flour as a US government programme to correct problems with nutrient deficiency was probably the first modern attempt to design a food for functional purposes related to nutritional outcome. The first consequence of this was the eradication of pellagra with niacin, and a current programme in the United States aims to do the same for neural tube defects through mandatory fortification of grain with folate at source.1 2

The ramifications of this mass …

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