Why does the US put folic acid in food? Understanding the public health mandate

December 13, 2025 •

4 min read

In 1998, the U.S. Food and Drug Administration (FDA) mandated that food manufacturers add folic acid to enriched grain products, a policy that has since prevented thousands of serious birth defects. But why does the US put folic acid in food? This public health strategy was implemented primarily to protect infants from neural tube defects (NTDs), which often occur before a woman even knows she is pregnant.

Quick Summary

Folic acid is added to enriched grain foods in the US to prevent neural tube birth defects, a public health initiative implemented by the FDA in 1998.

Key Points

Primary Goal: The US mandates folic acid fortification primarily to prevent neural tube defects (NTDs) in infants.
Mandatory Fortification: In 1998, the FDA required food manufacturers to add folic acid to enriched grain products like bread, pasta, and cereal.
High-Risk Timing: NTDs occur very early in pregnancy, often before a woman knows she is pregnant, making population-wide fortification a vital strategy.
Proven Effectiveness: Post-fortification surveillance shows a significant reduction in the prevalence of spina bifida and anencephaly in the US.
Folic Acid vs. Folate: Folic acid is a synthetic, more stable form of the B vitamin folate, making it ideal for industrial food fortification due to its durability.
Reaching All Women: The program helps ensure that women of childbearing age receive crucial nutrients, regardless of whether their pregnancies are planned.
Monitored Policy: The policy is continuously monitored by health authorities like the CDC to balance the benefits of NTD prevention with broader public health considerations.

The Critical Role of Folate and Folic Acid

Folate, a B vitamin, is naturally present in foods such as leafy green vegetables, citrus fruits, and legumes. Folic acid is the synthetic, more stable form of this vitamin, making it ideal for fortifying processed foods. Both are crucial for cell growth, DNA synthesis, and red blood cell production. However, the most compelling reason for the fortification mandate concerns fetal development.

Preventing Neural Tube Defects (NTDs)

Neural tube defects (NTDs) are severe birth defects of the brain, spine, or spinal cord. The neural tube forms early in pregnancy, and if it fails to close properly, it can lead to conditions such as spina bifida and anencephaly. The risk of these conditions is significantly reduced when a woman has sufficient folate levels in her body before and during early pregnancy. With nearly half of all pregnancies in the US being unplanned, relying solely on supplements or high-folate diets was an insufficient public health strategy. Widespread food fortification ensures that women of childbearing age have higher folic acid levels even if they are not actively planning a pregnancy.

The Public Health Strategy: Fortification Explained

The US folic acid fortification program began as a recommendation in the early 1990s and was officially mandated by the FDA for all enriched grain products by 1998. This mandate is considered one of the most successful public health initiatives of the last century.

How the US Folic Acid Program Works

Identification of a need: Researchers established a strong link between low folate levels and NTDs in the late 20th century.
Formulation of recommendations: The U.S. Public Health Service recommended that all women of childbearing age consume 400 micrograms of folic acid daily.
Mandatory action: The FDA issued regulations requiring folic acid to be added to staple grain products consumed widely by the public.
Monitoring and evaluation: The Centers for Disease Control and Prevention (CDC) and other agencies have tracked the prevalence of NTDs since the program's inception, showing a significant decline.

What Foods are Fortified with Folic Acid?

To have the broadest impact, the FDA required fortification for staple foods made from enriched grains. Today, you can find added folic acid in many common pantry items, including:

Enriched breads and rolls
Breakfast cereals (many brands have 100% of the Daily Value)
Enriched rice
Cornmeal
Flour
Pasta and other enriched grain-based products

Benefits of the Fortification

Since 1998, the mandatory fortification program has led to a significant reduction in the rate of NTDs in the United States, with estimates ranging between 19% and 32%. The strategy is highly effective because it does not rely on individual behavioral changes, like remembering to take a daily supplement, reaching even those with unplanned pregnancies.

Folic Acid vs. Naturally Occurring Folate

It's important to understand the difference between folic acid and the folate found naturally in foods. While both provide vitamin B9, their stability and absorption differ, which is why folic acid was chosen for fortification.

Comparison of Folic Acid Sources


Feature	Folic Acid (in fortified foods/supplements)	Natural Folate (in food)
Chemical Form	Synthetic, highly stable form	Biologically active, less stable
Stability	Very stable, not easily destroyed by cooking or processing	Unstable, easily destroyed by heat, light, and cooking
Absorption	Highly bioavailable and absorbed more effectively by the body	Less bioavailable, absorption can be variable
Source	Supplements, enriched grains, cereals, pasta	Leafy greens, beans, citrus fruits
Role in Fortification	Ideal for mass fortification due to its stability and high absorption rate	Inefficient for mass fortification due to instability and lower absorption

Considerations and Modern Perspectives

While largely a success, the program is not without ongoing discussion. Some concerns revolve around the potential for high folic acid intake to mask a vitamin B12 deficiency, particularly in older adults, though evidence for harm from fortification levels is limited. There is also recognition that some individuals have genetic variations (like MTHFR) that affect their ability to metabolize synthetic folic acid, though research is ongoing. For these reasons, the program continues to be monitored by public health authorities. The fortification level is carefully chosen to benefit the population broadly without causing harm to vulnerable groups.

Conclusion: A Public Health Success Story

The reason the US puts folic acid in food is a powerful story of preventive public health policy. By mandating the fortification of common food items, the US government effectively and efficiently addressed a critical nutritional deficiency that posed a significant risk to fetal development. The program successfully decreased the prevalence of severe and life-altering birth defects, protecting thousands of families across the country. As research continues to evolve, the core principle remains: proactively ensuring adequate nutrient intake for the population, particularly for those at risk, is a cornerstone of modern public health. For more information, you can visit the Centers for Disease Control and Prevention.

Frequently Asked Questions

Folate is the naturally occurring form of vitamin B9 found in foods, while folic acid is the synthetic form used in supplements and fortified foods. Folic acid is more stable and better absorbed by the body.

The FDA mandates folic acid be added to enriched grain products, including enriched flour, bread, pasta, rice, and cereals.

Scientific evidence shows that the levels of folic acid added to food in the US do not cause harm to the general population. However, excessive intake from supplements could potentially mask a vitamin B12 deficiency in some individuals.

The mandatory fortification of enriched grain products with folic acid in the US began in January 1998.

Folic acid is vital for the healthy development of a fetus's brain and spinal cord. Adequate intake before and during early pregnancy can prevent serious birth defects called neural tube defects (NTDs).

While natural folate is important, many people, especially women of childbearing age, do not consume enough through their diet alone. Fortification provides a widespread and consistent baseline level of intake.

Neural tube defects are birth defects of the brain and spine, such as spina bifida and anencephaly, that result from the neural tube not closing properly early in pregnancy. Folic acid helps ensure the proper development and closure of the neural tube.

Yes, the mandatory folic acid fortification program for enriched grains is still in effect in the United States and is considered a public health success.