The Mailbag: A Word from Our Nutritionist

Today's question comes from Rachael, a third-year medical student from Kingston, Ontario.

Dear Ms. Kirsch, I just read the "What supplements should I take" section on page 25, and was very disappointed not to see folic acid in the list.

In a woman who becomes pregnant, folic acid is important for the prevention of neural tube defects (like spina bifida) and other birth defects. Supplementation with folic acid has been proven to decrease such defects.

I am sure that most of the women reading your book are not trying to get pregnant. Half of all pregnancies, however, are unplanned. Furthermore, neural tube defects occur very early on, usually before a woman knows that she is pregnant. It is therefore recommended that all women of reproductive age (ie your audience) should be taking folic acid BEFORE they are even thinking about having children.

I think that this is a very important message, which young women often don't receive until they are actually pregnant. Your book targets the very group that needs to know about folic acid: adult women who are not yet starting their families. If you produce a 2nd edition at some point, please please please include information about folic acid in your nutrition section!

Thanks for the great book.

Rachael's question got me thinking, because I've heard a lot about folic acid being necessary for expectant mothers, but never thought it was important for women who weren't trying to become pregnant.

Since that list of nutritional supplements was compiled with the aid of our resident nutritionist, Dr. Jeffrey Morrison, I took Rachael's question to him. Here's his response:

Dear Rachael,

Thank you so much for your comments about the fact that women of child bearing years need to be concerned about adequate folic acid intake.

Currently The U.S. Preventive Services Task force recommends that all women planning pregnancy take a daily multivitamin or multivitamin-multimineral supplement containing folic acid at a dose of 400-800 mcg, beginning 1 month prior to conception and continuing through the first trimester, to reduce the risk of neural tube defects.(1)

Even though it was not expressly written, a diet high in fruits, vegetable and fortified whole grain products contribute to that goal. In addition, my recommendation that women take an additional B-complex will typically cover the folic acid requirement.

That all being said, I agree with you. In the next addition to the book, I will recommend to Melissa to add a bullet point to clarify the importance of folic acid to women's health. Thank you for your comments and good luck with medical school!

(1) Combs GF. Ch.4 on Vitamins, in "Krause’s Food, Nutrition and Diet Therapy." Mahan LK, Escott-Stump S, editors. 10th ed. W.B. Saunders Company. Philadelphia: 2000. p. 94

Thanks, Rachael! I hope this helps. As I wrote in the introduction to the book (Who reads introductions? I know), The Girl's Guide to Absolutely Everything is not meant to be the last word on anything, but the opening of a conversation. I wrote the book so women could benefit from the accrued experience of other women. The exchange continues beyond the pages of the book.

If you have any questions, corrections, stories, comments, ideas, wisdom, advice or anything else you want to get out there, write me at melissa@melissakirsch.com.