Ralph Green, MD, PhD, FRCPath

Fortification of the U.S. diet with several essential nutrients has occurred, both voluntarily and because it was mandated by the federal government. The usual vehicle is flour because of its widespread consumption, but salt (iodine) and the water supply (fluoride) have also been used.

How often do you prescribe folic acid and in what doses? You should certainly not be seeing much in the way of folate-deficient megaloblastic anemia these days, not with folic acid fortification. We are approaching the 10th anniversary since the introduction of mandatory fortification of the U.S. diet with folic acid, so perhaps now is a good time to look back and take stock. Has folic acid fortification paid off, and how do we do the balance sheets? Basically, this is a public health question, but there is more to it for prescribing physicians, including hematologists and oncologists.

How often do you prescribe folic acid and in what doses? You should certainly not be seeing much in the way of folate-deficient megaloblastic anemia these days, not with folic acid fortification. We are approaching the 10th anniversary since the introduction of mandatory fortification of the U.S. diet with folic acid, so perhaps now is a good time to look back and take stock. Has folic acid fortification paid off, and how do we do the balance sheets? Basically, this is a public health question, but there is more to it for prescribing physicians, including hematologists and oncologists.

The fact that elevated plasma levels of homocysteine are associated with vascular disease and thrombosis is now in little doubt, but the nature of this relationship remains unclear. Does high homocysteine cause disease or is it merely a marker?

---Ralph Green, MD