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March 19, 1997

Folate Supplementation and the Risk of Masking Vitamin B12 Deficiency

Author Affiliations

Presbyterian/St Luke's Medical Center Denver, Colo

JAMA. 1997;277(11):884. doi:10.1001/jama.1997.03540350034026

To the Editor.  —The article by Dr Tucker and colleagues1 recommends the addition of folate to flour to combat problems of folate deficiency in the elderly. This article and others, such as those recommending folate fortification to prevent neural tube defects in fetuses whose mothers do not receive prenatal care, generally claim that the benefits outweigh the risks of masking of vitamin B12 deficiency by hiding macrocytic anemia. Vitamin B12 deficiency is also a common problem in the elderly. Those recommending folate supplementation generally allege that B12 deficiency is easily recognized by most physicians, even when it does not cause anemia and, therefore, the downside of folate supplementation is small.My personal experience with this condition has not been nearly so favorable. My wife, who had taken folate supplements, developed quite advanced neurologic findings from vitamin B12 deficiency because of the absence of anemia as