Renee Krul has been seeing disturbing levels of spina bifida in the fervently Orthodox community.

Though population surveys don't define health statistics according to religious denomination, Krul has firsthand knowledge of the patterns in the community as Northern New Jersey nursing coordinator for the Spina Bifida Association of the Tri-State Region.

She suggests that the birth defect, characterized by a spinal cord that fails to close properly, is overrepresented in a community with dietary restrictions, early marriages, and large families.

"The people themselves have begun to perceive spina bifida as a Jewish genetic disease — which it isn't — because the incidence is so high," she says. "In other communities I see one child with spina bifida, if that. When you see five children under the age of five with it in one community — like in Lakewood — you know something is wrong."

She said she is also getting word of similar problems from Orthodox areas in New York, Canada, and Israel.

As a result, Krul, who lives in Elizabeth, is reaching out to Orthodox communities in New Jersey to raise awareness about the defect, its prevention, and its treatment. In the fall she plans to bring her presentation to the Jewish Educational Center's Bruriah High School for Girls in Elizabeth, and is hoping other schools around the state will follow that example.

She is also preparing mailings to pediatricians and other doctors, and sharing information and tactics with colleagues from all over the country.

One of her primary goals is to get Orthodox teenage girls and young wives into the habit of taking a daily dose of folic acid, either by itself or in a multivitamin pill. Studies show that about 70 percent of neural tube birth defects — of which spina bifida is the most common — can be prevented if fertile women consume adequate amounts of folic acid. It can be obtained in its natural form, folate, in leafy green vegetables and from fortified grain products, but research has shown that the most efficient method of delivery is with supplements.

This is not just talk from Krul. Her husband, pediatrician Geddy Krul, put her daughter Elana onto a multivitamin when she was a student at Bruriah. She is 24 now, still taking those pills, married and expecting her first baby.

Their son Steven, 25, and recently married, is engaged in rabbinic and social work studies at Yeshiva University in New York. Asked for his view of his mother's work, he cited the profound importance the Torah places on having children, and the belief that all healing comes from God. With that in mind, he said: "I think it's a beautiful and tremendous thing to look after the health of children, not just the wonderful ones who are in front of us, but also those who are not yet born. To me, given what a significant impact folic acid has, it's a holy act to take it."

Just why Orthodox communities show higher than usual incidences of spina bifida has not been established. Krul said the causes may include a lack of leafy greens in their diet due in part to problems of washing such food according to the rules of kosher preparation, which is concerned about bug infestation. She also suggested that young women interested in a good match, or shidduch, can develop eating disorders that lead to malnutrition. Large family sizes can increase the chances of maternal metabolic deficiencies, she said.

The early age for marriage is also a major factor, she suggested. Krul says she encounters young wives who are ignorant about nutrition and more concerned with their appearance than their health. "Some of them are really just adolescents when they get married," she said.

Whatever the reasons, some notable Orthodox figures have endorsed Krul's efforts to provide young Orthodox women with information about spina bifida and nutritional supplements.

Chai Lifeline, the international Jewish nonprofit organization that provides support for seriously ill children and their families, has expressed support for her cause. This past March, Torah Umesorah, the organization that links and supports about 700 Orthodox Jewish day schools around the country, issued a letter on the subject, urging females of childbearing age to take folic acid. The letter, signed by Rabbi Joshua Fishman, executive director of the organization, cited a "leading Rosh HaYeshiva" (yeshiva head), and urged principals to convey the information to 12th-graders and seminary students.

In addition to brochures, she has also produced small prayer cards for young women. They carry a prayer with paraphrasing approved by Rabbi Simcha Bonim Cohen, senior Kollel fellow at Beth Medrash Govoha in Lakewood, to have children without struggle and free of defects. On the flip side of the card is information on spina bifida and how to avoid it. "It looks almost like a credit card," Krul said.

Krul has reached out to most of the fervently Orthodox girls' high schools in the state, but come the next school year, she hopes to continue her outreach to modern Orthodox schools as well. She said Chaya Newman, the principal of Bruriah, has invited to her to show her PowerPoint presentation to a science class there.

She has also been invited to come to Israel, where the same problems have been observed in the Orthodox population. She wants to reach the youth there, too.

"Teenagers' diets are usually lacking in nutrition, so taking a multivitamin is good anyway," she said. "The important thing is to make taking one a habit. They say it takes a year to form a habit but just a week to break one."

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Spina bifida