Saturday, May 12, 2007

Folic acid should be added to flour, says watchdog

Folic acid should be added to all flour to help reduce birth defects, the UK's official food watchdog said last night.

The addition of the vitamin to all flour would be the first mandatory fortification of a food since the second world war.

Following much debate, the Food Standards Agency today issued its judgment which its board will consider next Thursday. If the board backs the evidence it could make the recommendation officially to ministers as early as next week.

Research has shown that adding folic acid to bread via white and brown wheat flour would help cut neural tube defects (NTDs), which include spina bifida and leave people severely disabled.

Between 700 and 900 pregnancies are affected by NTDs every year, with most diagnosed women opting for abortions.

Mandatory fortification has been introduced in the US, Canada and Chile, where it cut NTD rates by between 27% and 50%. But there is some scientific evidence that there could be unwanted side effects.

In papers to be submitted to next week's board meeting, FSA officials say that advice to pregnant women to take folic acid supplements has failed and recommends fortification of flour because four other vitamins have already been added to flour since the 1940s.

"Some might object to forced fortification," the FSA warns. Some health groups have objected to it being added to all flour to catch the women who are failing to take folic acid pills prescribed by doctors when they fall pregnant, but evidence suggests that it can help prevent spina bifida if taken before conception too.

An FSA consultation on the issue drew 202 responses from industry, consumer groups and individuals.

The baking industry raised practical concerns about the fortification of bread. It said bread-making flour could not easily be separated from other flours in mills.

The FSA's board previously considered the issue in 2002 and decided at that time not to go ahead with mandatory fortification due to concerns about the potential risks that folic acid can mask vitamin B12 deficiency in older people, as well as the move limiting consumer choice.

The board said that it wished to further review emerging evidence on the impact of fortification in other countries such as the US that had already moved to mandatory fortification.

The Scientific Advisory Committee on Nutrition (SACN), which drew up the advice, said it had addressed these concerns and the measure should be brought in alongside controls on voluntary fortification, advice on use of supplements, and long-term monitoring.

It recommends a review of the policy after five years which would include monitoring whether there were any links with changes in rates of cancers.

The report says: "Although supplementation with folic acid is advised prior to conception until the 12th week of pregnancy approximately half of all pregnancies are unplanned, which limits the value of recommendations.

"European Union countries with policies recommending women to consume folic acid supplements to reduce NTDs have observed no effect on NTD reduction."

It also rules that although folic acid can mask the effects of vitamin B12 deficiency, particularly anaemia, in older people, the quantities which would be added to bread were not enough to pose a risk. It says that voluntary fortification which currently exists would have to stop to make sure people were not getting too much.

The agency found public opinion divided, with slightly more people backing the move towards fortification.


Folates - folic acid - are water-soluble forms of vitamin B9. These occur naturally in food, particularly vegetables and pulses and can also be taken as supplements. Folate is necessary for the production and maintenance of new cells - particularly important during periods of rapid cell division and growth such as infancy and pregnancy. Low intake of folic acid can cause neural tube defects during pregnancy which can result in miscarriage, neonatal death and lifelong disability.


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