Why the UK may start putting folic acid in flour

Flour manufacturers in the UK will be legally obliged to add folic acid to their produce under new plans aimed at preventing birth defects.

Following years of lobbying by charities, the Government has launched a 12-week consultation on the mandatory fortification of flour with the chemical, which has long been known to prevent birth defects in babies, in particular spina bifida. Experts believe around 200 cases a year could be prevented by introducing the measure, Sky News reports.

Public Health Minister Seema Kennedy said: “We all want to give our children the best start in life and a birth defect diagnosis is devastating for parents. The simple measure of adding folic acid to flour would help spare hundreds of families from such a life-changing event.”

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What are folates?

Folates, including folic acid, are vitamins that occur naturally in food and form an important part of the diet. A deficiency of folates can cause neural tube defects (NTDs), which currently affect around 1,000 pregnancies a year in the UK, according to The Daily Telegraph. More than 40% of these cases result in the death of the baby, and most infants who survive need continuing care.

Natural sources of folates include Brussels sprouts, asparagus, beef liver, spinach and white rice. Folates are also found in wholemeal flour, which therefore could be exempted from the proposed mandatory fortification rules.

Pregnant women are currently advised to take a folic acid supplement before conceiving and for the first 12 weeks of pregnancy.

Is folate fortification mandatory anywhere else?

Yes, adding folates to flour is a legal requirement in more than 60 countries, including Australia, the US and Canada. When folate fortification was introduced in Canada in the late 1990s, neural tube defects halved. And in Australia, the same change led to a 14% reduction in cases, says the BBC.

Although folic acid is not currently added to flour in the UK, the industry is required to add iron, calcium and the B vitamins thiamine and niacin to all flour other than wholemeal, under the Bread and Flour Regulations (BFR) 1998.

What are the arguments against?

The main argument against fortification is that it’s “using a sledgehammer to crack a nut”, investigative food journalist Joanna Blythman wrote in The Guardian in 2007. For every baby saved from spina bifida, half a million people, of both sexes, will be taking folic acid.

Blythman quotes a nutritionist who asked: “Why not target potential young mothers rather than mass-supplementing the population at large?”

That is essentially what happens currently: pregnant women are advised to take the supplement. But some women may forget to do so, or may not realise they are pregnant. The primary concern with the advisory approach, however, is that the message may not reach women living in remote or disadvantaged areas.

Are there any other concerns?

Last October, the BBC reported concerns among some experts that folic acid may mask the symptoms of vitamin B12 deficiency, a particular problem for the elderly and vegetarians. Previous research had also suggested that high doses of folic acid could cause symptoms such as diarrhoea, cramps, sleep disorders, confusion, nausea and seizures.

However, government advisors are now “satisfied that these concerns are not supported by the evidence”, says the broadcaster.