UK to discuss folic acid fortification

It seems that on an almost daily basis new evidence arises to reveal the benefits of folic acid to our health. Discussions about the implications of fortifying a nation's food with folic acid are currently taking place both in Europe and North America. The UK Food Standards Agency, together with the UK's four Health Departments, is to hold an open meeting in London on 18 March to discuss this very issue.

The meeting aims to help shape and inform the Agency's and Health Departments eventual recommendations to the government on whether flour should be fortified with folic acid.

Research findings imply that the fortification of flour with folic acid could significantly reduce the risk of babies being born with spina bifida and other neural tube defects (NTD). However, folic acid is only effective if taken by women before and during early pregnancy.

The government's former advisory committee the Committee on Medical Aspects of Food and Nutrition Policy (COMA) estimated that its recommendation to fortify flour would reduce the risk of NTD-affected births by 41 per cent. This would prevent a small number of annual NTD-affected births, 38 out of a total of 93 in England and Wales, 30 out of 74 in Scotland and 6 out of 14 in Northern Ireland.

However, high daily intakes of folic acid can potentially mask anaemia, an early symptom of a vitamin B12 deficiency in older people. If such a deficiency is not identified early enough then there is a possible risk of neurological damage to this vulnerable group.

Suzi Leather, Deputy Chair of the Food Standards Agency​, said: "The question of whether we fortify flour with folic acid is a highly emotive one. The main reason to do so is to reduce the numbers of babies being born with neural tube defects. That is an important issue, but we also need to consider the risks involved for other groups such as the elderly, who may be exposed to a potential risk connected with undiagnosed vitamin B12 deficiency. There are a range of options and important ethical, medical and practical issues that need to be fully debated before any recommendation can be made."​

While fortification could reduce the numbers of babies born with spina bifida and neural tube defects (NTD), the dosage would have to be balanced. The level of fortification suggested by COMA maximises the opportunity to prevent against NTD-affected births and minimises the risk of masking a vitamin B12 deficiency in the elderly. Women who are likely to become pregnant would still need to further supplement their intake with an additional dose of folic acid in order to protect against the risks of NTD-affected births.