Should bakers add folic acid to bread?
In babies it stops neural tube defects
We know that if pregnant mums take folic acid supplements in the first four months of pregnancy their baby will be protected against neural tube defects (NTD) such as spina bifida and hydrocephalus.
But not all mums take this vital vitamin. Plus low folate levels can lead to a serious form of anaemia, especially in older people who are vulnerable.
So should we fortify our foods with folic acid? Should we be putting folic acid in bread and cereals?
I know this is a contentious issue but the case for mandatory fortification with folic acid is quite strong. Taking the US as an example, before mandatory fortification, the prevalence of folic acid deficiency was nearly 25%. But after fortification, it was less than 1%. This translates into millions of cases of folate deficiency corrected or averted.
Roughly 80 countries have mandatory fortification of cereals and bread resulting in a fall of NTD of 20% to 60%. Rates haven’t fallen elsewhere.
Here in the UK it’s not just pregnant mums who need folic acid supplements. One large study reported that about 10% of people aged 65-74 and 20% of those over 75 were at high risk of folate deficiency and the anaemia linked to it.
Fortification would be an excellent way to overcome this problem because the folic acid used for fortification is more readily absorbed than naturally occurring folic acid.
Moreover, there’s a bonus effect. Higher folate levels are linked to a lower risk of bowel cancer and improved cognition in elderly people.
We have rafts of evidence about the major public health benefits of preventing folic acid deficiency anaemia, but critics of mandatory fortification argue that there could be a danger of neurological problems due to excessive intake.
However, such a risk is small and unproved for the levels of folic acid used in mandatory fortification programmes. The intake of folic acid from fortification is probably much too small to cause problems.
The main worry is that “high” doses of folic acid can cause nerve damage in patients with a vitamin B12 deficiency but this is unproven and not accepted by public health experts in the US and Europe.
Mandatory fortification has done much more than prevent NTDs. It has prevented millions of cases of folic acid deficiency anaemia without any proven adverse effects.
If we introduced mandatory fortification here in the UK we would prevent many more devastating birth defects and cases of anaemia.