Cross-party Parliamentarians met with members of the Health Food Manufacturers’ Association (HFMA) and leading nutrition experts recently to discuss the implications of mandatory fortification of flour with folic acid.
The HFMA recently convened a meeting in Westminster to explore the matter, with the aim being to discuss current evidence-based medicine on, and safety of, folic acid fortification, as well as the best course of action, given the UK Government’s recent announcement of its plans to consult on the matter early in 2019.
The meeting was chaired by Dr Michele Sadler, a consultant and Registered Nutritionist with over 30 years’ experience, with previous positions as Senior Nutrition Scientist at the British Nutrition Foundation and Programme Manager at IGD. Dr Sadler wrote the dossier for the only current approved EU health claim directly linking folic acid supplementation with the reduced risk of neural tube defects (NTDs) in infants.
The first speaker was Ursula Arens, a freelance nutrition writer with a degree in Dietetics. Ursula is a member of the British Dietetic Association, the Nutrition Society and the Guild of Health Writers. In her presentation, she spoke of the overwhelming evidence-based research which supports the fortification of flour with folic acid, and the resultant significant impact on reducing serious birth defects in infants. She referred to the surprising lack of response in the UK and Europe to date, given that over 80 countries elsewhere in the world had now introduced fortification of flour. She questioned why, given clear evidence of benefit in those countries, no countries in Europe had followed suit.
The next speaker was Anne Milne, a Senior Public Health Nutrition Advisor for Nutrition, Science and Policy at Food Standards Scotland (FSS), whose presentation focused on a report carried out by FSS into the potential impact of fortification of flour with folic acid in the UK, looking at various modelling structures. Anne spoke of her concern that only one third of women take folic acid supplements before pregnancy, in spite of the Government’s advice to do so, and despite the fact that before conception, and during the first 12 weeks of pregnancy, it is recommended that they take two times the current nutrient reference value, on top of increasing folate in the diet. She said that due to the fact that most women consume wheat flour regularly, mostly as bread, this is undoubtedly a good choice of vehicle for folic acid fortification. However, she added that women planning a pregnancy should continue to take supplements as advised, as fortified wheat flour alone will not give them all they need.
As the discussion opened up to the floor, questions raised included the potential risk of raised folate status, in the presence of vitamin B12 deficiency in older people, including increasing the risk of masking pernicious anaemia, and the potential for fortification to be a combination of folic acid and vitamin B12 to address this concern, which may, in addition, provide a further protective effect in relation to NTDs. This was followed by an important discussion on the upper level for folic acid being outdated, and a review could allow for higher fortification levels to increase the reduction in NTD incidences still further.
There was unanimous agreement that the critical issue was the need to address the lack of awareness among women of child-bearing age of the importance of taking an additional folic acid supplement, and that this needed the impetus of a new messaging campaign by the Government, because young women may feel that eating fortified bread may give them all the support they need. Addressing a question about the backdrop of a national obesity crisis and the increasing popularity of low carb diets, Graham Keen, Executive Director of the HFMA, pointed out that bread consumption in the UK has reduced by a significant 12 per cent in the last five years, so this absolutely should be taken into consideration.
He pointed out that young women “can purchase the folic acid supplements they need for less than a penny a day, whereas the cost of the additional bread required to be consumed by young women, even if we could persuade them to eat four times their normal daily bread consumption, would be between 25p and 30p per day”.
In conclusion, Dr Michele Sadler commented: “I think there is little doubt that the overall folate status of the general population would improve as a result of mandatory fortification. But raising awareness and education on the need to take a supplement is critical as women of child-bearing age may mistakenly believe that including bread in their diet means they are no longer at risk.
“So, I think a key action step from today would be to continue to support the fortification of flour with folic acid and welcome the resulting up to 25 per cent reduction in the incidence of neural tube defects this may bring, but step up the pressure for a strong communications campaign for the additional supplementation that young women need, which would improve the reduction in NTDs to just over 70 per cent if all women were to follow the advice.”