Experts urge government to fortify flour with folic acid

By Julie Griffiths on 01 February 2018 Folic Acid Research

Results from a new study reinforce recent calls from experts to approve the fortification of flour with folic acid, in order to protect babies from having neural tube defects.

Despite successive recommendations from the Scientific Advisory Committee on Nutrition, the UK has not introduced mandatory fortification. One reason given is that this might lead to more people having a folate intake above an ‘upper limit’ suggested in 1998 by the US Institute of Medicine (IOM – now the National Academy of Medicine).

However, the new research reveals that the IOM analysis was flawed and there is no need for an upper limit.

A re-analysis of the data shows that there is no relationship between the dose of folic acid and the appearance of neurological symptoms, as claimed by the IOM.

The new research, published in Public Health Reviews by scientists at the Wolfson Institute of Preventive Medicine, Queen Mary University of London, and the School of Advanced Study, University of London, shows there is no need for a folate upper limit.  

With the upper limit removed there is no scientific or medical reason for delaying the introduction of mandatory folic acid fortification in the UK and other countries that have not yet adopted this proven public health intervention.  

Women who could become pregnant are advised to take a daily folic acid supplement, but most do not do so, particularly younger women and those in ethnic minorities, emphasising the need for fortification.

Even with fortification, women should still be advised to take folic acid supplements to achieve a greater level of protection than that afforded by fortification alone.  

In the UK, white flour is already fortified with iron, calcium and other B vitamins (niacin and thiamin) and flour millers are ready and willing to add folic acid under the current Bread and Flour Regulations.  

Professor Sir Nicholas Wald, who led the original MRC trial and is the lead author of the new study said: ‘Failing to fortify flour with folic acid to prevent neural tube defects is like having a polio vaccine and not using it.’

Co-author professor Joan Morris said: ‘From 1991, when the protective effect of folic acid was first shown, to 2017, an estimated 3000 neural tube defects could have been prevented if the UK had adopted the same level of folic acid fortification as in the US. It’s a completely avoidable tragedy.’

President of the Royal College of Paediatrics and Child Health professor Neena Modi said: ‘Folic acid taken in the early stages of pregnancy will prevent around seven of 10 neural tube defects. This new research is a game changer for fortification in allaying concerns about exceeding an upper limit of 1mg/day.'

Access the full study here.