• Dr Joanne Delange

Folic Acid Fortification: Folic Acid to be added to Flour in the UK


The UK Government has announced that folic acid will be added to non-wholemeal wheat flour to help prevent spinal conditions in babies.


Two years ago Nutritional Insight assessed the folate status of American women as folic acid has been added to cereal-grain products in the USA for more than 20 years. Since 1998, enriched cereal grain products have been compulsory in order to improve the folate status in women of reproductive age and subsequently reduce the risk of neural tube birth defects. In September 2021, our insight reported that 'data from the USA could indicate that a compulsory folic acid fortification programme in the UK may be an effective way of reducing the prevalence of folate insufficiency and subsequent neural tube defects in foetuses.'

Folate and Folic Acid


Folate is a water-soluble B vitamin, known as vitamin B9, which is essential for the formation of red blood cells. The folate form that naturally occurs in food is called folate. Folic acid is the synthetic form of folate and can be used in the fortification of food and within food supplements.


The levels of folate in an individual differs by age and population. Folate deficiency isn't a major problem for individuals eating a balanced diet, though there are many people that do not achieve the recommended intakes. This is most problematic in women of childbearing age, where a consequence of folate deficiency is that pregnant women are at greater risk of giving birth to babies with neural tube defects.


Neural Tube Defects


Neural tube defects are birth defects of the brain, spine or spinal cord. They occur to the foetus when the spinal cord and/or surrounding vertebrae fails to close properly or becomes damaged – with folate being involved with cell division and this closure.


Neural tube defects happen in the first month of pregnancy, often before a woman even knows that she is pregnant. As such, supplementation begins when it is already too late.


The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the foetal spinal column doesn't close completely, usually resulting in some paralysis of the legs. In anencephaly, most of the brain and skull do not develop, resulting in stillborn babies or babies who die shortly after birth.


The exact causes of neural tube defects aren't known. However, consuming enough folic acid, before and during pregnancy, is known to prevent most neural tube defects.


The UK Government's Announcement


The NHS strongly recommends women who could become pregnant or are planning a pregnancy take a 400 micrograms folic acid supplement every day before pregnancy and until they are 12 weeks pregnant. As approximately 50% of pregnancies in the UK are unplanned, the Government has taken action to increase folic acid intake nationally to help protect more babies from neural tube defects.


Sajid Javid, Health and Social Care Secretary, said: 'We are committed to giving more children a healthy start in life. With the safe and taste-free folic acid baked into the national diet, hundreds more babies will be born healthy each year.'


The Government believes that adding folic acid to foods made with flour, such as bread, will actively help avoid around 200 neural tube defects each year, which is approximately 20% of the annual UK total.


'Few things are as important as a baby's health – and folic acid-fortified flour is a quick, simple win to enhance their development' said Boris Johnson, Prime Minister, 'This will give extra peace of mind to parents and families, as well as helping boost the health of adults across the country.'


The costs of fortification to the food industry are expected to be minimal due to the fact that non-wholemeal flour is already fortified with a range of vitamins, including iron, thiamine and niacin.


Wholemeal flour and gluten-free foods are not included in the Government's announcement, and will not be required to be fortified with folic acid. This is because wholemeal flour has more naturally occurring folate than non-wholemeal flour, furthermore some wholemeal and gluten-free foods are already fortified with folic acid in the UK.


Conclusion


The Association of UK Dieticians (BDA) has praised the announcement. However, they have been campaigning for folic acid fortification for around 30 years and the UK Government originally consulted on whether folic acid should be added to flour two years ago.


Yet, this move by the Government is welcomed, and will improve the folate status of women in the UK leading to a reduction in babies born with neural tube defects such as spina bifida and anencephaly.


References:


Folic acid added to flour to prevent spinal conditions in babies. GOV.UK. Available at https://www.gov.uk/government/news/folic-acid-added-to-flour-to-prevent-spinal-conditions-in-babies


Folic acid fortification in the UK. The Association of UK Dieticians (BDA). Available at

https://www.bda.uk.com/resource/folic-acid-fortification-in-the-uk.html

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