All you need to know

Folic Acid Fortification in Flour

Nutrition and health had quite a win this year with the decision to go ahead with folic acid fortification in non-wholemeal flour in the UK. It’s been a topic of discussion for some time (close to 30 years), and it’s fantastic to witness productive action. Let’s dive into why folic acid is important and what this means for the population.

Let’s begin with the basics.

What is Folic Acid?

Folic acid is the synthetic, human-made, version of folate. The main reason behind the fortification is due to folic acid’s vital role in pregnancy. A staggering 45-50% of all UK pregnancies are unplanned meaning many pregnancies are detected late and receive antenatal care late (1). However, very important foetal developments occur early in pregnancy, like the development of the Central Nervous System (neural tube development) (2). This is the development of the brain and spine. Because this happens so early during the pregnancy, many women aren’t aware they are pregnant. Studies have shown that adequate intake of folic acid during early pregnancy has shown significant reduced instances of neural tube defects like spina bifida (1,2). Neural tube defects are very serious and affect 1000 pregnancies in the UK every year (1). Neural tube defects may lead to termination, miscarriage, stillbirth, loss soon after birth or long-term disability impacting both child and their family (2).

Folic Acid and Pregnancy

It is currently recommended to take a 400 micrograms folic acid supplement daily from before pregnancy until 12 weeks. This advice won’t be changing. By imposing mandatory folic acid fortification of flour, it will mean the intake of folic acid in the population will increase, helping prevent neural tube defects in unplanned pregnancies. As 99% of the UK population buy bread and other flour-containing products, it will be an effective strategy in fighting health disparities in our population as nearly everyone, of all backgrounds, will be affected by this (1). While it is ideal that we get all our folate needs met by our diet, it just is not always possible or guaranteed.

What is Folate?

Folate is the natural form found in food, also known as Vitamin B9.

Foods high in folate include:

• Spinach and kale

• Cabbage, broccoli, green peppers, spring greens, peas

• Blackeye beans, chickpeas, baked beans, lentils

• Yeast and beef extracts

• Oranges and orange juice

• Wheat bran and other wholegrain foods

• Eggs

• Fortified foods – cereal

Fortification of Folic Acid in Flour.

The fortification of flour is not novel news. We have been fortifying flour with calcium, iron, niacin, and thiamine since the Second World War (1)! Also, folic acid fortification in flour is not new either. It has already been happening in 80 other countries (2).

This law does not include wholemeal or gluten-free flour because wholemeal flour contains folate and gluten-free flour is often already voluntarily fortified.

Another benefit of folic acid fortification is that it may help prevent other diseases in the wider population. Low folate status is associated with elevated plasma homocysteine. Over time, this high level of plasma homocysteine can cause arterial damage and blood clots which may lead to heart attacks and strokes (2). Also, low folate levels have been associated to dementia, Alzheimer’s disease, and increased cancer risk (2).

There have been some reservations of this new law as Vitamin B12 and Folic Acid/Folate deficiencies share similar symptoms. However, within some communities such as the elderly, symptoms of B12 deficiency can be masked by adequate folic acid intake. While this is a valid concern for their health, the benefits to the general and future population far outweigh the risks.

All in all, I feel this is a fantastic move in the right direction to help promote good health and should be seen as a win for the nutrition and health community!

References:

(1)    GOV.UK. 2021. Proposal to add folic acid to flour: consultation response. [online] Available at: <https://www.gov.uk/government/consultations/adding-folic-acid-to-flour/outcome/proposal-to-add-folic-acid-to-flour-consultation-response> [Accessed 10 December 2021].

(2)    Wright, A. J. A., Dainty, J. R. and Finglas, P. M. (2007) “Folic acid metabolism in human subjects revisited: potential implications for proposed mandatory folic acid fortification in the UK,” British Journal of Nutrition, Cambridge University Press, 98(4), pp. 667–675.