The debate over whether food manufacturers should add folic acid to flour has been rekindled following the publication of recent comments by Professor Sir Colin Blakemore, former chief executive of the Medical Research Council.
Professor Blakemore used the election of a new government as an opportunity to call for action on the issue. “I hope this time the Government introduces folic acid fortification, which would save the lives of hundreds of babies a year. It would be shocking if it did not,” he said.
Studies have shown that by fortifying flour with folic acid – which is also known as Vitamin B9 – the lives of as many as 400 babies could be saved in the UK each year. Although supplements are available, studies show that despite being advised to do so since 1991, only one in three pregnant women take folic acid throughout pregnancy. The current NHS advice is that women take 400 micrograms of folic acid per day before pregnancy, extending until at least the 12th week following conception.
However, the introduction of folic acid into flour-based foodstuffs could have even more far-reaching implications. This is because Vitamin B9 has been shown to play an important role in the prevention of congenital disabilities, including brain abnormalities and spina bifida. However, despite a strong body of evidence indicating the benefits of fortification – including the success of fortification schemes in around 80 countries – successive UK governments have refused to take action on the issue.
Professor Blakemore’s comments follow a 12-week public consultation on folic acid fortification and are supported by an eminent colleague; Professor Sir Nicholas Wald, who has carried out ground-breaking research into folic acid’s role in preventing neural tube defects (NTDs), said fortification would come at no cost to the public purse so should be pursued without obstacle. “If it was deferred again, it would be a tragic missed opportunity,” he warned.
Neural tubes in foetuses eventually develop into the brain and spine. However, if a woman is B9 deficient at the time of conception, her child may be born with defects affecting the spine, spinal cord and brain. These include spina bifida, anencephaly and encephalocele. The latter two conditions severely affect brain development and anencephaly nearly always proves fatal.
One problem with folic acid supplements is that unless a woman is planning to become pregnant, she has no reason to take them. For many women, by the time they begin taking folic acid, it may already be too late. As such, flour fortification could help prevent the 190 neural tube defect pregnancies that take place in the UK each year.
This is why assorted experts recently told the Archives of Disease in Childhood, “The moral arguments for the public health intervention of fortification are undeniable.”