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Folic Acid

Policy Position

FDF recognises and acknowledges the medical evidence that underpins the fact that increased folate intake, including by fortification with folic acid, significantly reduces the incidence of neural tube defect (NTD) in the population. With regards to the other health benefits of folate, such as positive impacts on homocysteine and associated heart health the evidence is also strong, yet presently less conclusive than for NTD.

Further, FDF members do believe that Vitamin B12 deficiency in the elderly is important and can be masked by high levels of folate intake, therefore, FDF considers it prudent that the Department of Health investigates better methods of detection and thereby prevention of B12 deficiency. FDF also recognises that more recent concerns surrounding the safety of folic acid (as opposed to folates found naturally in foods), in particular its link with colorectal cancer, need further assessment before a full scale mandatory fortification programme can be undertaken.

Consumer safety is of paramount importance, and the FDF agrees that any decision likely to affect the diet and health of the population must be carefully considered. Voluntary fortification of breakfast cereals and spreads with folic acid for example is currently making an important contribution towards folate intakes in lower intake groups and without it there would be a rise of about 10% in the number of cases of NTD-affected pregnancies if it were not replaced with mandatory fortification.

FDF members are aware of recent information indicating potential adverse affects of folic acid, such as increased multiple births (and the associated risks to both mother and child), risk of colorectal cancer and cognitive decline, however, they feel such data is preliminary, and as such, would not support a firm conclusion. FDF members believe that there is a need for further, more thorough investigation into these possible effects before firm conclusions are made and any corrective action taken.

Background

Work in 2006

SACN published its final report on Folic Acid and the Prevention of Disease in December 2006. The full report is available on SACN’s website. It recommends mandatory fortification of flour with folic acid, provided voluntary fortification is controlled and advice is given about supplement use.

To coincide with the publication of SACN’s report, FSA held a consultation seeking views on options to increase folate intake of young women in order to attempt to reduce the number of pregnancies affected by neural tube defect

Work in 2007

In May 2007, the FSA Board agreed that white and brown flour should be fortified with folic acid in the UK[1] . This would be as part of a package of measures to help prevent the number of births affected by neural tube defects. In short, FSA’s Board stipulated that the overall effect of mandatory fortification should be to:

1. reduce the incidence of Neural Tube Defects (NTDs)
2. increase folic acid intakes by an average of 60-100micrograms/day
3. ensure numbers not achieving the reference nutrient intake (RNI) for folate do not exceed 10%
4. ensure that numbers exceeding the Upper Limit (UL) for folic acid do not increase above current levels
5. ensure folic acid reaches those with intake within the lowest quintile of consumers.

The Board also agreed that mandatory fortification would need to be introduced in conjunction with controls on voluntary fortification.

1. Organic flour is also likely to be fortified