Folic acid in white flour?

We have made headway so that most people know that you need folate (also called folic acid) in your diet, especially if you are planning a baby or already pregnant. Folate, a B vitamin which is vital for the formation of red blood cells as well as other important functions in the body, is found in many foods in the diet including spinach, kale and broccoli, wholegrain foods, liver, fortified breakfast cereals and orange juice.

However, folate intakes are still too low in the UK to meet people’s needs. Also, only 20-25 per cent of women follow official advice to take 400mg folic acid daily as a supplement when planning a pregnancy and during the first three months, although the percentage increases significantly once they know that they are pregnant. That means 75 per cent of women are not taking folic acid supplements at the right time.

Although there are benefits to starting to take daily folic acid supplements in early pregnancy, it is far better to start before a pregnancy occurs. This is the best way to minimise the risk of a baby developing a neural tube defect, which occurs in the very first stages of the development of the foetal brain and can lead to severe cognitive impairment.

Younger women, and those from lower socio-economic groups are least likely to take folic acid before and during pregnancy, so clinicians and health workers need to concentrate their efforts here in terms of advice and information. There may be a false perception that folic acid supplements are expensive. In fact, if you buy non-brand versions in basic packaging, it can costs pennies a day. It is also available to some women on prescription, particularly if they have already had a pregnancy affected by neural tube defect.

We need to get women to think about the risk of not taking daily folic acid supplements – the birth of a child with lifelong health problems that are entirely avoidable.

In the USA and Canada, white flour is fortified with folic acid by law so that most people will receive enough in their diet. Mandatory fortification of folic acid was rejected in England and Wales because of concerns that it can boost bowel cancer risk or mask B12 deficiency in elderly people which causes pernicious anaemia and confusion. However, this is now being re-examined by a UK nutrition expert committee to weigh up the potential benefit to many thousands of infants compared with the theoretical risk to elderly people. I will await the committee’s conclusions with interest as it could revolutionise women’s folate status in the future.

The Republic of Ireland is close to legislating in favour of mandatory fortification of white flour with folic acid and Scotland will also be deliberating this point in the next couple of years.

Of course, adding folic acid to flour won’t be a complete solution. Women who are thinking of having a baby or already pregnant will still need to top up their levels with a daily supplement, but it will be a good safety net. It will bring most people into the normal range.

Overdose of folic acid is unlikely because it is a water-soluble vitamin and excess amounts are simply excreted through the kidneys in the urine. Older people need lower amounts of anyone over 50 years or with a history of bowel cancer shouldn’t take more than 200μg folic acid a day.

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