Vitality

UK Under Pressure To Add Folic Acid To Flour In Order To Prevent Birth Defects

Bread
The UK is under pressure to start adding folic acid to its bread and other flour products following rise in rare birth defect. Sonja Pieper, CC BY-SA 2.0

The UK is under renewed pressure to enact a public health measure that would have prevented thousands of children from a rare birth defect if it had been implemented in the early 90s.

As reported by the BBC, a bevy of UK public health researchers and organizations have recently come out and recommended that the UK begin artificially fortifying its flour products with the essential nutrient folic acid. Also known as Vitamin B9, an adequate intake of folic acid during pregnancy (around 400 milligrams a day) is known to prevent the formation of neural tube defects (NTDs) in developing fetuses. The change would represent a dramatic shift from its current policy of simply advising pregnant women to regularly take folic acid supplements, though it would follow in the footsteps of 78 countries, including the United States.

"The Royal College of Obstetricians and Gynaecologists (RCOG) is calling for mandatory fortification of bread or flour with folic acid in the UK with the appropriate safeguards, such as controls on voluntary fortification by the food industry and better guidance on supplement use," said the RCOG’s Vice President of Clinical Quality Professor Alan Cameron in a statement earlier this November. "Food fortification will reach women most at risk due to poor dietary habits or socio-economic status as well as those women who may not have planned their pregnancy."

The RCOG’s statement was released on the heels of a November study in The BMJ that demonstrates the rate of NTDs occurring annually in the UK hasn't dramatically changed since the voluntary policy was first put into place in 1992. In 1991, it was shown that proper folic acid intake could conceivably cut the risk of NTDs among pregnant women by 72 percent, the most infamous of which is spina bifida. The U.S., after enacting a similar policy following the study's findings, switched to mandatory fortification in 1998 as dozens of other countries have in the years since.

The latest charge to promote folic acid fortification has come from a December study published in the Archives of Disease in Childhood. Much like many a time travel movie, these researchers decided to imagine an alternative future where the UK followed the U.S.'s lead and added folic acid to the food supply in 1998. They determined that 2014 pregnancies with NTDs would have been prevented from 1998 onwards in that scenario.

"Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children," they wrote.

In the UK, NTDs occur in 1.28 of every 1,000 births, with about 80 percent ending in abortion. Meanwhile, the amount of UK women taking enough folic acid supplements has actually declined from 39.6 percent in 1999 to 27.8 percent in 2012. In the U.S., comparatively, the rate of NTDs has dropped 23 percent since the 1998 change.

The largest reason for the UK’s hesitance surrounding fortification is likely tied to the concern that too much folic acid may lead to an increased risk of certain cancers. According to a 2013 Lancet review of the available evidence, however, this possible link has since been dismissed as unlikely, with the researchers concluding that "folic acid supplementation does not substantially increase or decrease incidence of site-specific cancer during the first 5 years of treatment." Since fortification generally involves smaller doses of folic acid than are available in supplements, that risk is even more minuscule.

According to the BBC, the UK's Department of Health is now looking into the matter more closely. However, the government has resisted calls for fortification for quite some time, despite recommendations by organizations like the Food Standards Agency Board in 2007 and the Scientific Advisory Committee on Nutrition since 2000.

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