Folic acid to be added to UK flour

Within the next few weeks, the UK government is planning to introduce a law which states that all flour and flour-based products must be fortified with folic acid. Here’s what Maeve Hanan, consultant dietitian and health writer, has to say about it.

Firstly, here’s why it’s being considered. Folic acid is the synthetic form of folate, a type of B-vitamin. It plays an essential role in spine and nerve development in a foetus. A lack of folic acid in the first trimester of pregnancy hugely increases the risk of the foetus developing a neural tube defect (NTD), like spina bifida (where a section of the spine is underdeveloped and exposed) or hydrocephalus (excess fluid in the brain). NTDs can cause severe disability in some cases — for example, paralysis, seizures, and learning difficulties. So it’s really important for women to get enough folic acid when they’re planning a pregnancy and during the first trimester.

So I think this planned fortification is great news, especially since very few women in the UK take the recommended folic acid supplements. And worryingly, around 90% of women of childbearing age in the UK were recently found to have low folate levels. The UK also has one of the highest rates of NTDs in Europe — so reducing this is vital for the health of babies, and could save the NHS a lot of money.

This move is actually overdue, as it was discovered back in 1991 that folic acid supplementation could reduce the risk of NTDs by 72%. Also, over 80 other countries already have this in place, like Australia, the US, and Canada.

Folic acid fortification is also safe and effective. A study from the US found a 28% reduction in NTDs after folic acid fortification was introduced. Similarly, an estimated 2000 NTDs could have been prevented in the UK between 1998 and 2015 if this fortification had been in place.

The specific details of this plan haven’t been announced yet, but it’s very unlikely that recommendations for taking folic acid supplements in pregnancy will change. So it’s vital that women who are planning a pregnancy continue to take a daily 400 mcg folic acid supplement for the first 12 weeks of pregnancy. Some women need to take a higher 5 mg dose if there’s a family history of spina bifida, or if they have diabetes.  

There’s some controversy about whether folic acid fortification works for everybody. And there’s a risk that it could hide if someone has low levels of vitamin B12 because it can mask the symptoms. But these haven’t been seen to cause problems in other countries. Plus this move is backed by many professional health bodies, like the World Health Organisation, the Medical Research Council, the British Medical Association, and the British Dietetic Association. So when the reduced risk of NTDs is considered, I feel it makes a lot of sense to fortify flour with folic acid.

A lot of the credit for this plan goes to the charity ‘Shine’ and the Royal College of Obstetricians and Gynaecologists (RCOG) for their ongoing campaigning in this area.

Read more from Maeve by checking out her blog and Instagram account @dietetically_speaking.