Bread and Flour Regulations (Folic Acid)

A Bill to amend the Bread and Flour Regulations 1998 to require flour to be fortified with folic acid.

What are people's views on this? - Do we need to petition against this? - I understand that Folic Acid (vitamin B9 or M) can have an adverse effect on people's ability to absorb B12 into their bodies, which concerns me greatly, as this could be extremely bad for anyone with existing B12 deficiency levels; although I realise that many of us are probably already eating foods with this additive (quite probably without even realising it). Folic Acid, B12, and Iron and Folate Deficiency (both about half-way down the page).

20 Replies

  • Do the powers that be also intend fortifying flour with B12? This would make more sense. Folic acid(B9) without B12 can't be right.

  • Too true wedgewood - they both go together like peaches and cream...

    I'll break into song in a minute so I'd better go and get the wife's breakfast :)

  • I think it more likely that the Folic Acid will be added in much the same way that similar additives are added to cereal, ie: sprayed onto the end product, or added into the mix; and, yes, if you look at the linked Wikipedia page (the link does not seem to work that well for some reason, so search engine -> folic acid) you will see:

    Folic acid (conjugate base folate) is a B vitamin. It is also referred to as vitamin M,[4] vitamin B9,[5] vitamin Bc[6] (or folacin), pteroyl-L-glutamic acid, and pteroyl-L-glutamate.[7], B9 is part of the same vitamin group, but otherwise completely seperate from B12. Unfortunately, the rest of the article (and linked references) do confirm that B9 does not co-exist happily with B12, and can inhibit the body's intake, or ability to process, B12.

  • Are you sure about folic acid affecting absorption of B12? Have you got any evidence?

    The danger of supplementing with folic acid/folate/B9 is that it can mask haematological signs of B12 deficiency e.g. raised MCV. I've never read anything to suggest that it actually affects absorption of B12.

  • Folic Acid (vitamin B9 or M) can have an adverse effect on people's ability to absorb B12 into their bodies

    Nope, folic acid has zero effect on the absorption of B12.

    I'll petition against the addition of folic acid to bread at the same time as I petition against people being allowed to eat spinach because it contains folic acid and zero B12.

    Folic acid has been added to bread in the USA for 18 years. In that time it has saved thousands of children from having neural tube defects. The level of fortification in the US was designed to minimise the number of people who might consume more than 5000 ug per day. This is the level at which folate can begin to mask the macrocytic anaemia caused by B12 deficiency.

  • I was a little concerned about some of the issues, and some of the linked material, but do not understand the subject well enough to know if my concerns were justified, so if you are happy with the situation then that will do for me (you understand the subject better than myself, my doctor, or any of the specialists I have tried to work with!).

    engels: go with fbirder's reply: they are the resident expert, not me =] ...I was a bit confused over what I had read and would appear, thankfully, to be wrong in my concerns.

  • Are you based in the UK or the US? Just useful to know.

    The subject of folic acid fortification of bread does get a lot of bad press in relation to B12 because high levels of folic acid can counteract the macrocytosis that is one potential symptom of a B12 deficiency, and so, the argument goes, could delay a diagnosis.

    However, I personally think that arguing on these lines is not helpful. The problem isn't the lack of macrocytosis. The problem is poor understanding of the way in which B12 works and a tendency to view B12 as a blood disorder - which it isn't.

    Something like 30% of those with a B12 absorption problem have neurological symptoms long before any sort of anaemia develops. It would be a lot more helpful to have the medical community really come to terms with the fact that B12 isn't a blood disorder, that measuring levels in blood serum as a way of diagnosing B12 is a pretty poor way of going about things and that they need to understand and assess the full range of B12 symptoms: to start diagnosing and treating B12 deficiency based on symptoms rather than blood levels or the presence of macrocytosis.

  • "High levels of folate are normally okay as long as your vitamin B12 level is also normal. Cells need vitamin B12 to use folic acid and when vitamin B12 levels are too low, folic acid cannot be used and builds up in the blood." :

    Re. masking of B12 deficiency and other information:

    Sally Pacholok, haemotologist, and others talk about folic acid in products masking B12 deficiency in this film :

  • There's a lot of misconceptions about folate masking B12 deficiency. So I thought I'd clear up some of them.

    Yes, it is true that high levels of folate in the blood can mask one of the symptoms of B12 deficiency. That is macrocytic anaemia. But we all know that macrocytic anaemia isn't the only symptom. Indeed, we should all know that many sufferers of PA don't actually have macrocytic anaemia.

    And high folate isn't the only thing that can mask macrocytic anaemia. Iron deficiency anaemia can do exactly the same.

    So, how does one get folate levels high enough to mask macrocytic anaemia? Well, the easiest way is by consuming large amounts of folate supplements - often at the behest of clickbait websites that warn of the dire consequences of 'methylation'.

    The second easiest is through your diet. In the UK recommended amounts are 200 ug per day, rising to 700 ug for newly pregnant women. So how much will people get from fortified bread? In Australia they add sufficient to flour so that they get 135 ug per 100g of bread. Warburtons medium sliced bread comes in at 40 g per slice. So that's 14 ug of folic acid per slice. To get half of your recommended amount you'd need to eat 7 slices per day if you're a man and 25 if you're a pregnant woman. And that's just to get to half of the recommended amount. I've seen people advocating 5000 ug a day - that's 360 slices of bread!

    But what about other dietary sources? Well, if fortified bread shouldn't be allowed nor should Black Eyed Peas (1 slice per 1/2 Tbsp) or Spinach (1 slice per 20 g).

  • That's just the kind of thing I was trying to work out after replying to Polaris's post, - thanks. - I can easily eat 14 slices of Warburton bread in a day (especially if I am running low on provisions); so does 100% of my daily folate requirement equal the masking level, then, or the point at which I do not want to take my intake any higher in order to avoid hitting the masking level?

  • does 100% of my daily folate requirement equal the masking level

    Not at all. The level of fortification with folic acid was set to minimise the number of people who would reach the level at which masking may cause problems, This was deemed to be ingestion of 1000 ug per day, which would require you eating 70 slices a day (or one tin of black eyed peas).

    But that's 70 slices a day, every single day. No matter how much you enjoy a sarnie that seems a lot.

    Besides, you already know that you have PA (a positive anti-IFAB test) so it doesn't really matter if any macrocytic anaemia is masked. It won't affect your current diagnosis.

  • My vegetarian relative had undiagnosed B12 deficiency for years with high folate, which masked her deficiency. The ensuing battle to have symptoms recognised delayed adequate treatment with B12 injections. The result:

    Severe fatigue and other subtle symptoms misdiagnosed as ME for years, then misdiagnosed dementia and schizophrenia.

    Neurological and psychological damage now permanent.

    I do not believe blanket folic acid supplementation in flour products is helpful. It is complicated and is explained well in the film above.

  • It sounds more like medical ignorance than high folate which masked her deficiency. The common idea that 'no macrocytic anaemia' = 'no B12 deficiency' was much more responsible for the misdiagnosis.

    There's about a 20% chance that she would have been like me - no macrocytic anaemia despite low folate.

  • I'm with you on this one. The real issue is that many doctors still refuse to accept that it is possible to have PA or B12 deficiency in the absence of macrocytic anaemia. I can't see any sound reason for opposing fortification of flour with folic acid.

  • My concern, too; but I am a novice when it comes to these matters and not in any way a medical professional, and so I defer to those, like fbirder, whilst I try and improve my knowledge on the matter. I will certainly be trying to investigate my folate intake, though, in view of the comments on the subject and will need to work out how x amount in food translates to y amount in the blood.

  • Sally Pacholok is already doing her best to bring awareness of B12 deficiency FBirder - unfair to expect her to take on a big corporation as well!!!

    She and her husband have worked on the frontline for years in a large city hospital emergency department, seeing and treating first hand the varying results of B12 deficiency. She also brings folic acid supplementation to public attention in the film above. I prefer to listen to the many experts in the film, who have vast knowledge and research at their disposal.

    Having lived quite a long while and known many vegan/vegetarians, I've noticed that all have had years of ME/CFS and then neurological problems later in life.

    Someone posted on HU recently that, although there was no evidence that non vegetarians were more likely to die earlier, research showed that vegetarians were more likely to die of neurological diseases than other diseases suffered by non vegetarians.

    Folic acid is used to treat anaemia and masks B12 def. - the result is neurological damage - and even more difficulty in getting the correct treatment.

  • The main problem with many so-called vegetarians (and especially vegans and the similar diet consisting purely of nuts, berries, roots, and tubers) is that they are not: vegetarianism is a very expensive (and difficult) lifestyle choice - you _really_ need to know what different vegetables will give you by way of various requirements, and it is necessary to eat a very large variety (to a far greater extent than with a 'normal' diet) of vegetables if you are not to starve, or deprive, the body of the full range of vitamins and minerals.

  • I've just been reading this paper - - which summarises the experiences of various countries. One bit made me stop and check something.

    Breakfast cereals in the UK are fortified with folic acid. Indeed, one 30 g serving of All Bran contains an amazing 400 ug of folate - - or the same as 28 slices of fortified bread!!

    So why no massive outcry about the potential health effects of your kiddie's cereals? Yes, they are also fortified with B12 but so what. If you have PA then you won't absorb any of that (well, maybe one tenth of a microgram which ain't going to do much). When is Sally Pacholok going to stand up to the mighty Kellogs and expose this terrible health scandal.

  • Whilst you are decrying our cereals (which I do not eat because they are so unhealthy and have a very high Glycemic Index), check out the added salt and sugar levels. - If that does not make you cringe, then nothing will ...and I am not even going to go into _why_ the likes of Kellogs should feel it necessary to pollute supposedly 'healthy' breakfast cereals with such additives...

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