Folate to be added to flour

[Dadvatar]

Link below

I thought this had been shelved as it masks b12 deficiency?

theguardian.com/society/201...

[Sleepybunny]

Hi,

Think PAS have had some input.

Issue of fortification of flour with folate is mentioned in this blog post from Martyn Hooper's blog.

martynhooper.com/2018/10/10...

[fbirder]

Here’s what I wrote about this two years ago...

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).

[helvella in reply to fbirder]

I find myself taking issue with this statement:

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

Iron deficiency works in the opposite direction and counters the macrocytic anaemia. But, at least in theory, Red cell Distribution Width can help to clear up the issue. Of course, ignorance can mean this is not realised.

[fbirder in reply to helvella]

Yes, IDA doesn’t mask MA in ‘exactly the same’ way. But it can mask MA in people who believe that MCV is the be-all and end-all for MA diagnosis. Just like folate can mask B12 deficiency in people who believe that MA is the be-all and end-all of B12 deficiency.

[Polaris]

The doctor/B12 researcher has strong views about not adding folic acid to flour in the film about how Sally Pacholok came to write her book :

m.youtube.com/watch?v=OvMxJ...(Not working as expected?)

[deniseinmilden]

I hear the concerns raised but it is going to be at such a low level it is unlikely to do any significant harm (or much good).

[Gambit62 Administrator in reply to deniseinmilden]

agree on the levels - concern should be around administering high dose folate acid when there could be a B12 deficiency going on because that has been a circumstance in which there are a few reported cases of precipitating nerve damage.

to be clear, folate intake can mask one symptom of B12 deficiency but as it is a symptom that isn't present in 25% of patients first presenting I personally think the problem is more to do with the tendency to be confused andthink that anaemia is the be all and end all of B12 deficiency - which it most definitely isn't.

[deniseinmilden in reply to Gambit62]

Definitely!

The reason I struggled to get any treatment and couldn't get any further testing from my GP was because I wasn't anaemic - yet I was at death's door.

I wonder if high level folate supplementation before therapeutic dose B12 treatment can make matters worse beyond just disguising the anaemia though, as it may improve some of the symptoms as so many are similar and this could result in the B12 treatment being put off for longer. I think in theory this shouldn't happen as each deficiency is specific but I'm not so convinced about how it works in practice as increasing folate levels from normal for the person to optimum may give rise to some improvement and therefore delay the correct B12 treatment.

A bigger problem that I'm aware of is that some rheumatology clinics (and other medical professionals) freely prescribe 5mg folate pills without testing B12 levels! When challenged and shown the guidelines, even senior staff are unaware of the potential issues.

Thank you for your reply.

[Polaris]

It doesn't make sense to add folic acid to flour without balancing it with B12 or at least without more accurate B12 testing and treatment for everyone. Pregnancy in particular makes huge demands on stores of vitamin B12 in the body and many older people are likely to be deficient in B12 too as less able to absorb it. There's also the growing number of younger vegetarians and vegans of child bearing age to be considered, who would probably have high folate but lower B12......

The original doctor/researcher was Dr Lucy Wills. She discovered the link between folic acid and anaemia in many pregnant women (particularly Indian vegetarians) and that this was reversed by adding Marmite to the diet. Marmite is loaded with other B vitamins, not just folic acid and including B12 - the DNA building molecule we can't do without - rather important I would guess when nurturing a growing foetus! These links show more:

ucdmc.ucdavis.edu/welcome/f...

researchgate.net/publicatio...

Note: edited by admin

[KimberinUS]

14 ug per slice doesnt sound bad but my question is, once it is done will it be easily increased to the larger amounts like in the US?

In the US the daily recommended amount is 400 mcg. my bread has 20% per slice so a 2 piece sandwich has 40% which is 160 mcg. my pasta has 40% and my cereal has 50%. so if i have a bowl of cereal for breakfast, a sandwich for lunch and pasta or even bread with my dinner i am over 400 mcg without eating a single fruit or vegetable. add to this the fruit and vegetables i do eat plus the multivitamin and b100 i was directed to take when i was diagnosed with a b12 deficiency and i was getting 1200 to 1500 per day and they never checked folate because uhm, all US citizens get more than enough.

my very first folate test on 11-17-2017 was <24, the top of range and I had not taken the b100 for over a year. my only other folate test was <20, also top of its testing range. 2nd one was done 8-28-18 after i had been off the b100 for 2 years and off the multi for 45 days.

so in short i have no idea how high my folate actually was.

i do know my mcv was only 95 prior to any supplimentation except my supplimented food, of course. my very first b12 test, which was 169 pmol might have showed a higher mcv and been taken more seriously without the possibly high folate level. i say more seriously because they recommended tablets which i took for 30 months as i deteriorated much further. i thought i had early onset dementia or Alzheimer's disease and was going to die. seriously, DIE

some might be ok. more might not be better

[fbirder in reply to KimberinUS]

I've no idea why your bread contains so much folic acid. The FDA requirement is almost the same as the Australian one I quoted - 140 mcg per 100g - ods.od.nih.gov/factsheets/F... - so that 1 slice contains 32 mcg or 8% of the RDA.

[Polaris in reply to KimberinUS]

I agree KimberinUS On beginning to inject B12 and wanting to supplement other nutrients that were probably not being absorbed either, I noticed that folic acid was included in 'Gentle Iron' and BComplex, as well as a multivitamin I'd already been taking for some time.

Re. Professor Ralph Green, UC Davis - from link given previously :

“Vitamin B-12 and folate (B9) have a complex interaction in the body,” Green said. “A deficiency of one may be ‘masked’ or at times aggravated by excess of the other.

High levels of folate, for example, may mask underlying B-12 deficiency. On the other hand, work from his laboratory and a group in Boston have shown that in the U.S., among individuals with low B-12 levels, those with high folate levels may actually show more profound metabolic derangements than those with normal folate." 😳

[fbirder]

Ah! I've just found my other old post.

The level of fortification in bread in the USA was set so that almost nobody would consume more than 1000 mcg (at 8 mcg per slice that would equate to 125 slices of bread) per day.

Why set the limit at 1000 mcg a day? In the words of the experts....

The tolerable upper intake level (UL) (1000 μg/day) was established by the IOM in 1998 as one-fifth of the lowest observed adverse effect level (5000 μg/day) associated with a potential adverse outcome in early case reports (the masking of vitamin B12 deficiency anemia)

ncbi.nlm.nih.gov/pmc/articl...

So eating 125 slices of bread a day would give you one-fifth of the amount of folic acid that masks B12 deficiency anaemia.

[KimberinUS in reply to fbirder]

i super love all the science you lay down on us less knowledgable folks but im wondering if there was a math issue when you calculated your numbers the first time you did this a couple of years ago.

my bread has 20% of rda per slice, so 80 mcg per slice, not 8.

so 12.5 slices of bread a day would be 1000 mcg per day.

my spaghetti says 40% per serving, my cereal boxes vary from 25% to 50%.

They are loading us up on folic acid over here

[fbirder in reply to KimberinUS]

I am basing my calculations on what the FDA say in the document I linked. - But I did make a mistake. It's 32 mcg per slice, or 8% per slice.

Table 2: Selected Food Sources of Folate and Folic Acid [12]

Food Micrograms

(mcg) per serving Percent DV*

Spaghetti, cooked, enriched, ½ cup† 45 11

Bread, white, 1 slice† 32 8

So to get to 1000 mcg you'd need to eat 31 slices of bread. And that's still one-fifth the amount to mask megaloblastic anaemia caused by B12 deficiency.

Interestingly the FDA say that fortified spaghetti should have 11% per serving. I wonder if companies are relying on the 'if some is good, more must be better' myth.

[Polaris]

Oh no 😱 - more folic acid and less meat ! Just arrived in my inbox:

Humans need to eat less meat? :

globalcitizen.org/en/conten...

Should perhaps be balanced by

'The Vegetarian Myth'

amazon.co.uk/Vegetarian-Myt...