Fortification of flour is a public health policy known to reduce neural tube defects in babies

[helvella]

Note: As written, no mention of B12.

I know I have previously seen the concept of fortifying with folic acid possibly being a problem in those who are B12 deficient being dismissed.

Folic acid is to be added to the most commonly consumed flours in the UK to help prevent spinal conditions in babies, the government has announced.

Doctors advise pregnant women to take folic acid supplements but, with about 50% of pregnancies in the UK being unplanned, many mothers-to-be may not be able to do this early enough.

The government said requiring flour millers to boost non-wholemeal wheat flour with folic acid will actively help avoid about 200 neural tube defects in babies each year – reducing the annual UK total by about 20%.

theguardian.com/society/202...

Adding link to BBC (accessible in the UK but likely not elsewhere) as the story there does mention B12:

bbc.co.uk/news/health-58615838

Also posted to my "home" Thyroid UK forum, in case it is of any interest:

healthunlocked.com/thyroidu...

[Scotlad76]

Was just reading the sane in The Times and wondering how it would affect us. And specifically how if eoukd affect those who are taking additional Folic acid supplements.

[helvella in reply to Scotlad76]

I suspect it will have limited effect given the following:

Gluten-free diets are quite common;

There are no plans (currently) to mandate fortification of gluten-free flour;

Wholemeal flour is not included;

Low wheat-flour intake is quite common;

The actual amount to be added is unclear. Australia apparently adds 2-3 milligrams per kilogram of flour.

We also get certain bakery goods in considerable quantity from EU countries but, in 2019:

11. Other countries adding folic acid to flour

The use of flour, specifically wheat flour, as a product for folic acid fortification has been adopted in more than 60 countries world-wide (including Australia, Canada and the US). Its primary advantage compared with fortifying other foods is that flour is widely consumed in some form or other.

Countries that have mandated folic acid fortification have seen falls in rates of NTDs of between 16% and 58%, and have not identified increased risks associated with fortification. However, these countries may not have similar diets or populations to the UK.

Currently, no EU country has a policy of mandatory fortification of flour with folic acid.

gov.uk/government/consultat...

So those who like French croissants and Irish bread might miss out.

[Scotlad76 in reply to helvella]

I'm assuming it's aimed at the poor who will be less likely to be gluten free, into artisan breads, and far less likely to comply with supplementation guidelines.

[helvella in reply to Scotlad76]

However, I believe that quite a number of pizza bases (for one example) are manufactured outside the UK.

Nor do I know where Subway bread, MacDonalds buns, etc. come from.

Trying to avoid stereotyping and assumptions, but these products do seem to supply a considerable proportion of our food - poor or not.

[Scotlad76 in reply to helvella]

It's all about the white bread consumption which is still very high per capita, so is overweight and obese possibly unrelated lol. statista.com/statistics/284...

[helvella in reply to Scotlad76]

I see the average is around 500 grams a week - so at Australian fortification rates, that could provide 1 to 1.5 milligrams per week. (Assuming no losses in processing/cooking, no waste, etc.)

But I strongly suspect that the distribution is uneven with some consuming rice, potatoes or pasta to a greater extent and bread less. (And much pasta is imported.)

From a personal point of view, I pretty much never buy white bread. The odd item such as biscuits or cakes - yes. Far more wholemeal bread, potatoes, rice, etc.

[ACritical in reply to Scotlad76]

For people having reduced MTHFR enzyme activity. As I understand, Folic acid added to food can then result into a highly reduced ability of the body to convert folic acid into a usable form and can lead to accumulation of the amino acid homocysteine – which is toxic to the body. Correct me if I got this wrong.

[Scotlad76 in reply to ACritical]

Not sure this is an issue with regards to fortified flour. I have not seen anything concerning this from countries that already firtify flour with Folic acid.

[Gambit62 Administrator]

I believe the PAS has expessed some concerns.It won't affect anyone who has been diagnosed but it has been noted that it can mask the development of macrocytosis and could cause problems with diagnosis. Personally I think this is a bit of a red herring and the real issue is that GPs need to realise that macrocytosis isn't a defining characteristic of PA or other B12 absorption problems. There are a large number of patients who don't have macrocytosis when they first present and if this was really in the consciousness of GPs then masking because of folic acid fortification would not be an issue.

The regulations would require fortification of flour rather than bread - wholemeal being excepted (not quite sure why ... may be it is higher in folate anyway or may be it is just a whim). That means that making your own bread wouldn't escape - unless you use 100% wholemeal.

[helvella]

Extra information:

Flour, wheat, white, plain, soft

Folate µg 16 (per 100 grams)

quadram.ac.uk/UKfoodcomposi...

Flour, wheat, wholemeal

Folate µg 27 (per 100 grams)

quadram.ac.uk/UKfoodcomposi...

Australian supplementation (2 to 3 milligrams per kilogram) is in the region of ten times the level in wholemeal flour.

We also need to know how the folic acid content of flours will be monitored. It is all very well imposing a mandate but unless it is monitored there will be mistakes and carelessness resulting in inappropriate levels of folic acid - possibly both too much and too little.

[ACritical]

Exactly. Also for people having reduced MTHFR enzyme activity. As I understand, Folic acid added to food can then result into a highly reduced ability of the body to convert folic acid into a usable form and can lead to accumulation of the amino acid homocysteine – which is toxic to the body. Correct me if I got this wrong.

[Espeegee]

😡

[helvella]

Attempts to educate have failed.

Whether you think the attempts were not good enough, or not funded enough, fine. But what has been done, not just here but in other countries, seems not to have worked. If it had worked, we'd not have seen any appreciably effect of implementing a fortification regime.

The (voluntary) breakfast cereal fortification has failed.

[Hidden in reply to helvella]

It's a difficult subject as not all people respond to blanket education on nutrition. We are all individual and what suits one can have a detrimental effect on another. Having IBS for over thirty years even doctors are baffled as to what is good and bad. Salt and sugar are supposed to bad, but we need both. ITs moderation ,variety and getting to know your own body and what works.