Folic acid to be added to flour in effort to reduce serious birth defects
Ministers reject food industry objections in major U-turn over compulsory fortification
All flour will be fortified with folic acid after ministers swung behind a plan that medical experts believe will stop hundreds of babies a year from being born with birth defects, the Guardian can reveal.
Ministers will order the introduction of automatic fortification within weeks after being convinced by their own advisers that the policy will reduce the risk of babies developing spina bifida and other conditions that involve severe disability or death.
The move represents a significant U-turn as ministers in successive governments have ignored repeated pleas to embrace the move.
Downing Street has approved the switch following a long-running campaign by doctors, scientists and baby health campaigners in favour of fortification, well-placed Whitehall sources say. Theresa May, who was opposed to it, has been persuaded to change her mind, a key official said.
Not forgetting those who avoid yeast, and of course those who bake their own bread from various other types of flour rather than buy it ready made. I suspect the decision makers on this have absolutely no idea that many people simply don't eat 'generic bread' for one reason or another.
I suspect the decision makers have made this decision to make some of our products compatible with some other countries as a prelude to attempting to increase UK exports to non-traditional markets which have mandatory folate fortification regimes.
That is, the prime reason is not our health and that of our offspring.
They are concerned about the masking in the context of doctors being terrible at diagnosing B12 issues and the available tests being pretty poor.
COT
The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) contacted me in the summer to ask my opinion on the accuracy of the B12 test. The committee secretariat had visited our website and were made aware that there seemed to be “issues” with the accuracy of the test. I prepared a report for the committee and was then asked to attend a meeting in London. The committee was acting as the secretariat for the UK Government who are considering raising the ‘upper tolerable level’ of folic acid fortification to flour. Adding folic acid to flour will help reduce the number of babies born with neural tube defects (such as spina bifida). However, it would mean that some of the indicators of B12 deficiency would be masked. The committee wanted to know if the present test to determine the B12 status of patients was accurate. I told the committee that the PA Society is not against fortifying flour with folic acid but we are concerned that the current B12 test is far from being an accurate assessor of patients B12 status and that the committee needed to be aware of that. The committee decided not to raise the upper tolerable level of folic acid fortification of flour until a more accurate test was developed.
Vitamins are provided free under the Healthy Start scheme - Healthy Start vitamins contain vitamins A, C and D for children aged from six months to four years, and folic acid and vitamins C and D for pregnant and breastfeeding women. Eligibility is being pregnant or have a child under 4yrs and be in receipt of certain benefits; or being under 18 yrs and pregnant but not needing to be in receipt of benefits.
I wasn’t prescribed or even told to take folic acid for my pregnancies, even after I miscarried in 1987. Didn’t know about folic acid for pregnancy until well after my youngest was born in 1991.
Before I got ill I once worked on a research project that was related to the Welsh assembly introducing free breakfasts in primary schools.
We went into schools and interviewed children at various ages about all the food they had eaten in the past day. We had big directories with pictures of all kind of food, and other techniques to help them remember.
Overwhelmingly the children had had no fruit or vegetables at all all day. The research team were very middle class and a bit patronising. On one of the days I was working, someone found a child who had had an apple, and there was a big celebration in the team when we met at the end of the day.
So definitely there are many people eating no fruit or veg at all.
I am really concerned about mass-medication; where does it end? I do not need, nor want, fluoride in my water. If I wish to keep my teeth I clean them. (I understand that there is some contention as to whether or not fluoride does prevent caries.). I do not need folate added to flour, if I want folate I take it as a supplement. This smacks of medicating everyone so that doctors do not have to do extensive testing and diagnoses. Next step soma?
I have been reading a book by Charlotte Gerson about the Gerson Therapy. With the therapy they hardly drink any water, but do masses of fresh juices throughout the day. Any water they do use is distilled water.
Before anyone says it, yes distilled water will leach minerals from the body. But that's precisely why there are lots of fresh juices drunk, to ensure a ready supply of minerals and vitamins etc.
But apparently distilling is the only method of getting really pure water. It even removes fluoride that is left behind by many other water treatment methods.
Fluoride is a toxic industrial byproduct with negative side effects, including endocrine disruption. Folate an essential micronutrient. I eat little wheat flour or processed food, but for those on solely on poor quality diets, it could mean better health.
well it is worrying, in my case after the area I lived in put fluoride in the water approx 12 months afterwards I developed a goitre which then some 20 years later ending up having part of my thyroid removed - could have been a coincidence but you never know
Fluoride displaces iodine in the body. It's a halide with a very similar chemical composition to iodine which a healthy thyroid relies on. If for whatever reason you are deficient in iodine in the body and fluoride is available then fluoride is taken instead.
Fluoride is a byproduct of nuclear waste apparently. But now they are putting it in everything.
I have often wondered just how many on the thyroid forum live in areas where fluoride is added to the water supply.
I started making my own bread for the simple reason that store bought bread contains so much additional sh*t, including soya flour and iron, that I neither want nor need in my diet, but if they're now going to start messing about with the flour you bake with, what am I supposed to do to escape it? It's as though these busybodies have to do anything to justify their existence apart from get a proper job! Food is becoming far too chemically formulated these days and it's no wonder people are becoming more and more susceptible to all sorts of medical conditions including, but not confined to, hypo/hyper-thyroidism.
Perhaps try some organic heritage grain flours? There are many interesting varieties available for baking. I'm experimenting with kefir as a sourdough starter. Sometimes I add a little molasses for extra minerals.
In Canada, wheat flour has been fortified since 1998. This has resulted in a reduction of by over 40% in neural tube defects. There has also been a very significant reduction in atrial and ventricular septal defects.
Despite everything:
Currently, at least 25% of women of child-bearing age do not have folate intake sufficient to optimally protect their offspring from NTDs. Inequality remains, with women of lower socio-economic status being less well protected by folate. As a consequence, they bear the greatest burden of this serious congenital anomaly.
It is true that women oftentimes have unplanned pregnancies. It is also true that looking from the outside, a person could JUDGE women who bear children when their socio-economic circumstances are very sub-optimal. However, it happens and what with the current situation where the rich are getting richer and the poor and middle class are getting poorer, working harder for less, it would only compound the difficulties to not acknowledge that giving birth to severely deformed babies does not make life any easier. It is hard enough to raise 'normal' children much less have to care for disabled children.
Even though fortifying wheat flour will not eliminate all neural tube defects, it's a good start.
It's all very wonderful that there are people who manage to consume sufficient folate from their diets but from what I've seen on laboratory results on this forum, there's an awful lot of people with low folate levels.
There's quite enough suffering in life. If just some of it can be reduced, I say 'go for it'.
When I lived in Trinidad and was waiting to get an ultrasound done because I was pregnant, a woman came out from her appointment crying uncontrollably. She was about
5 or 6 months pregnant and had just found out that the fetus had no brain: anencephaly. This also is one of those inadequate folate developmental problems. This was 1982 so I don't know if any of this was known at the time.
I never took folate for either pregnancy. No one told me and no one tested. Thankfully neither of my children were born with a congenital defect due to nutritional inadequacy.
But I would never consider denying anyone else from having an increased chance of delivering a healthy baby on account of opposing folic acid fortification of flour.
It's about time the U.K. mandates fortified wheat flour.
In Canada, wheat flour has been fortified since 1998.
I assume you were being specific about folate which is the subject if the thread. Just so everyone knows, technically, wheat flour in the UK has been fortified for a very long time. I think this is a fair summary:
The addition of calcium carbonate became mandatory in 1943 to increase calcium levels in the diet and throughout the 1940s to the end of food rationing in 1954 the milling of flour up to 80% extraction or higher was required by law in order to make full use of the nutritional value of the wheat grain.
In 1953 the milling requirement was removed, bread could again be made from flour of 70-72% extraction but it contained much lower levels of nutrient found in the germ and outer layers of the grain present in flour of 80% extraction. Regulations were introduced to restore the iron, thiamin and niacin lost in the milling process and continue the addition of calcium.
Does too much folate cause any side-effects for people who are not deficient? I note that there are mentions of it masking B12 deficiency. Would there be any unacceptable issues such as those with fluoride? Assuming that 50% of the population are male, 50% of the population would not need folate for pregnancy. I cannot find a percentage for the UK of childless women but 20% was stated for the US. That’s a lot of people who do not need folate for pregnancy. I can understand the concern about birth defects but I would like to be reassured that there are no detrimental effects for those of us who are not deficient in folic acid and are not going to get pregnant. I do feel that mass-medication is a slippery slope.
I have found some of the USA's papers on nutrients very useful, at least as starting points. I encourage reading the full link but the risks section I quote below:
Health Risks from Excessive Folate
Large amounts of folate can correct the megaloblastic anemia, but not the neurological damage, that can result from vitamin B12 deficiency. Some experts have therefore been concerned that high intakes of folate supplements might “mask” vitamin B12 deficiency until its neurological consequences become irreversible. Questions about this possibility still remain, but the focus of concern has shifted to the potential for large amounts of folate to precipitate or exacerbate the anemia and cognitive symptoms associated with vitamin B12 deficiency [2,86,149-154].
Concerns have also been raised that high folic acid intakes might accelerate the progression of preneoplastic lesions, increasing the risk of colorectal and possibly other cancers in certain individuals [1,3,61,81,82]. In addition, intakes of 1,000 mcg per day or more of folic acid from supplements during the periconception period have been associated with lower scores on several tests of cognitive development in children at ages 4–5 years than in children of mothers who took 400 mcg to 999 mcg [155].
Intakes of folic acid that exceed the body’s ability to reduce it to THF lead to unmetabolized folic acid in the body, which has been linked to reduced numbers and activity of natural killer cells, suggesting that it could affect the immune system [5,6,157]. In addition, some scientists have hypothesized that unmetabolized folic acid might be related to cognitive impairment among older adults [156]. These potential negative health consequences are not well understood and warrant further research [1,9].
Studies have found unmetabolized folic acid in blood from children, adolescents, and adults [1,5,158,159]; breastmilk [160]; and cord blood from newborns [161,162]. Limited research suggests that single doses of 300 mcg or 400 mcg folic acid (a common amount in folic acid-containing supplements or servings of fortified foods, such as breakfast cereals) result in detectable serum levels of unmetabolized folic acid, whereas doses of 100 mcg or 200 mcg do not [163,164]. In addition, a dose-frequency interaction appears to occur in which smaller amounts of folic acid consumed more frequently produce higher unmetabolized folic acid concentrations than the same total dose consumed in larger, less frequent amounts [165].
Based on the metabolic interactions between folate and vitamin B12, the FNB established a UL for the synthetic forms of folate (e.g., folic acid and 5-methyl-THF) available in dietary supplements and fortified foods (Table 3) [2]. The FNB did not establish a UL for folate from food because high intakes of folate from food sources have not been reported to cause adverse effects [2]. Thus, unlike the RDAs, the ULs are in mcg, not mcg DFE. For folic acid, 1,000 mcg is equivalent to 1,667 mcg DFE because 0.6 mcg folic acid = 1 mcg DFE [11,18]. The ULs do not apply to individuals taking high doses of supplemental folate under medical supervision [2].
Table 3: Tolerable Upper Intake Levels (ULs) for Folate from Supplements or Fortified Foods [2] Age Male Female Pregnancy Lactation
Birth to 6 months Not possible to establish* Not possible to establish*
7–12 months Not possible to establish* Not possible to establish*
1–3 years 300 mcg 300 mcg
4–8 years 400 mcg 400 mcg
9–13 years 600 mcg 600 mcg
14–18 years 800 mcg 800 mcg 800 mcg 800 mcg
19+ years 1,000 mcg 1,000 mcg 1,000 mcg 1,000 mcg
* Breast milk, formula, and food should be the only sources of folate for infants.
Interactions with Medications
Folate supplements can interact with several medications. A few examples are provided below. Individuals taking these medications on a regular basis should discuss their folate intakes with their healthcare providers.
Methotrexate
Methotrexate (Rheumatrex®, Trexall®), used to treat cancer and autoimmune diseases, is a folate antagonist. Patients taking methotrexate for cancer should consult their oncologist before taking folate supplements because the supplements could interfere with methotrexate’s anticancer effects [166]. However, folate supplements might reduce the gastrointestinal side effects of low-dose methotrexate taken for rheumatoid arthritis or psoriasis [167,168].
Antiepileptic medications
Antiepileptic medications, such as phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®), and valproate (Depacon®), are used to treat epilepsy, psychiatric diseases, and other medical conditions. These medications can reduce serum folate levels [169]. Furthermore, folate supplements might reduce serum levels of these medications, so patients taking antiepileptic drugs should check with their healthcare provider before taking folate supplements [166].
Sulfasalazine
Sulfasalazine (Azulfidine®) is used primarily to treat ulcerative colitis. It inhibits the intestinal absorption of folate and can cause folate deficiency [170]. Patients taking sulfasalazine should ask their healthcare provider whether they should increase their dietary folate intake, start taking a folate supplement, or both [166].
I'm feeling very anti-establishment as I suspect this is a cynical move as they are prioritising this (using babies) over the health of the frail and the elderly who need B12. Also no mention of the fact that folic acid requires an enzyme in order to metabolize it (which many of us lack). How, I wonder, are they going to fudge the stats when there is an increase in neuropathy ( due to low B12).
I wonder if this is a big problem now (?) e.g. birth defects.
The link to the Guardian in the original post leads to their version which includes this:
It is estimated that two women a day in the UK have an abortion because doctors have identified an NTD and two children a week are born with an NTD, often spina bifida, which in some cases can necessitate the use of a wheelchair.
Britain is believed to have the highest rate of NTDs in Europe. A major academic study in 2015 estimated that 2,000 fewer babies in Britain would have been born with an NTD between 1998 and 2015 if the government had introduced folic fortification of flour.
Aside from it being very obviously a huge problem to those afflicted, the numbers do seem very significant. Further, as has been said elsewhere on this thread, other defects are also suspected of being at least in part attributable to inadequate folate.
But yet there is a distinct lack of education as to what exactly comprises a nutritious diet. Society has changed so children do not learn these skills from their mothers to the same extent as in the past as with all adults often working convenience foods have taken over.
If knowledge of nutrition is not learnt at an early age, then without later self study of the subject, people really have large gaps in their understanding of what is a good diet.
I don't think anyone deliberately sets out to eat a poor diet but people often really don't know that they are eating poorly.
I will admit that I used to believe that a burger and fries was a balanced meal. It had 'meat', salad and carbs. I don't think I was the only one to think that way.
Somehow there needs to be a real education push 're the links between nutritional deficiencies and chronic illnesses. It is going to bankrupt the country or totally sink the NHS, if it is not addressed.
Problem is their business is selling their product. If businesses are left to their own devices they will come up with whatever statistics or advertising to make their product seem the best ever.
If there is to be unbiased nutritional advice or standards, all of that needs to be directed from elsewhere. But with agencies that have real teeth.
Back when I was still at unversity, part of the program was a nutrition course. I did my own analysis of one week of my own diet. Then to figure out how to obtain 400 mcg of folate in the diet on a daily consistent basis was challenging.
As with everything we say on the forum - it's not what we put in our mouths that makes us healthy - it's what we can actually absorb.
Anyone with liver problems e.g. middle aged onwards, may struggle to convert folic acid and would be far better off with a diet high in naturally occurring folate, b12 and b6 - or to take the methylated forms of these vitamins as a supplement in combination.
The fact that neural tubes require b12 as well as folate, makes me wonder why b12 is not also mandatory for pregnancy. Instead, the baby will 'rob' the mother of her b12 stores, which may explain post-partum depression! Folate requires b12 to work properly. It also needs Magnesium and other co-factors. Many people are deficient in both of these too.
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