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%.
The new rules will only apply to non-wholemeal wheat flour, with gluten-free foods and wholemeal flour exempt.
There was a concern that for some people, particularly the elderly, boosting folic acid might have unintended negative consequences, such as covering up the symptoms of vitamin B12 deficiency.
Am I right in remembering that Martyn Hooper addressed parliament regarding the issue of B12 deficiencies being masked by fortification with folic acid in flour at the time it was announced. Somewhere around the time that Matt Hancock was telling us to eat more broccoli to improve our B12 levels.
Yes - I think that went into the 2019 paper (if not explicitly - it would have fed into it).
Alongside that, we have also seen a huge increase in plant milk substitutes and vegetarian/vegan diets - so likely a reduction in dietary B12 for many.
I really dislike mass-medication. What if one doesn’t need folic acid? I had a quick glance at the announcement in the BBC news headlines and this is all to prevent 200 birth defects per year. (I saw some of a programme made in, I think The Netherlands, about the women injured by the HPV vaccine which was given to thousands, all to possibly prevent 112 deaths per year.). My other thought was that this action assumes that pregnant women only eat white bread/goods. Maybe women will think that they are getting enough folic acid from wholemeal bread and not bother to take any. How can one measure the doses?
I cannot remember the interview, but a ‘boffin’ was saying that we are going to allow total ‘invasion’ and control of our bodies as a price for safety; which in my opinion is too high a price to pay.
Benjamin Franklin once said: "Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety."
Curious how things can change round. Back in 1982, this paper reported controversy about NOT supplementing at least a group in pregnancy.
Nature. 1982 Sep 16;299(5880):198.
doi: 10.1038/299198b0.
Trials ahead
J Wynn
• PMID: 7110341
• DOI: 10.1038/299198b0
Abstract
KIE: Controversy has erupted in Britain over the ethical implications of an impending clinical trial to investigate the role of folic acid and other multivitamin supplements in the prevention of neural tube defects. The study population will consist of women who had previously conceived a spina bifida child and who are now planning another pregnancy. Some critics, believing there is already sufficient evidence of a folic acid link to spina bifida, object to withholding folic acid from one of the high-risk control groups. Concern has also been expressed about the extent to which participants will be briefed.
Wow!An estimated 90% of women aged 16 to 49 have a folate status below the level recommended to reduce the risk of an NTD-affected pregnancy. An estimated 28% of girls aged 11 to 18 years, 15% of boys aged 11 to 18 years and 7% of adults have low blood folate levels, putting them at risk of anaemia
......................and a few elderly are concerned about masking their B12 deficiency?
Mass medication without consent worries me enormously. Fluoride can have negative effects on thyroid health, now folic acid could cause real problems for people with B12 deficiency. Surely it should be up to women considering pregnancy to take steps to ensure that they are as healthy as possible and ensure the health of their babies? It’s what I did, and what my daughter did. I fully support initiatives to minimise birth defects, but it can be done by targeting the appropriate group rather than forcing everyone to medicate.
That is something which is down to the individual, it shouldn’t be up to the rest of society to take unnecessary medication to help them out. Family planning is taught in school, so there’s very little excuse.
Unfortunately it happens anyway. And usually to those who are most at risk of nutritional deficiencies.
I lived in San Fernando, Trinidad back in the early 1980s. I was pregnant and waiting
for my ultrasound when the door opened and a very upset crying approx. 5 months pregnant woman came out after having hers done.
When I went in to have mine done I asked what happened. "The fetus has no brain."
I never took any vitamins when I was pregnant with my two children. But I had taken a nutrition course at university so I knew to make sure I got everything I needed from my diet. Even so, I have studied the subject extensively over the decades because it takes quite a bit to get a thorough handle on the subject.
Furthermore, even in Canada, the doctor never tested folic acid or suggested I take a supplement. Fortunately neither of my children was born deformed.
I worked at a hospital during high school. A baby with anencephaly was born while I was working. What did they do? Fed it glucose water until it died. I'm sure you wouldn't have wished to be in the place of that baby's parents. They were devastated. Ultrasound was not routine before 1975. And abortion was not legal until 1988.
I really have no interest in debating this, I’m afraid. Women who go for regular checks during pregnancy are monitored carefully. That, and education, should be enough. What happens in other countries should have little bearing on the rights and responsibilities of people in the UK. I fully support Covid vaccination because, by having it, we protect ourselves and each other. I do not support forced medication which could have serious implications for one section of society in order to help others who can and should be looking after the health of their unborn child themselves. Obviously this is something we are not going to agree on, and it isn’t really something relevant to this website.
56 years ago, my wife became pregnant with our first child. A certain Professor Smithers was at Leeds University, the one local to us. He advocated taking either folic acid tablets or drinking 1/2 pint Guinness daily to lower the risk of spina bifida in the infant. She took the Guinness option, even though she didn't like the taste. Smithers' findings were not well received at that time, and were effectively ignored by the medical profession. Strange it takes over 50 years for the light to dawn. A good example of medical failure. If 200 infants/year will not get spina bifida because of taking in folic acid, over 50 years this translates to 10000 SB infants needlessly born earlier with this condition. Mea culpa anyone?
Re mass medication. Sometimes it is absolutely necessary. In mid Germany for example, iodine is low in diet and drinks, so that goitre is very frequent there. Iodised salt can help. And it can be safely taken by anyone, as the iodine content is only sufficient for a good supply. Also, don't eat any mass produced cereals for breakfast. And also chlorine is used to sterilise drinking water which otherwise can contain nasties like E coli. This is mass medication which I don't think anyone can complain about. The chlorine is administered as a salt. Horses for courses.
I've recently done many hours of research into the mutant MTHFR gene. I definitely have it, along with hypothyroid. There are now medical papers pointing to the mutated MTHFR gene causing autism, ADHD & other (mental health) illnesses.
Due to this muation, my body struggles to convert folic acid and the cheapest form of vitamin B12 (cyanocobalamin). Folate (vitamin B9) and Methylcobalamin should be taken instead. 40 years ago I was given folic acid to take whilst pregnant. It obviously didn't work as I do have the MTHFR mutated gene. My son has ADHD/hypo symptoms and I'm sure it goes back to the lack of folate in the womb.
If anything is to be added to bread, it should be Folate, not folic acid, as many of the population have the mutated gene unknown to them.
This is in our family too. There is mild autism, ADHD, and dyslexia/dysphasia I was never told to supplement with anything when pregnant (35, 34 and 31 years ago). I lost my first early on and just got told 1 in 4 lose their first 😔
My sister wasn’t told to supplement and I don’t think my cousin was either.
So surely the nhs/government should educate us more? Why not tell years 11, 12 and 13 about it? Boys and girls. It might sink in somewhere.
I’m obviously more aware of these things now and make sure my daughter and daughter-in-law take note too.
The major UK study which recommended folic acid supplementation was this:
Lancet. 1991 Jul 20;338(8760):131-7.
Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group - PubMed
Abstract
A randomised double-blind prevention trial with a factorial design was conducted at 33 centres in seven countries to determine whether supplementation with folic acid (one of the vitamins in the B group) or a mixture of seven other vitamins (A,D,B1,B2,B6,C and nicotinamide) around the time of conception can prevent neural tube defects (anencephaly, spina bifida, encephalocele). A total of 1817 women at high risk of having a pregnancy with a neural tube defect, because of a previous affected pregnancy, were allocated at random to one of four groups--namely, folic acid, other vitamins, both, or neither. 1195 had a completed pregnancy in which the fetus or infant was known to have or not have a neural tube defect; 27 of these had a known neural tube defect, 6 in the folic acid groups and 21 in the two other groups, a 72% protective effect (relative risk 0.28, 95% confidence interval 0.12-0.71). The other vitamins showed no significant protective effect (relative risk 0.80, 95% Cl 0.32-1.72). There was no demonstrable harm from the folic acid supplementation, though the ability of the study to detect rare or slight adverse effects was limited. Folic acid supplementation starting before pregnancy can now be firmly recommended for all women who have had an affected pregnancy, and public health measures should be taken to ensure that the diet of all women who may bear children contains an adequate amount of folic acid.
I am under the impression that at least some organisations were recommending folic acid before then - otherwise the controversy I mentioned in an earlier response would not have occurred.
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.
Canada mandated the addition of folic acid to wheat flour and some corn flours in 1998.It is added at the rate of 1.5mg/kg. This works out to less than 15 mcg per 30 gram slice of bread if that contains approx. 65% water.
However, since fortification, the incidence of neural tube defects have gone down by 46%.
Folic acid deficiency also causes anencephaly and cleft lip.
Some developmental heart defects have also decreased in incidence which was a surpise.
'27 percent reduction in conotruncal defects, or severe heart outflow tract abnormalities; 23 percent reduction in coarctation of the aorta -- a narrowing of the major artery (the aorta) that carries blood to the body; 15 percent reduction in atrial and ventricular septal defects -- holes in the wall separating heart chambers; however, no changes were seen with regard to chromosomally associated defects -- abnormality in the number of an infant's chromosomes.'
Breakfast cereals are fortified. Here's instant Quaker Oats:
Vitamins and minerals: iron (coated with hydrogenated soybean oil), niacinamide, thiamine mononitrate (vitamin B1), calcium pantothenate, pyridoxine hydrochloride (vitamin B6), folic acid.
USDA, the Quaker oats contain 202 mcg folic acid/100 grams. One serving is 40 grams.
Who eats one serving? (I don't eat this stuff but when my daughter was still living at home, she would eat 2 packs.)
To be honest, UK is really behind the times. There are many countries around the world that have added folic acid to wheat, corn, and other cereal grain products with significant reductions in various types of birth defects.
Good folate levels in the elderly reduce the risk of stroke.
The amount of folic acid added to bread, let's say someone consumes 4 slices per day, is not going to mask a B12 deficiency.
'The mandatory enrichment of white flour with B vitamins, iron and folic acid is a cornerstone of Canada's fortification program aimed at helping to prevent nutrient deficiencies and maintain or improve the nutritional quality of the food supply.'
Sale of unfortified wheat flour in Canada is illegal.
I 100% support all of this because as the gap between the haves and have nots has increased, and as the knowledge of nutrition is abysmal, at least this helps those who rely on various grain products as a significant portion of their diets.
The gap between the haves and have nots is another discussion of course. The Covid situation has only made it worse for many.
'Fresh' vegetables are expensive. I grow my own and used to think 'why bother growing tomatoes when they get ripe when the market is full of them?' Well, a small basket of tomatoes costs $5 at the No Frills supermarket. That's expensive for tomatoes that probably were picked before they were even remotely ripe. Same goes for everything else. Ontario asparagus at Costco was packed 10 days before I went to buy some. This despite the fact that the farms are 2 hours from Toronto. Pathetic or what?
I don't grow asparagus but it is an excellent source of folate provided it's fresh. How much is there in 10 day old asparagus if a person cooks it the day they buy it?
From what I read in The Guardian UK, there's a problem over by you in regards to food security. Apparently farmers are letting produce rot in the fields due to a lack of workers. I don't know if this is Guardian hyperbole or fact but it doesn't look good from here.
From the British Nutrition Foundation:
A range of different foods can be fortified – the choice of food will depend on the dietary habits of the population/community and technological limitations (for example vitamin B12 is unstable in acid conditions).
'In 2000, the UK’s Advisory Committee on Medical Aspects of Food and Nutrition Policy, COMA, recommended mandatory folic acid fortification of flour at the concentration of 240micrograms per 100g flour to prevent neural-tube defects (NTD) in babies. However in 2002, the Board of the UK’s Food Standards Agency decided against such action. A primary concern was the possibility of masking vitamin B12 deficiency anaemia in older people, a condition known to increase in prevalence with age, and to affect about 127 per 1000,000 people in the general UK population. Folic acid prevents megalobastic anaemia, an early symptom of vitamin B12 deficiency, and hence potentially delays diagnosis of the neurological complications that can arise in B12 deficiency.'
Old people vote. Babies don't. I guess.
Neural tube defects affected 2.55 to 2.61/1000 babies born in Nova Scotia. I'll assume it was similar in other parts of Canada. This was prior to the fortification of foods with folic acid. There is a table with the stats on changes in neural tube defects in this paper:
So you could consume 700 ml of that every day! But I doubt many do so.
And you have to check each and every product. Other similar products contain none. And others even contain more!
I don't think it unreasonable to consider that any substitute type of product should be fortified to be broadly equivalent to what it substitutes. But at present it is each person's responsibility to check everything and decide whether they get enough B12. Or pop a B12 tablet every day.
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