Folic acid added to flour to prevent spinal conditions in babies
Folic acid will be added to non-wholemeal wheat flour across the UK to help prevent life-threatening spinal conditions in babies, the government and devolved administrations have announced.
Adding folic acid will mean foods made with flour, such as bread, will actively help avoid around 200 neural tube defects each year – around 20% of the annual UK total.
Adding folic acid to flour across the UK builds on 80 years of fortification and follows consultation with industry, stakeholders and the public. The costs of fortification to industry are expected to be minimal.
The addition of folic acid to food has been a successful public health policy more than 80 countries worldwide such as Australia, New Zealand and Canada, resulting in falls in neural tube defects.
The neural tube forms the early part of the brain and spine within the first 12 weeks of pregnancy – usually before the mother knows she is pregnant. Folic acid is the synthetic/man-made form of folate. Not getting enough folate (Vitamin B9) at this crucial time can lead to neural tube defects and result in spinal conditions such as spina bifida or anencephaly.
Folate helps the body make healthy red blood cells and is naturally occurring in certain foods, such as leafy green vegetables. Folic acid is already voluntarily added by food manufacturers to breakfast cereal, including some gluten-free products, meaning people can usually get all they need from eating a balanced diet, but a higher intake is required in the first 12 weeks of pregnancy.
The NHS strongly recommends women who could become pregnant or are planning a pregnancy take a 400 micrograms folic acid tablet every day before pregnancy and until they are 12 weeks pregnant. This advice will continue, but with around 50% of pregnancies in the UK unplanned, the government is taking action to increase folic acid intake nationally to help protect more babies, especially where a pregnancy is unplanned and supplements are not taken early enough.
Over 99% of British households buy bread and over a quarter of all groceries in the four biggest supermarkets contain flour, making adding folic acid to flour-based products a simple way to increase folate levels for tens of millions of people across the UK.
Since the Second World War, flour has been fortified with calcium, iron, niacin and thiamin during milling to support the nation’s health.
This public health decision is not anticipated to require major overhaul for industrial-scale flour producers. Folic acid will need to be added to the labelling of all foods made with flour – as is the case with other fortification.
However, there have previously been concerns that mandatory fortification could have unintended health effects, such as masking a vitamin B12 deficiency or increasing the risk of colon cancer.
But the government's independent advisory body - the Scientific Advisory Committee on Nutrition - has been satisfied that these concerns are not supported by the evidence.
Wholemeal flour and gluten-free foods are not subject to mandatory fortification and these products are not in the initial scope of this policy. Wholemeal flour has more naturally occurring folate than non-wholemeal wheat flour, and some wholemeal and gluten-free foods are already voluntarily fortified with folic acid in the UK.
A 4-nation review of Bread and Flour Regulations is being undertaken by officials in Defra, the Department of Health and Social Care, Food Standards Agency and Food Standards Scotland. The implementation of the UK decision on the mandatory fortification of flour with folic acid will be included in this review.