Bread and flour will be fortified with folic acid under law in a bid to prevent serious birth defects in babies, the government has announced.
The new legislation will require millers to add folic acid to non-wholemeal wheat flour from the end of 2026, meaning that everyone who consumes these foods will be exposed to the synthetic supplement, whether they need it or not.
Folic acid is a synthetic form of vitamin B9—also known as folate—which helps the body produce healthy red blood cells and new cells. While the government announcement does not make clear the distinction between folic acid and folate, some health experts have warned of the potential risks of too much folic acid to children, men, and women who aren’t pregnant or trying to conceive.
A deficiency of the vitamin during pregnancy can increase the risk of neural tube defects, which can lead to spina bifida, when the spine does not develop properly, and anencephaly, when a baby is born without parts of its brain and skull.
The neural tube is a structure that forms the brain and spinal cord of a developing baby from around day 21 to day 28 of pregnancy.
Health authorities recommend that women trying for a baby should take folic acid supplements for about three months before getting pregnant and for at least three months after getting pregnant.
Folate Not Folic Acid
Experts including Dr. Joseph Mercola have argued that women should seek out folate supplements rather than folic acid, and should look to increase their intake through foods naturally high in the vitamin. Folate rich foods include asparagus, avocados, Brussels sprouts, broccoli, and spinach.Mercola argues that synthetic folic acid from supplements and fortified foods may harm brain development and could be involved in rising rates of neurodevelopmental disorders in children.
While it is extremely rare to get too much folate from foods, it is possible to get too much folic acid.
Studies of pregnant mice revealed that high levels of folic acid harmed brain development in offspring, and accompanying low levels of vitamin B12 made the damage worse.
In the United States, the Food and Drug Administration began folic acid fortification in foods in 1998, and it is now required that the supplement is added to bread, flour, cornmeal, pasta, rice, and other foods made with cereal grains.
Statistics from the U.S. Centers for Disease Control and Prevention show that while neural tube defects have declined since supplementation began, other health conditions—namely neurodevelopmental disorders—have risen.
How Much is Too Much?
“There’s no doubt the introduction of folic acid diet fortification has been beneficial, substantially lowering the incidence of neural tube defects,” Ralph Green, University of California–Davis professor in the Department of Pathology and Laboratory Medicine, said in a news release in January.“However, too much folic acid may have detrimental impacts on brain development, and that’s something we need to sort out.”
Green and his colleagues conducted a study, published in Nature magazine, that found excess folic acid is associated with neurodevelopmental risks, especially in concert with vitamin B12 deficiency.
High amounts of supplemental folic acid—classed as 1,000 micrograms per day or more—during pregnancy have also been linked with impairments in neurocognitive development in 4- to 5-year-old children. While acknowledging results were not conclusive, the California study explored a possible link between excessive supplementation and attention deficit disorder in boys as well as the exponential rise in other neurodevelopmental conditions, since supplementation began.
Societal Benefits
The department also pointed to what it said will be £571 million in benefits to society through an increase in live births, as well as £54 million owing to increased labour market participation and £39 million from parents not having to leave the labour market to care for disabled children.Public health minister Andrew Gwynne said, “These measures are a simple and effective intervention to improve health outcomes in babies, giving them the best start in life.”
England’s Chief Medical Officer Professor Sir Chris Whitty welcomed the plans to add folic acid.
He said, “The fortification of flour is a simple and effective way to help to reduce cases of neural tube defects, although it is important that women who are pregnant or intending to become pregnant continue to take folic acid supplements before and during the first 12 weeks of pregnancy.”
Kate Steele, the chief executive of Shine, the charity that provides support for people whose lives have been affected by spina bifida and hydrocephalus, said: “After more than 30 years of campaigning, Shine can finally celebrate the introduction of this very important public health initiative.
“It will improve the health of the general population across the UK but, more importantly, mandatory fortification will reduce the number of babies affected by spina bifida, a lifelong, complex disability.
Bread and Flour Regulations
The changes were proposed by the previous Conservative administration, and the government said it is engaging with the food industry to implement the changes, which will apply to the whole of the UK.The Bread and Flour Regulations of 1988 lay down labelling and compositional standards, and specify that four vitamins and minerals must be added to all white and brown flour: calcium, iron, thiamine (vitamin B1), and niacin, with folic acid about to join them.
Wholemeal flour is exempt as the wheatgerm and bran from the grain included in the final flour are natural sources of vitamins and minerals.
There is no legal requirement to bolster breakfast cereals with vitamins and minerals, but makers can do this voluntarily in line with government guidelines, and manufacturers often market their products as being “fortified.”
