As early as 1991, the Medical Research Council published a report recommending that white flour in the UK was fortified with folic acid (a B vitamin) as this had been shown in other countries to prevent neural tube defects (NTD) in foetuses. Mandatory fortification with limits on voluntary supplementation was backed by the Scientific Advisory Committee on Nutrition in 2006 and again 2017. The Committee on Toxicity has produced a report on safe upper limits for fortification, which will be used to guide the consultation process.
NTDs, such as spina bifida, cause moderate to severe disability leading to human suffering and higher health care costs. The prevalence of NTD pregnancies is 1.28 per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths ≥20 weeks’ gestation). A recent study estimated that more than 2000 NTD pregnancies could have been prevented since 1998 had the UK adopted flour fortification. Thus, the failure to act on this straightforward policy has resulted in a missed opportunity for those families affected.
According to the latest NDNS, 91% of women of childbearing age (16 to 49 years) in the UK as a whole had a red blood cell folate concentration below the threshold (748nmol/L) indicating elevated risk of NTDs.
What is the BDA doing?
We are pleased that consulted on mandatory fortification of flour in the UK, following our joint letter with RCOG, SHINE and others to the minister, Seema Kennedy MP. Read the BDA's response to the consultation here.
We will look to engage with the consultation process regarding the implementation of this policy. We will also look to communicate the benefits of the policy and alleviate concerns about other impacts. We will continue to work with colleagues and partners, such as the Spina Bifida charity SHINE and the Royal College of Obstetricians and Gynaecologists (RCOG), who are were so successful in campaigning in this area.
What we want members to do to help
Some members of the public will remain concerned about the possible impact of folic acid on those parts of the population where folic acid has no benefit in preventing NTDs (such as children or men). It will therefore be important to understand this policy and be able to communicate it to the public. Keep an eye out for the BDA's consultation response and any policy briefings on this page.
- Check out the BDA's own Folic Acid food fact sheet.
- The Shine Charity, which provides support to those living with spina bifida and/or hydrocephalus, have produced a briefing page on their website.
- Read the latest debate on this issue from the House of Lords, led by Lord Rooker.
- Take a look at the Westminster Hall debate on 16th May 2018, led by Owen Smith MP, at which the Minister Steve Brine agreed to push for a quicker response from the COT on the tolerable upper limit for folate, seen as a barrier to forification.
- Read more about the Scottish and Welsh Government's call for folic acid fortification.
- See a letter to the Times from Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, and Neena Modi, president of the Royal College of Paediatrics and Child Health and others calling for the introduction of folic acid fortification (£).
- Read SACN's recently updated recommendations on Folic Acid.
- Read Wald et al's 2018 review in Public Health Reviews, which argues that government should drop the outdated upper limit for folate intake: Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate.
- Read Stephenson et al's 2018 series for the Lancet, looking at preconception health, which calls for a greater focus on nutrition (including folate status) in women of childbearing age.