Folic Acid Fortification
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. However, no action has been taken by the UK Government.
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.
Despite the fact that SACN, the Food Standards Agency, Food Standards Scotland and all three devolved governments support mandatory fortification, the UK government remains unwilling to introduce regulation. Food Standards Scotland recently looked at the possibility of a Scotland-only policy of fortification but concluded it was not feasible due to the country-wide nature of the UK food industry. The Welsh and Scottish Health Ministers wrote to the Health Secretary, Jeremy Hunt in December 2017 to urge him to implement UK wide fortification of flour.
What is the BDA doing?
The BDA has supported the mandatory fortication of flour with folic acid for over ten years - see our response to the Food Standard Agency's consultation on this issue in 2007.
The BDA plans to engage with parliamentarians and government officials to encourage the government to implement these steps. There have been attempts to introduce mandatory folic acid fortification via private members bills, and we will look to work with parliamentarians who may wish to try this route again. We will also look to work with colleagues and partners, such as the Spina Bifida charity SHINE and the Royal College of Obstetricians and Gynaecologists (RCOG), who are already campaigning in this area.
It may be that Britain's exit from the European Union serves as an opportunity to change the law on folic acid fortification, as all EU food regulation will come back under UK jurisdiction, and will undoubtedly be placed under greater scrutiny.
What we want members to do to help
The case for the introduction of folic acid fortification is extremely strong. We need to build political pressure to get the government to change their mind and regulate. We want you to write to or meet with your local MP, AM, MSP or MLA and encourage them to write to ministers or ask questions to encourage folic acid fortification. You can find your local representatives using this tool.
We have tips on how to contact political representatives in our Influencing Action Pack and we've written an example letter which you can use for inspiration - although a considered and personal letter is always better.
- 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.
- 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.
- See the oral question asked during Health Question Time by Anna Turley MP
- Lord Rooker, a long time advocate for fortification, asked an oral question that led to a short debate on the need to introduce mandatory fortification. Lord Rooker did the same at the beginning of March.
- Sharon Hodgson MP and Lord Richard Balfe have raised further questions in December 2017
Take a look at the Private Members Bill introduced by Lord Rooker which would have allowed for the fortification of bread and flour. Lord Rooker has raised further questions on this topic in the House of Lords.