The debate over folic acid fortification of bread has been with us for some time. It took a new turn this week as research from Sweden that suggests low folate levels may guard against colorectal cancer was taken on board. What is it we hear about the importance of balance? Those mad-keen on dumping extra folate into foods should start listening to the warnings.
Folate is found in foods such as green leafy vegetables, chick peas and lentils, and an overwhelming body of evidence has linked folate deficiency in early pregnancy to increased risk of neural tube defects (NTD) — most commonly spina bifida and anencephaly — in infants. That folate is useful in pregnancy is not questioned. Doubts relate to the safety and wisdom of food fortification.
The NTD – folate link led to the 1998 introduction of public health measures in the US and Canada, where all grain products are fortified with folic acid — the synthetic, bioavailable form of folate. There is increasing debate in the UK over whether to add the nutrient to flour.
The UK’s Food Standards Agency’s Scientific Advisory Committee on Nutrition has asked the board for more time before delivering its final report on the fortification question.
Meanwhile, other countries are also playing this dangerous game. In July, Ireland’s National Committee on Folic Acid Fortication recommended that most white, brown and wholemeal breads sold in the country be fortified with 120 micrograms of folic acid per 100g of bread. Food Standards Australia New Zealand (FSANZ) has also embarked on the path towards fortification, last month calling for public comment on a proposal that would require all bread-making flour to be fortified with folic acid.
But, while preliminary evidence indicates that the measure is having an effect with a reported 15 to 50 per cent reduction in neural tube defect incidence, the study published in the October issue of Gut (2006;55:1461-1466. doi 10.1136/gut.2005.085480) indicates that colorectal cancer risk is also a factor. People with low folate levels may actually have some protection so fortification to possibly benefit some may harm mnay others. I say again, fortification is not the wise way to go.
In an accompanying editorial, Dr Y-I Kim of the University of Toronto calls mandatory folic acid fortification “probably the most important science drive intervention in nutrition and public health in decades”.
But given that certain segments of the population may benefit less and may even experience adverse effects, he said that wavering over fortification “should not be construed as public health malpractice but should be regarded as public health prudence”.
In Dr Kim’s opinion, long term follow-up studies into the relation between folic acid supplementation and fortification and cancer risk are “urgently warranted”. I agree.
Of course well informed people do not consume bread or refined flour products. This is quite important for health and longevity. Not surprisingly, thanks to Big Pharma and their sales force of medical practitioners and the complicity of the major food manufacturers, and even the role of bought science and the agricultural market protection policies behind the food pyramid, such notions are ignored, burried or railed against. He who laughs last…
