F

To fortify or not to fortify Scotland’s big question

A

Discussions unfolding from the start of this year have revealed that Scotland is edging ever closer to a decision some 16 years in the making, whether or not to fortify flour with folic acid.

s concerns rise over the potential for an increase in birth defects, Scotland moves towards mandatory fortification, as Westminster continue to delay their Can you tell our readers a little about whyfortifying decision. flour with folic acid needs to be considered in Scotland The uncertainty surrounding the issue of fortification has led what does it mean to fortify flour with folic acid in your to a reduction of the amount of folic acid added to products by view? Where has it been successful/unsuccessful? companies who voluntarily fortify their foods, Fortifying flour with folic acid will be a very in order to comply with regulations should effective way to reduce the number of babies fortification be implemented. This has led to who are born with neural tube defects like mounting concerns of the level of folic acid intake spina bifida. The folic acid could be added across the UK. to flour during the manufacturing process Folate, from the family of B-Vitamins, occurs relatively easily, and this would go some way naturally in foods such as nuts and green to increasing folate levels among the general vegetables. Folic acid is a synthetic form of population. Folic acid is tasteless, entirely folate, often used for food fortification and in safe within recommended intake levels and is dietary supplements; it plays a pivotal role in the already included in many foods like breakfast prevention of birth defects, specifically neural cereals. tube defects (NTD) such as spina bifida. Folic acid is naturally present in grain, and Since 1992 advice to women UK wide has the manufacturing process removes it along Milling and Grain speaks to been to begin to take folic acid supplements with other vitamins and minerals - niacin, the Scottish Health Minister while trying to get pregnant to reduce the risk thiamine, iron and calcium - which are Maureen Watt about of NTD, but studies have shown that as little as currently added back in to flour. This is clearly Scotland’s push to fortify flour 28 percent of women take the correct dosage of labelled on packaging. Folic acid is simply a 400 micrograms three months prior to pregnancy, water soluble vitamin like niacin and thiamine following this through until the 12th week of pregnancy. which are B vitamins – low levels of which can also cause As the required amount of dietary folate intake does not significant symptoms and long term conditions. appear possible through diet alone, women who have unplanned There are 78 countries around the world that already have pregnancies, as well as the those who have not taken the required mandatory fortification of flour. The USA has done it for supplement at the correct time, are at greater risk of NTD. It is the past eight years, with no adverse effects on health. believed that as many as 50 percent of births in Scotland are According to Spina Bifida Hydrocephalus Scotland, neural unplanned, expounding the need for the addition of folic acid into tube defects have reduced by between 27 percent and 50 diets. percent in countries where mandatory fortification has been A study published in December 2015 concluded that the failure to introduced. implement mandatory fortification at the same time as the US in 1998 led to an estimated 2000 children being born with NTD, and ignoring What major health benefits will mandatory folic acid it further could lead to an additional 150 children born with NTD year fortification tackle and why is it being considered for on year; where the US has seen a decrease of children born with NTD Scotland? of 28 percent. The Scientific Advisory Committee for Nutrition estimates Extensive research has been carried out by a plethora of scientific that around 50 pregnancies are affected by neural tube defects bodies including the Scientific Advisory Committee on Nutrition every year. This is a particular concern in some of our more (SACN), who were looking into potential adverse effects of folic deprived communities, where rates of unplanned pregnancy acid. The conclusion of this research culminated in a collective call are higher. Within the UK, folate levels tend to be lower in for fortification. Scotland and Northern Ireland, so we have a particular interest In a report to UK health ministers last autumn, officials at SACN in wanting to take action. It’s important to note that these are testified that where mandatory fortification has been implemented in life-long conditions, causing families significant distress and nearly 80 countries worldwide, none had not reported any adverse placing an additional and unnecessary cost burden on our health conditions as a result of fortification. NHS. 50 | March 2016 - Milling and Grain