29 November 2006

Folic acid: a public affair?

When the idea of fortifying staple foods with vital nutrients is raised, the battlecry goes up from industry groups and advocates of consumer choice: Why should we bear the costs?

When the idea of fortifying staple foods with vital nutrients is raised, the battlecry goes up from industry groups and advocates of consumer choice: “Why should we bear the costs?” “Educate, and let people make their own decisions”.

But when evidence for the benefits is overwhelming, neither the state nor the individual can afford to let their interests be shouted down.

Nothing new
Food fortification is nothing new. In the 1940s, the US introduced the fortification of milk with vitamin D, resulting in an 85 percent reduction of rickets incidence in children. More recently in 1998, the US and Canada introduced the mandatory fortification of grain products with folic in a bid to reduce incidences of neural tube defects in babies.

Several other countries have been weighing up whether to follow suit for some time. In Australia and New Zealand, where the baking industry has been resisting with all its might, proposals are on hold while the food standards agency FSANZ takes another look at “technical considerations”.

And in the UK, the FSA is taking its time reviewing additional evidence of the risks and benefits, particularly the levels at which folic acid may mask detection of vitamin B12 deficiency in the elderly.

A complicated issue
Statistics from across the pond point to the success of the measures there. The US Centers for Disease Control and Prevention estimates that the incidence of NTDs has declined by 26 percent since 1998, now affecting around 2000 pregnancies each year.

But the issue is complicated by B12 deficiency which, if unaddressed, can lead to dementia. Particularly prevalent in older people, it has identical symptoms to anaemia caused by folate deficiency – but while folic acid will remove these symptoms, it won’t address the lack of B12. If folic acid impedes diagnosis, it could result in neurological damage.

It would be easy to sit on the fence over this one. I don’t envy the food standards agencies the judgement call they have to make between looking out for the interests of unborn babies and elderly people. It’s like playing eeney, meeney, miney, mo with people’s wellbeing.

Siding with fortification
But at the risk of being called an advocate of the nanny state, my mo comes down on the side of fortification.

I am not saying ‘forget the old folks’. But disease prevention and disease management are not the same thing. Whereas for a foetus, the damage is often done before a woman even knows she is pregnant, vitamin B12 deficiency can be identified with a simple blood test. The emphasis here should be on stepping up screening programmes to identify sufferers and treating them accordingly.

You can educate and tell women of child-bearing age to take extra folate until you are blue in the face. Some will do so. Some won’t, and neither they nor their children will suffer any ill consequence.

Yet still around 1200 pregnancies in the UK alone are affected by neural tube defects – every one a tragedy and the majority preventable.

A public affair
There are clearly many women out there who, although they may be planning their own families, still need a nanny of their own.

There comes a point when, if the individual is not taking responsibility for their own health, it stops being a matter of personal choice and becomes a public affair. When the emotional aspect of babies born with neural tube defect is put to one side, at bottom line level it is better to invest in interventions to reduce incidence when we can, than to do nothing and carry the costs of sufferers' specialist needs for a lifetime.

Why not keep some unfortified products on the market for those who make a conscious decision to avoid additional folic acid?

But please, there’s no excuse for poor nutrition in the Western world today. Until every woman of childbearing age is looking out for her folate intake, someone else has got to do it for her. - (Jess Halliday, Decision News Media, November 2006)

Jess Halliday is editor of award-winning website and Over the past decade she has worked in print, broadcast and online media in both Europe and the United States.

Read more:
Folic acid prevents birth defects
Health before pregnancy


Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

Live healthier