They're Adding Folic Acid to Flour. So What?

An Inquiring Mind by Ginny Smith

This week, the story broke that the UK government would begin adding folic acid to flour, to help prevent neural tube defects in new-borns. As someone who spends a reasonable amount of time on social media, I wasn’t surprised to see there was an instant backlash.

“So we are all going to be forced to consume artificial additives” whined White Man No 1 “when they are ONLY beneficial for women and children?” My instinct was that this was a lot of fuss about nothing- complaints from the same people who believe that vaccines cause autism and obsess over juicing. But this might just be my bias, and I didn’t actually know much about folic acid- so I decided to find out.

It turns out the decision came after a long-running campaign by scientists and medical professionals. Although we have known for years that folates are vital for a developing foetus, many pregnant mothers don’t consume enough. According to Shine, a charity that helps people with neural tube defects, two babies a week are born with spinabifida or related conditions, and two pregnancies a day are terminated after diagnosis.

While it is possible to get enough folate (the natural form of folic acid) from a healthy diet, it’s not easy. Adults are recommended to consume 400mcg, which means eating 2 cups of edamame beans, 8 potatoes or 29 brussel sprouts a day. Every day. Folic acid is water soluble, so can’t be stored in the body, meaning you must keep your levels topped up. Pregnant women, and those trying to conceive, should be getting 600mcg a day- but reports have shown ¾ women of childbearing age aren’t getting enough.

The other problem is the nutrient is most important to embryos during the first trimester- when many women don’t know they’re pregnant. So while supplements are (and continue to be) recommended for anyone who is pregnant or trying to conceive, they alone are never going to be the answer. Flour fortification should boost levels in those most at risk from deficiency- lower socio-economic groups, younger mothers and those with unplanned pregnancies.

This idea isn’t new –80 other countries now do it, including the USA (where it has been in effect since 1998). And it works; mandatory fortification reduces the number of live births with spina bifida by 30%. So then why are some people so worried about getting a bit more Folic Acid? Is it just a case of the usual social media fear mongers, against anything ‘unnatural’?

As is often the case, there is a grain (pun intended) of truth in their concerns. There have been tentative suggestions that taking high levels of Folic Acid (over 1000mcg daily) might raise the risks of some types of cancer. But these are far from being proven, and countries that have mandatory fortification haven’t seen any evidence of harm. There is also a risk that high folate levels can mask the symptoms of B12 deficiency in the elderly, which can cause cognitive impairment if left untreated. But again, this link is far from clear.

So the question in, should we base policy on a proven benefit for some, or a hypothetical harm for others? As Prof Sir Colin Berry (QMUL) said: “If regulation is hazard based (based on the possibility of harm occurring) rather than a risk/benefit evaluation, harm may follow.”¹

And I don’t believe for a second that the social media #Wellness brigade have weighed the pros and cons for society as a whole. Their reaction stems from a natural selfishness: if I’m not going to benefit directly, why should I take any extra hazard, however small? This is a problem that comes up time and time again in society- one action may benefit you the most, but another will benefit the group as a whole. It’s simple game theory, but it’s not an easy one to solve. But as far as I’m concerned, the government have made a good decision here, one supported by the evidence and which will change the lives of many for the better. And anyone who doesn’t like it can always go #paleo, as long as I don’t have to read about it on Instagram.

¹Quote from Science Media Centre:

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Ginny Smith is a science presenter and writer. A Natural Sciences and Psychology graduate of Cambridge, Ginny performs science shows all over the world and presents a wide range of science content for the likes of the Cosmic Shambles Network and the Naked Scientists. She is the co-author of three DK Publishing books looking at science, food and the human body. She is @GinnyFBSmith on Twitter.

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