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Higher levels of folic acid needed in flour and rice to prevent birth defects in UK, scientists say

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4 min read
AUTHOR: Fiona Holland
Sliced Italian ciabatta bread on wood cutting board

Larger amounts of folic acid need to be added to flour and rice to stop hundreds of babies being born with neural tube defects (NTDs) like spina bifida and anencephaly in the UK, a group of scientists have argued.

In 2021 the Government announced it would fortify all flour, except gluten free and wholemeal, with folic acid – also known as vitamin B9 – in order to boost the intake of the vitamin.

According to the Government, only fortifying one type of flour would still give people the ability to choose whether or not they want to consume folic acid.  

Women are advised to take 400 micrograms of folic acid supplements every day, from around 12 weeks before they get pregnant up until three months into pregnancy. With nearly half of pregnancies in the UK being unplanned however, many do not take it for long enough, if at all.

The current proposals are predicted to prevent around 200 NTDs every year, which is around 20% of the total number of NTDs that are recorded annually in the UK.

But a group of scientists have claimed the move will not be enough. Speaking at Science Media Centre briefing, a panel of experts from University College London, Imperial College London, Imperial College’s St Mary’s Hospital Campus, and University of Oxford among others, said the current Government proposals will still result in avoidable deaths, abortions and neural tube defects in babies.

Dr Gareth Nye, Ambassador of the Society of Endocrinology, and Endocrinology Theme Lead at the Physiological Society, explained in a statement: “The government’s plan is to fortify flour used in white bread but that in itself isn’t at a level thought to reduce the risk of neural tube defects. You also exclude a large proportion of women who do not eat white bread for dietary reasons.

“At the proposed level – the risk will only be reduced by 12%, certainly there is big room for improvement and the government should rethink the plan.

Around 1 in 1,000 women currently give birth to babies with lifelong conditions such neural tube defects like spina bifida and anencephaly in the UK. Dr Nye continued: “This is one of the highest levels globally according to BPAS. It is reported that 80% of these babies will be subject to therapeutic abortion.”

In an interview with The Daily Mail, Professor Sir Nicholas Ward, Professor of Preventive Medicine at University College London, explained that women who don’t get their main carbohydrates from white flour products will not benefit from the changes.

Under the current Government proposals, 0.25mg of folic acid will be added to non-wholemeal wheat flour, but the scientists argued that adding 1mg per 100g of any type of flour or rice would be far more beneficial. According to the Royal College of Obstetricians and Gynaecologists this higher level could prevent around four out of five neural defects.

While some past studies have suggested a high consumption of the vitamin could be related to a slightly higher risk of developing cancer, the panel argued there is enough evidence to contradict this belief. Professor Andrew Prentice FMedSci, Head of Nutrition & Planetary Health Theme at MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, said: “The benefits of folic acid in preventing many NTDs are overwhelmingly proven but minority voices in prior committees have been concerned that collateral harm might be caused, for instance in increasing cancer rates or obscuring the diagnosis of other rare diseases.”

As over 80 countries worldwide already add vitamin B9 to flour, including most countries in Europe, as well as Canada, Australia and New Zealand, the concerns over the harms of folic acid seem unjustified, Prentice said. “Now the accumulated evidence of benefit from many countries is surely sufficient to calm these fears. England is being left behind.”

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