Folic acid is on track to be added to UK flour to help prevent spinal birth defects in babies, the UK government is preparing to announce. It is estimated that the move will prevent up to 200 birth defects a year, but could pose some challenges for the flour milling industry.

The new rules will only apply to non-wholemeal wheat flour, with gluten-free foods and wholemeal flour exempt. Mandatory fortification – which the government ran a public consultation on in 2019 – would see everybody who ate foods such as bread, for example, getting more folic acid in their diets.

Previously, the government had stated that all UK countries would consider any decision on mandatory folic acid fortification. The Department for Environment, Food and Rural Affairs (Defra) holds responsibility for the existing requirements for flour fortification.

In response to the announcement, Alex Waugh, director of UK Flour Millers, a London-based trade association, tells FoodIngredientsFirst: “Flour, whether white brown or wholemeal, is an ingredient in many foodstuffs and supplies a big proportion of our daily fiber and protein along with essential nutrients such as calcium, iron and B vitamins.”

“If it is decided that folic acid should be added to flour for public health reasons, flour millers will do all they can to overcome any practical challenges to make it happen.”

The government says that it “did not anticipate the move would require a major overhaul for industrial-scale flour producers,” and the B vitamin would need to be listed on the labeling of all foods made with flour.

Global success 
The use of flour, specifically wheat flour, as a product for folic acid fortification has been adopted in more than 60 countries worldwide, including Australia, Canada and the US. Its primary advantage compared with fortifying other foods is that flour is widely consumed in some form or other.

Countries that have mandated folic acid fortification have seen falls in rates of neural tube defects (NTDs) of between 16% and 58% and have not identified increased risks associated with fortification. However, these countries may not have similar diets or populations to the UK.

Currently, no EU country has a policy of mandatory fortification of flour with folic acid.

Targeting spina bifida
NTDs, such as spina bifida and anencephaly, a condition affecting the brain, affects about 1,000 pregnancies every year in the UK. Many infants diagnosed with spina bifida will survive into adulthood, but many experience life-long impairment.

Countries that have mandated folic acid fortification have seen falls in rates of neural tube defects.Women are advised to take 400 mg of folic acid a day for at least a month before conception and the duration of the first trimester. 

NTDs are birth defects of the brain, spine or spinal cord of the fetus wher a fault in the development of the spinal cord and/or surrounding vertebrae can leave a gap in the spinal cord, meaning the cord does not form properly or may be damaged.

NTDs often arise in the first few weeks of pregnancy, sometimes before pregnancy has even been /confirm/ied. 

FoodIngredientsFirst has also reached out to Shine, a charity that supports people affected by spina bifida. The organization has campaigned for mandatory fortification of flour for more than 30 years and is “delighted” by the decision.

Redirecting risks
There have previously been concerns that mandatory fortification could have unintended health effects, such as masking a vitamin B12 deficiency or increasing the risk of colon cancer.

The government’s independent advisory body – the Scientific Advisory Committee on Nutrition – has been satisfied that the evidence does not support these concerns.

Since World War II, the UK’s non-wholemeal flour has been fortified with iron, calcium and two other B vitamins – thiamin and niacin.

Adding folic acid to flour in everyday foods, such as bread, will mean dosing the general population. However, most consumers already get their required amount of folate from a well-balanced diet.

The government has stated that it would work with industry to consider its impact on voluntary fortification of other products and food supplements to ensure people do not exceed the recommended maximum intake.

Prime Minister Boris Johnson believes that folic acid-fortified flour would be “a quick, simple win” to enhance the development of infants, as well as boosting the health of UK adults.

Health and Social Care Secretary Sajid Javid says that preventing life-threatening health problems such as spina bifida would mean fewer people hospitalized for treatment.

In 2019, NutritionInsight reported that proposals had begun to explore what kinds of products should be included in the UK government’s proposals to add folic acid to flour in a bid to reduce NTDs. 

The move was welcomed by the Association of UK Dieticians (BDA). However, the organization says this has been a “long time coming” as recommendations for folic acid fortification in flour date back to the early 1990s, and much suffering could have been prevented if these proposals had been adopted sooner.

It has also been previously flagged that fortifying UK flour, bread and milk with vitamin D could be helpful in the fight against COVID-19.