Sue Kedgley

Moving forward on folic acid fortification

by Sue Kedgley



Image by Lyndon Hood

The Green Party welcomes the decision of the Government to review the decision to mandatorily fortify almost all bread sold in New Zealand with folic acid.  We are not sure why such a review would take three years, however.

In our view a panel of experts should review the new science and perhaps liaise with colleagues in Ireland and the United Kingdom who are undertaking a similar review. The Irish review panel says new data that will become available at the end of the year should allow for an assessment of folic acid levels and the risk of cancer.

We are delighted too, that the Government has worked out that, contrary to what the Minister of Food Safety previously claimed, there is no joint standard between Australia and New Zealand on folic acid fortificatiion, so we are free to make our own decisions on the matter, rather than being bound by an Australian agreement.

We’re pleased that the Bakers Association is already convening a conference to discuss voluntary fortification of some lines of bread. We suggest highly processed white bread would be a good place to start.

And given that the issue has not been debated in our Parliament, and New Zealanders have not been consulted about this contentious issue, we welcome the idea of a discussion paper on the issue.

We note some people are suggesting that a review isn’t necessary – that we should just go full steam ahead with mandatory fortification – irrespective of new evidence of potential dangers from excess folic acid emerging in the past few years, since we signed up to the original standard.
But in our view, if you are going to add a synthetic additive to almost every loaf of bread sold in New Zealand, you have to be absolutely certain that it will be effective;  that there won’t be any harmful side effects, and that nobody is going to get too high a dose of it. 

And we cannot be certain of this when new research has emerged which suggests that high levels of folate can cause pre cancerous cells and undiagnosed colon cancer tumours, to grow more quickly.

This research comes on top of warnings from our very own New Zealand Food Safety Authority that a significant number of children (13% of boys and 8.2% of girls) would be exposed to higher than recommended (ie unsafe) levels, and that there are unknown risks from mandatory fortification that may not become apparent for a generation. 
I note that some commentators claim there isn’t any serious evidence that excessive folic acid levels can cause adverse effects or even harm. But I very much doubt that anyone making such claims has actually read the new research.

Take for example the latest research from Oxford Professor David Smith  (an expert in folic acid) and  his  colleagues. Their paper warns about the link between high levels of folate and potential increase in pre cancerous tumours, and says there is good reason to expect adverse effects on some members of society from mandatory fortification. He says  there has been insufficient research to establish the rates at which these  adverse effects might be occur – especially a lack of large-scale long-term studies.  They claim  that if the US knew what we now know, they would  probably  not have gone ahead with  mandatory  folic acid fortification.  

They are also concerned about recent research that shows that rates of colorectal cancer went up in North America around the same time that fortification began there. Another study shows that the same thing happened in Chile after fortification began there.

Some of the research suggests that the level of intake of folic acid that is safe for one person may be harmful for another.

And then there is the problem  that  some New Zealanders are taking  medications that are designed to block folate acid – to treat malaria, rheumatoid arthritis, psoriasis and some cancers.  What would happen to them if they were to consume high levels of folate in bread. There is also the concern that amongst  elderly  New Zealanders  high folic acid  combined with low B12 (which is prevalent in older people) increases cognitive impairment and anaemia – one US study found 70% increased risk of cognitive impairment.

None of these are trivial concerns – they are serious issues that have to be weighed when deciding whether the benefits of  mass medicating an entire population with a synthetic substance,  outweigh the risks. Or whether it would be wiser to take an approach more targeted to the people who really need it.  

Some scientists such as Dr Sian Astley say there is as yet insufficient evidence to make a decision one way or the other about whether the benefits of fortification would outweigh the risks. 

Incidentally its curious that a scientist who had just returned from a conference in Europe, who said one paper said there was no evidence linking high folic acid intake with cancer, forgot to mention that the conference (comprised of the worlds experts on folate), having heard all the evidence for and against mandatory fortification, voted against folic acid fortification.

And here’s another curiosity: one large study reported by Prof Smith et al found a 19% higher risk of breast cancer in women taking supplementary folic acid, but there was no increased risk between breast cancer and folate derived solely from food, i.e. natural folate.  

Perhaps, after all, its worth making more effort to get people to eat  healthy unprocessed foods  that are high in natural folate and other health-giving vitamins and minerals.  

Even just eating wholemeal bread instead of white bread will dramatically increase the folate intake of many people (maybe that’s why the US doesn’t fortify wholemeal breads).  It doesn’t seem to make sense to fortify wholemeal bread, when it already contains natural levels of folate.

Published in Health & Wellbeing by Sue Kedgley on Mon, July 20th, 2009   

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