Moving forward on folic acid fortification

 

facebread

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.

16 thoughts on “Moving forward on folic acid fortification

  1. People wake up … Grow, barter, share your own food locally whenever possible! So many good people out there, but corporations are legally obliged to serve their investors. When it comes to widespread food manufacturing and distribution, profit is the #1 motive. Preventative health measures fall under this still, on a governmental level as well. If the U.K. or USA leads the initiative, better to read between the lines and follow the money … Learn about your bodies and how to build your own health/immune systems. Nutrient dense food (full of everything your body needs) results from healthy soil that is unsprayed with petroleum-based ‘fertilisers’ and pesticides. Fortification sources are not from healthy, safe, or natural sources … it is another profit-making industry. Only those who don’t know better trust these initiatives and ‘experts’ who are paid by the corporations.

  2. Isn’t it all rather absurd to argue whether folate fortified bread is vital or possibly dangerous? Centuries ago, the snobbish habit of manufacturing white bread began. All the goodness was removed, and even the flour bleached with chlorine (producing the toxic chemical alloxan, a cause of diabetes). The wheatgerm and bran was fed to farm animals. We were supposed to get ecstatic over “nature’s pure white heart of the grain”, i.e. devitalised starch. And started dying young from various diseases.
    Now they are debating whether to put back what was extracted, and there is an outcry. Surely it would be safer, less trouble, more natural, healthier, and less controversial – simply to make the manufacture of white flour and bread illegal?

  3. I have no objection to having non-fortified bread available, but this mustn’t be a cheap way out. If bread suppliers want to offer non-fortified bread, then tax them to pay for the additional medical costs of treatment for those extra babies born with neural tube defects plus the amount that they would save by not having to add the folate. And bread with less than the minimum required folate levels should be clearly labelled as such.

    Trevor.

    PS: As far as I know, there is no requirement that the additional folate should be in the form of synthetic folic acid, merely that a certain level of folate is required.

  4. Note that Ireland have decided not to impose mandatory fortification only because they have a high rate of voluntary fortification.

  5. I think you should read Sue’s post again. There are plenty of reasons to doubt a plan that would force everyone to have more folate. Even then, Sue is sympathetic to the benefits and doesn’t agree with the long delay National has decided on. A shorter time to determine if the Ireland and the UK are onto something is what she asked for. And why does it have to be all bread? I think the controversy would go away if some choice were provided.

  6. I’ve re-read my posting, and note that my comments about naming the affected baby Sue or John were perhaps a bit below the belt.

    Having admitted that, this backtracking of what I consider a perfectly reasonable public heath measure will definitely have the effect of causing a significant number of children to be born with neural tube defects who otherwise wouldn’t. That’s a really onerous burden in taking such a stance as the Greens and National have. When you have knowledge, and refuse to act on it, however well intentioned the reasons, there is a consequent ethical responsibility for what then happens, perhaps culpability wouldn’t be too strong a word.

    I would suggest that if the Greens are going to continue their resistance to this measure that they rapidly come up with an alternative well-thought out and properly costed public health measure that will provide all women of child bearing age sufficient folic acid in their diet or as a supplement with the assurance that it will deal with all this cohort. It won’t be easy. When you start to acknowledge our derisory immunisation statistics, and think of the years of effort put into getting high immunisation rates, you begin to understand the problem. And what happens if any future report comes out against compulsory folic acid addition to bread or flour? (And even if it does support the move, you can’t be sure that opposition in the Greens might not still prevail). If the Greens can’t find a workable alternative, I would urge the Greens reverse their opposition to this proposal.

  7. I won’t use this space to clutter up arguments for or against adding folic acid to flour/bread, but it seems to me that deliberately depriving a vulnerable population of an essential vitamin is reprehensible. If our modern diet is inadequate to provide a sufficient quantity of folic acid then what on earth is all the fuss about in adding a small amount to bread? I for one would not now like to be the midwife or obstetrician to have to say “oops” when presenting the new born offspring to its mother. Perhaps mum could call the child “Sue” or “John” in honour of these politicians.

    Sue’s and the Greens’ concerns about this matter are exaggerated and we now have an uneasy and downright peculiar alliance of Greens and right-wing zealots putting paid to a sensible and well analysed public health initiative. The research has already been done, for instance in Canada, published in the New England Journal of Medicine to name just one article, it does not need to be revisited here, there are betters things our policy analysts and medical professionals could be doing, for instance working out some way to deal with our appalling and shaming rates of rheumatic fever.

  8. Sue K said:
    It doesn’t seem to make sense to fortify wholemeal bread, when it already contains natural levels of folate.

    The whole drive to fortify bread is to bring all bread up to the level of folate found in wholemeal bread, by replacing the folate that was removed when the flour was refined. Therefore it has never been suggested that wholemeal bread would need additional folate.

    It also has not been the intention to subject people to high levels of folate. To get to the upper level (of 800-1000 micrograms per day) which might be considered high would require a person to eat only 22-28 slices per day :) Those people that might be considered at risk of exceeding the upper level if they eat too much fortified bread would be equally at risk if that ate an equivalent amount of unfortified wholemeal bread with its natural folate.

    Trevor.

  9. Well I’m sure all the tradesmen who buy their gear there (and have protective feelings towards their prostates) got it. It’s a country town so we have to make our own entertainment.

  10. Thanks Sue … for this hugely informativea and interesting post AND for all your (thankfully effective) efforts in making the Govt take a more reasonable approach.

    I was interested to see the how the debate spread like wildfire. One day after the relevant Q&A program one of our local hardware stores’ (an independant) posted a street sign “NONE OF OUR PRODUCTS CONTAIN FOLIC ACID”.

  11. One of the concerns is that fortified bread might lead to some people receiving more than the recommended daily upper limit of folate. In turn, one of the concerns that lead to this upper limit is that high folate levels can mask a B12 deficiency. Many vitamin tables have around 300 micrograms of folate, and the RDI is 400-1000. However concerns about masking B12 deficiency for those who take these tablets are easily overcome – the tablets also have around 25-30 micrograms of B12.

    Trevor.

  12. An excellent summary.
    Sadly, this episode mainly demonstrates our Main Stream media’s total inability to cope with any scientific issue.
    While I agree with the decision I was dismayed by how many were obviously swayed by media reports (bombardments might be a better term) that a woman “at risk” would need to eat eleven slices of bread to get her daily dose.”
    Wrong, wrong, wrong.

    Assuming she is otherwise on an average diet it takes only two to three slices.
    If they cannot get this right what faith can we have in any of the reporting.
    I eat vogels toast with eggs and then a bowl of fresh fruit for breakfast and that just about does my B9 dose for the day.

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