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Experts back folic acid in bread | Experts back folic acid in bread |
(20 minutes later) | |
Folic acid should be added to bread on a mandatory basis, the Food Standards Agency has advised government. | Folic acid should be added to bread on a mandatory basis, the Food Standards Agency has advised government. |
It says the move could prevent dozens of babies developing spina bifida every year, as the vitamin plays a key role in foetal development. | |
Women are advised to take supplements before becoming pregnant, but many do not do so, or take them too late. | Women are advised to take supplements before becoming pregnant, but many do not do so, or take them too late. |
Research has linked folic acid to a raised cancer risk, but the FSA said the evidence was not convincing. | Research has linked folic acid to a raised cancer risk, but the FSA said the evidence was not convincing. |
We don't know the exact effects of this and much is not proven one way or the other Dr Sian AstleyInstitute of Food Research | We don't know the exact effects of this and much is not proven one way or the other Dr Sian AstleyInstitute of Food Research |
The US and Canada started fortification of bread flour in the late 1990s, and some of the subsequent research has pointed to an increase in cases of bowel cancer. | The US and Canada started fortification of bread flour in the late 1990s, and some of the subsequent research has pointed to an increase in cases of bowel cancer. |
However the Scientific Advisory Committee on Nutrition, which advises the FSA, said this evidence was insubstantial and that any increase in cases could be down to improved screening. | However the Scientific Advisory Committee on Nutrition, which advises the FSA, said this evidence was insubstantial and that any increase in cases could be down to improved screening. |
It did, however, recommend that those deemed to be at greater risk of colon cancer should receive precautionary advice on taking extra supplements containing folic acid, and that the situation should be monitored. | It did, however, recommend that those deemed to be at greater risk of colon cancer should receive precautionary advice on taking extra supplements containing folic acid, and that the situation should be monitored. |
Unplanned pregnancies | Unplanned pregnancies |
Between 700 and 900 pregnancies are affected by spina bifida every year. Experts estimate this could be reduced by up to 18% with fortification. | |
There are also positive health implications for the entire population, as inadequate levels of folate have been linked to a range of diseases - including cancer. | There are also positive health implications for the entire population, as inadequate levels of folate have been linked to a range of diseases - including cancer. |
Last month there were calls for all Scottish women to take folic acid - even those not planning a family - after 15 babies were born with spina bifida since the start of the year. | Last month there were calls for all Scottish women to take folic acid - even those not planning a family - after 15 babies were born with spina bifida since the start of the year. |
Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and green leafy vegetables. | Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and green leafy vegetables. |
The body cannot store it, so it must be ingested daily via supplements or folate-rich foods. | The body cannot store it, so it must be ingested daily via supplements or folate-rich foods. |
The vitamin is known to prevent neural tube defects in foetuses, but many women do not take it - in part because pregnancies are often unplanned and can go unnoticed for many weeks. | The vitamin is known to prevent neural tube defects in foetuses, but many women do not take it - in part because pregnancies are often unplanned and can go unnoticed for many weeks. |
As well as cutting the incidence of spina bifida, latest research from Canada also suggests it can reduce the risk of congenital heart problems in babies. | As well as cutting the incidence of spina bifida, latest research from Canada also suggests it can reduce the risk of congenital heart problems in babies. |
Cereal has long been fortified on a voluntary basis by manufacturers, but suggestions that bread must be supplemented by law have been rejected by those who argue it is tantamount to mass medication. | Cereal has long been fortified on a voluntary basis by manufacturers, but suggestions that bread must be supplemented by law have been rejected by those who argue it is tantamount to mass medication. |
Concerns about the how the potential risks weigh up against the benefits have been expressed. | Concerns about the how the potential risks weigh up against the benefits have been expressed. |
As well as suggestions of a link with colorectal cancer, studies have also shown it may speed up cognitive decline in elderly people with other B vitamin deficiencies. | As well as suggestions of a link with colorectal cancer, studies have also shown it may speed up cognitive decline in elderly people with other B vitamin deficiencies. |
SACN did look at these issues for a report in 2007, which ultimately recommended fortification. But following publication of that report it was also asked to analyse two more studies relating to bowel cancer. | SACN did look at these issues for a report in 2007, which ultimately recommended fortification. But following publication of that report it was also asked to analyse two more studies relating to bowel cancer. |
The FSA said that since SACN's advice on fortification has not changed significantly as a result, its own recommendation in favour remained the same. | The FSA said that since SACN's advice on fortification has not changed significantly as a result, its own recommendation in favour remained the same. |
Discussions planned | Discussions planned |
The government's Chief Medical Officer Sir Liam Donaldson is expected to discuss the issue with counterparts in Scotland, Wales and Northern Ireland having received the updated advice. | The government's Chief Medical Officer Sir Liam Donaldson is expected to discuss the issue with counterparts in Scotland, Wales and Northern Ireland having received the updated advice. |
Legislation would be necessary to introduce the measure, and it would also mean stricter controls on fortified foods like cereals to ensure people did not exceed recommended daily intakes. | Legislation would be necessary to introduce the measure, and it would also mean stricter controls on fortified foods like cereals to ensure people did not exceed recommended daily intakes. |
Dr Sian Astley of the Institute of Food Research said mandatory bread fortification was premature. | Dr Sian Astley of the Institute of Food Research said mandatory bread fortification was premature. |
"You cannot fault SACN for their review of the evidence, the problem is that it is a very fast-moving situation," she said. | "You cannot fault SACN for their review of the evidence, the problem is that it is a very fast-moving situation," she said. |
"Folic acid as we are given it is not a nature identical substance, and so we metabolise it in a different way. We don't know the exact effects of this and much is not proven one way or the other. | "Folic acid as we are given it is not a nature identical substance, and so we metabolise it in a different way. We don't know the exact effects of this and much is not proven one way or the other. |
"We really should be waiting for the full picture to emerge from the US - they are 10 years ahead of us with this - before we make a decision on this front." | "We really should be waiting for the full picture to emerge from the US - they are 10 years ahead of us with this - before we make a decision on this front." |
A spokesman for the Department of Health said: "We will now consider their recommendation for the introduction of mandatory fortification of flour with folic acid alongside controls on voluntary fortification." | A spokesman for the Department of Health said: "We will now consider their recommendation for the introduction of mandatory fortification of flour with folic acid alongside controls on voluntary fortification." |