British government urged to add folic acid to white bread as a public health measure; proponents say it would save hundreds of lives each year

A study carried out by researchers from the Queen Mary University of London have called on the U.K., as well as other countries, to look at the mandatory fortification of flour with folic acid to curb spina bifida cases and other neural tube defects (NTDs). The study, which was published in Public Health, explained that an earlier report used to determine a daily upper limit for folic acid consumption – set at one milligram per day – was based on a “flawed interpretation of data.

Neural tube defects such as anencephaly and spina bifida are two of the most severe birth defects known all over the world. Unfortunately, it’s also one of the most common: NTDs affect one in every 500 to 1,000 pregnancies. Of the two, spina bifida is the more common, where the base of the spinal cord and surrounding vertebrae aren’t connected properly, resulting in a gap in the spine. This can cause issues with walking, as well as with bladder and bowel control. A child born with spina bifida may also have cognitive disabilities. Anencephaly, which is a condition where the neural tube isn’t closed at the top, is a rarer condition. However, it is serious: a child born with this condition are either stillborn or will die in infancy.

In the study, the researchers looked at increasing folic acid intake as a way to prevent NTDs. Folic acid – a synthetic compound for folate – doesn’t naturally occur in food. However, it can still become biologically active after metabolic reduction. For the study, researchers proposed fortifying foods using folic acid because it is more stable and twice as bioavailable as folate.

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An earlier randomized double-blind trial conducted by the Medical Research Council demonstrated that increasing the intake of folic acid to 4 mg per day before and during the early stages of pregnancy arrested the prevalence of NTDs by 80 percent. However, a cross-sectional study of 500,000 women in England found out that only 31 percent of women took folic acid supplements immediately before their pregnancy. While 62 percent took supplements during pregnancy, these were taken at a time where NTDs were already too late to be prevented. (Related: Folic acid during pregnancy may reduce baby’s cancer risk.)

The upper limit for folate comes from a study made by the Institute of Medicine which concluded that treating cases of vitamin B12 deficiency with higher doses of folic acid were more likely to have neurological damage. This was revisited in the current study, with the results indicating that folic acid did not cause the damage; rather, it was because B12 deficiency was not treated with vitamin B12.

With these outcomes, the researchers opined that flour should be fortified with folic acid to increase intake to at least 0.2 mg a day and reduce the incidence of NTDs.

“Having such a limit, which has been set at 1 mg per day, has acted as a barrier to the wider introduction of mandatory fortification of flour with folic acid to prevent neural tube defects. For both reasons, the upper limit should be discarded,” the authors concluded in their report. “This would have the practical effect of leaving no scientific obstacle to the introduction of mandatory folic acid fortification in all countries, which would have an important global impact on the prevention of neural tube defects.”

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