Scientists claim 250 μg/100g folic acid fortification in UK wheat flour is too low

UK – Researchers led by University College London (UCL) claim the planned amount of folic acid fortification in UK wheat flour — 250 micrograms per 100g — is too low, and instead recommend a fortification level of 1mg/100g.

Last year, a new legislation was passed by the Government of the United Kingdom (UK) to make fortifying all non-wholemeal wheat flour with folic acid mandatory by the end of 2026.

This is in a bid to prevent around 200 cases of debilitating brain and spine defects in infants and children every year, a 20% reduction, as well as improving the health of the population, including pregnant women.

The experts suggest that by increasing the level of folic acid fourfold to 1 mg per 100g, the number of cases prevented will rise to 800 per year.

“Fortifying all flour and rice to a higher level of fortification would prevent many more serious cases of disability,” Professor Sir Nicholas Wald, a specialist in preventative medicine at UCL, said.

Prof. Wald and his colleagues analysed two major studies in Ireland and China which involved 56,000 and 230,000 women, respectively. The researchers concluded that the original authors of those studies had published erroneous findings.

When they re-tabulated the data for the relationship between folate levels and defects, they found that by doubling the levels of serum folate, the risk of developing neural tube defects went down by around 50%.

Concerns have been raised that higher levels of folic acid fortification could lead to people exceeding the daily limit which the NHS recommends to be 1mg per day. Exceeding this limit can mask the symptoms of anaemia caused by a vitamin B12 deficiency, which can damage the nervous system if untreated.

But the researchers argued that this fear was unfounded since diagnosis of nerve damage linked to B12 does not rely on anaemia detection.

Folic acid, or vitamin B9, is found in foods such as leafy greens, asparagus, eggs and oranges.

The vitamin plays a vital role in early pregnancy and development of the baby’s brain, skull and spinal cord. Deficiency is a leading cause of neural tube defects, which can cause serious, bedevilling conditions, including spina bifida.

Pregnant women are recommended to take 400 micrograms of folic acid every day until 12 weeks, and the flour fortification will be an added measure. Some women at higher risk take 5mg per day.

A Department of Health and Social Care spokesperson said the plans were based on a clear agreement about the correct level of fortification.

“Public health programmes must take account of all available scientific evidence, and there is a clear consensus that this level of fortification is balanced and offers substantial benefits. Levels of folic acid fortification and health impacts will be kept under review,” the spokesperson added.

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