1. Folic acid sparks debate among scientists
  2. Opponents question need for folic acid in bread
  3. New news section

Folic acid sparks debate among scientists

Monday, 18 May 2009

Concerns have been expressed about the possible negative effects of folic acid fortification, especially for those who are deficient in vitamin B12. An article in the Herald on Sunday yesterday highlights concerns about this standard.

Here in New Zealand, the standard was passed recently requiring all bread manufacturers to fortify bread with folic acid by September 2009. More information can be found on the Food Standards Australia New Zealand (FSANZ) website.

Folate is a B vitamin found naturally in foods such as leafy vegetables, dried peas and beans, bananas and oranges. Folic acid is the synthetic form of the vitamin, which may be added to manufactured foods and drinks, or may be taken as a vitamin supplement.

Women who have inadequate intakes of folate in the early stages of pregnancy are at increased risk of having a baby with a neural tube defect, and as such it is recommended that pregnant women take a folate supplement when planning to conceive and during the first 12 weeks of pregnancy.

Mandatory fortification of enriched breads, cereals, flour and other grain products has taken place the USA, for some years and has resulted in a 25% drop in the rate of neural tube defects. Further, a paper published in the BMJ last week found that in Canada, public health measures to increase folic acid intake were followed by a decrease in the birth prevalence of severe congenital heart defects.

We asked some New Zealand experts about their view on mandatory folic acid fortification and whether they had any concerns about possible adverse effects.

Elaine Rush is Professor of Nutrition at Auckland University of Technology. She comments:

“The fortification of food with folic acid will help prevent neural tube defect in babies and has the potential to lower plasma homocysteine, which is a risk factor for vascular disease. However, vitamin B12 is also an important factor in the prevention of neural tube defect as well as in the reduction of plasma homocysteine. Folic acid will mask vitamin B12 deficiency. Vitamin B12 is only found in foods of animal origin

“Those at risk of vitamin B12 deficiency in New Zealand include the elderly and those who do not eat meat such as vegetarian Indians, an increasing number of young girls, and people who believe that plant foods are more sustainable for the planet. With the recession, those who cannot afford the more expensive meat and dairy foods will eat more plant foods. New Zealand (unlike Australia) does not allow vitamin B12 to be added to cereals.

“There is evidence from India that maternal low B12 and high folate status are related to intrauterine growth retardation, and also with adiposity, insulin resistance and poor neuro-cognitive performance during childhood. We have measured pre-adolescent Indian girls and adults here in New Zealand, and B12 is also a problem for them.

“In isolation, the addition of single nutrients to a food supply may cause other unintended effects and the issue of fortification does need thinking though carefully so that all the population groups in New Zealand benefit”.

Jan Milne is Executive Director of the New Zealand Dietetic Association. She comments:

“The New Zealand Dietetic Association’s preferred option throughout the consultation process with Food Standards Australia New Zealand was the continuation of voluntary folic acid fortification in foods in combination with increased education to women of childbearing age about the role of folic acid in reducing the risks of neural tube defects.

NZDA is concerned that the success of the mandatory fortification process relies on women of child bearing age continuing to take a folic acid supplements. In relation to this, NZDA is concerned that the dose of the folic acid supplement that is available to women has not been altered to take account of the change in folate and folic acid available in the food supply as a result of mandatory fortification”

Dr Claire Wall is a senior lecturer in nutrition from the University of Auckland. She comments:

“I am supportive of mandatory folic acid fortification in New Zealand, there are likely to be significant benefits in terms of reducing neural tube defects and no adverse effects have been reported in the USA where there has been mandatory fortification of folic acid for several years.

“At a population level, the proposed amount of of folic acid that will be added is very safe, and will not increase the risk of cancer.”

Lydia Buchtmann is spokesperson for Food Standards Australia New Zealand. She comments:

“There have been many years of research on the issue of folic acid fortification. We have concluded that at the levels we are proposing to add folic acid it will be perfectly safe for the general population and will greatly reduce the risk of neural tube defects.

“Mandatory fortification of folic acid has taken place in the USA for over 12 years and during this period neural tube defects have been reduced and there is no other evidence of ill health.

There is very strong evidence for the safety of folic acid, but there will be ongoing monitoring to ensure that fortification continues to be a safe and effective practice."

Opponents question need for folic acid in bread


The New Zealand Food & Grocery Council (FGC) says pregnant women don’t eat enough bread to justify a decision to make fortification of bread with folic acid mandatory.

Food Safety Minister Annette King yesterday said the decision, jointly made with Australia, was “a triumph for humanity and common sense”.

In New Zealand the acid would be added as the bread was made and Australia had decided to add it to flour — something the New Zealand Green Party opposed.

“New Zealand women do not get enough natural folate in the diet to prevent a large number of babies being born with devastating neural tube defects, the most common of which are spina bifida and hydrocephalus,” Ms King said.

Opponents of the idea have raised concerns that the fortification could have side effects such as an increase in the number of twins and bakers have said it would add costs.

FGC executive director, Brenda Cutress, said pregnant women would need to eat 11 slices of bread a day to get the necessary amount.

She said research by Professor Leonie Segal of the Monash University — found at the option was not cost effective and recommended promoting folic acid supplements through a public campaign targeting women of child bearing age.

“It’s laudable to seek a way of reducing birth defects, but it is more important to have a solution that actually works,” she said."

However Ms King expected the change would see between four to 14 fewer neural tube defect affected pregnancies a year.

“While fortification alone won’t provide the recommended amount of folic acid that should be taken before and during pregnancy, it will be enough to make a difference.”

Folic acid supplements were still recommended for women planning a pregnancy.

Organic and non-yeast leavened breads were exempt from mandatory fortification.

“We promised that New Zealanders will have a choice, and we have delivered on that promise, but I urge all women considering a diet low in folate or folic acid to consult their doctor about the risks and consequences,” Ms King said.

In New Zealand fortification of bread at levels of 80 to 180mg of folic acid per 100g of bread will occur in the bread-making process and will be mandatory two years after the standard is gazetted.

Dietary modelling studies showed this would increase folic acid intake in New Zealand women by 140 mg of folic acid a day, she said.

“This is still below the 400 mg daily intake recommended by the Ministry of Health for women in the four weeks before and first twelve weeks of their pregnancy, and all pregnant women should ask their doctor about the right folic acid supplement for them.”

There would a review to see how the decision was working after two years.

Green MP Sue Kedgley said she was pleased that organic bread was exempt. Her party opposed the Australian model of all flour containing folate.

“We are pleased that the Minister has not slavishly followed Australia, and required folate to be added to all flour, and has instead come up with a New Zealand based solution — of adding folate during the breadmaking process.”

She said it would be hard for some small bakeries to implement the change because of measuring difficulties for small batches.

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