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Low folate levels- is fortification the answer?

Posted on 30 November 2017 .
Tags: public health, victims

We all know that we need certain vitamins and minerals to stay healthy; the benefits of having plenty vitamin C and calcium are particularly well publicised. But have we overlooked the importance of other vitamins like folate? Public Health England has recently published a report showing that the adult population are not getting enough of this important B vitamin.

The National Diet and Nutrition Survey (NDNS) carried out by a consortium led by NatCen, shows that a high proportion of woman aged 16-49 do not have therecommended level of RBC folate concentrations. Folate helps the body produce healthy red blood cells and is important in reducing the risk of central neural tube defects (such as spina bifida) in unborn babies. Folate occurs naturally in many foods such as broccoli, spinach, asparagus and peas, but is also fortified in others such as cereals, and can be taken as a supplement called folic acid.

The below graph shows the proportion of women of childbearing age who have levels of RBC folate below the threshold for avoidance of fetal neural tube defects (NTDs). 

graph for folate

Why is this a concern?


Low RBC folate is particularly concerning for women of childbearing age (aged 16-49 years). Women who are trying to conceive or are in the early stage of pregnancy are recommended to take 400mcg of folic acid daily to reduce the risk of their child developing neural tube defects (NTDs). Currently one in every thousand pregnancies in the UK is affected by NTDs. However 50% of pregnancies in the UK are unplanned which means that many women may not be getting enough folate in the first 12 weeks of pregnancy.

What can be done about it?

International health bodies (for example the United States Food and Drug Administration) have long argued that in order to ensure a healthy folate intake, certain food should be fortified with folic acid. This is already the case in the UK for some cereals and spreads, but many countries also add folic acid to flour as this is the most effective way to increase intake of folate; such countries have seen a reduced number of babies born with NTDs; in 2015 the USA saw 1300 fewer babies born with NTDs, a reduction of around 35% since folic acid fortification was introduced in 1998. The UK’s Scientific Advisory Committee on Nutrition state that fortifying flour with folic acid has proved to be “an effective way of reducing the liability to neural tube defects”.

What’s stopping the UK from taking action?

With the clear evidence that adding folic acid to flour will reduce NTDs, action undoubtedly needs to be taken. The Scottish government has been in favour of folic acid fortification for many years, but due to how industry is set up; this will need to be done on a UK-wide basis. With the growing pressure and evidence of the benefits of adding folic acid to flour, it is hopefully a case of when rather than if this will happen. Given the latest findings from NDNS, I hope it will be sooner rather than later. 

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