The UK government has been consulting on adding folic acid to flour, such as used in bread, biscuits and pastries to help nourish our nation with this essential B vitamin that is important for healthy pregnancy outcomes. The decision from the consultation was to add it to all non-wholemeal flour.
By adding folic acid to non-wholemeal flour, along with other legally required fortifications, such as iron and niacin, we would be joining an initiative adopted by many other countries to try and help prevent neural birth defects in babies such as spina bifida (a spinal cord defect) and anencephaly (a brain defect). This new regulation may help to prevent around 1,000 babies being born with these preventable conditions annually in the UK.
What is folate and why is it so important?
Folate helps the body make healthy red blood cells which carries oxygen around the body. If you are low in folate, you may make abnormally large red blood cells that do not function properly and can lead to tiredness, brain fog, shortness of breath and sores in the mouth.
Folate also helps make our genetic DNA and healthy cell division. People with depression and autism may be low in folate.
Folate is naturally found in certain foods, in particular, liver, salad leaves, green vegetables, pulses, eggs, papaya, bananas and cantaloupe melon.
A synthetic form of Vitamin B9 called folic acid has been added to several popular branded cereals such as Cheerios, Weetabix and Shreddies for many years now, but this fortification is voluntary so not in every cereal you buy.
Why are they adding folic acid to white flour?
It’s because as a nation, we simply do not consume enough natural dietary folate through healthy food choices. And this has got so bad that around 90% of women of childbearing age have blood levels of folate way below the level recommended levels.
Since around half of pregnancies are unplanned, many women don’t even know they are pregnant for a while, and therefore do not increase their intake of pulses and greens or take folate supplements when they first fall pregnant. And it’s the first 12 weeks which is the most important window for nourishing the baby with folate to help prevent any complications.
It’s not just women who are affected by low folate – an estimated 28% of teen girls, 15% of teen boys and 7% of adults have low blood folate levels, putting them at risk of anaemia.
Why wouldn’t you want to add folic acid to flour?
There are concerns that consistent high intakes of folic acid from food or supplements could potentially increase the risk of masking vitamin B12 deficiency in people with a condition known as pernicious anaemia (an autoimmune condition that attacks the parietal cells in your stomach to prevent you from absorbing b12 from food).
Folic acid may also interact severely with certain medications which are listed here.
The other key question about adding in folic acid is genetics. Mother Nature creates several types of folates which are usually found in edible leaves and beans (folate comes from the word foliage) and are all easy to synthesise and utilise. Folic acid however is the man-made synthetic form of folate, and some people genetically struggle to convert this folic acid into the more natural and bioavailable methyl form.
Around 60% of the population carry a certain family of genetics SNPs – the most famous one being the MTHFR gene which provides instructions for your body to process folate. If this MTHFR function is compromised, then synthetic folic acid can build up in the blood and does not covert that easily into the folate needed to nourish the blood cells. The degree to which this genetic profile can affect the conversion of folic acid into folate can alter from person to person.
It is thought that the MTHFR gene is one of the key reasons behind multiple miscarriage & milder mid-line issues in babies such as tongue tie and lip tie. You can read more in this blog I wrote all about MTHFR genetic SNPs and we are able to organise genetic testing if you have any concerns.
Therefore, we often recommend to our clients with this genetic profile to avoid dietary synthetic folic acid and to take folate in the bioavailable forms as well as eating lots of greens, pulses and eggs. If folic acid is added to flour across the board, then the people most affected by MTHFR may need to avoid eating foods containing flour and consume non-wheat-based flours like oat, rye, barley, buckwheat, teff, sorghum, chickpea or even ground almonds.
If you would like to have a better understanding of your genetic profile when it comes to folate metabolism, our clinical team can advise on testing and provide individualised interpretation.
The bottom line
In my opinion, the unintended consequences of blanket addition of folic acid to flour for the whole population are significant, so it makes sense to focus on the people most likely to have dietary deficiencies. For example, people who eat ultra-processed food with white flour are most likely to be nutritionally deficient. However, anyone cooking with or choosing wholemeal flour is fairly likely to be well nourished, and I don’t see the need to fortify that.
This was a very finely-balanced debate, and I don’t envy the government having to make these large scale decisions about our health. But if they are going to intervene, then there needs to be clear evidence of the overall benefit.The consultation was looking for opinions on a range of interventions – including wider and more narrow options than focusing just on non-wholemeal flour. I think they have come to the right conclusion by targeting the people most likely to be deficient, through their unhealthy eating habits.