UK's food regulator endorses folic-acid fortification

The UK looks set to follow the lead of the US, Canada and Australia by introducing mandatory fortification of bread or flour with folic acid in a bid to reduce incidences of birth defects such as spina bifida.

The UK's industry regulator, the Food Standards Agency (FSA), wrote to the British Government on 9 October recommending mandatory fortification after a panel of experts said evidence linking folic acid with bowel cancer was not strong enough to prevent introducing such a measure. The UK Department of Health will now consider the recommendation before deciding whether to give fortification the green light.

The FSA's decision represents, in effect, a double u-turn. In June 2007, the agency announced it would be backing mandatory fortification having been advised to do so by the UK's Scientific Advisory Committee on Nutrition (SACN) in December, 2006.

However, the FSA subsequently changed its mind when two new studies linking excessive intakes of folic acid with bowel cancer came to light, and it referred the matter back to the SACN for review. But the FSA said last week that the SACN had ruled the new evidence "does not provide a substantial basis to change its previous recommendation for the introduction of mandatory fortification with folic acid. However, SACN's recommendation has been amended to clarify the advice on supplement use for particular population groups."

This new advice from the SACN states: "There are no specific recommendations on folic acid supplementation for other population groups (ie children, women above childbearing age, and men) except on medical advice.

"For people who choose to take supplements, as a precaution, it would be advisable for those aged over 50 years not to consume supplements containing folic acid above the recommended nutrient intake for folate of 200µg/day since the risk of developing colorectal adenomas/colorectal cancer increases after this age.

"For people with a previous history of colorectal adenomas, folic-acid supplementation should also not exceed 200µg/day without medical guidance. This recommendation is relevant to current consumption patterns and those which would prevail if mandatory fortification were introduced."

In a letter to the government's chief medical officer, Sir Liam Donaldson, FSA chief executive Tim Smith wrote: "Since SACN's advice regarding mandatory fortification has not significantly changed, the FSA's advice of June 2007 remains unchanged. I shall be writing to the FSA Board to inform them of the outcome of SACN's review of the recommendation for mandatory fortification with folic acid, and to advise them that no further discussion by the Board on this matter is required at this time."

Fortification of bread and flour with folic acid is a hot topic globally. In Ireland, regulators decided in March 2009 not to introduce mandatory fortification, principally because it believed women already had enough folic acid in their diets through the voluntary fortification of food and drink. Mandatory fortification was due to begin in New Zealand in September, but in July the government agreed to delay any such move until 2012 while more research was conducted into its potential impact on human health.

New Zealand had been due to introduce mandatory fortification alongside Australia, with which it shares a food regulator in the form of Food Standards Australia and New Zealand. But Australia has now introduced the measure independently.

The US, Canada and Chile, meanwhile, have all had mandatory fortification of flour for ten years.

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