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Failure To Fortify Flour Is "Public Health Malpractice"

United Kingdom

The refusal of European governments to fortify flour with folic acid has continued to draw criticism. Professor Godfrey Oakley of the US Emory University has told the British Medical Journal that fortification could save as many lives as are typically lost each year in car crashes. He put the resistance to fortify down to 'erroneous speculation' of possible harm to elderly people.

In the UK recently, Sir John Krebs, chairman of the Food Standards Agency (FSA), defended the board's decision not to go ahead with mandatory fortification of flour, but many believe the time has come for a pan-European fortification policy.

There is much evidence to show that fortification improves the lives of adults, including elderly people, and that it is safe. Oakley highlighted 1998 figures—the year fortification was made mandatory in the US—showing that deaths from stroke and heart attack declined by 3.4 per cent.

"It is ironic that the UK has not required fortification, as it was a randomised controlled trial from the UK that conclusively proved that supplementation with synthetic folic acid prevents about 75 per cent of spina bifida and anencephaly, common and serious birth defects," Oakley said. "Rare is the opportunity to implement a sustainable, inexpensive and effective intervention to prevent major human diseases. Folic acid fortification of flour is one of those rare opportunities. Governments that do not ensure that flour is fortified with folic acid are committing public-health malpractice."

Krebs responded to the criticism in a letter to a national UK newspaper in which he noted that although the benefits in relation to spina bifida were well documented, the committee was also obligated to take into account the possible adverse effects on the elderly.

He wrote: "Fortification with folic acid could mask vitamin B12 deficiency in up to half a million elderly people. The fact that adverse effects have yet to be reported in the United States cannot be interpreted as meaning that such effects do not exist, as no data have yet been collected...The agency agreed that the evidence base was insufficient to commend compulsory fortification to health ministers."

The easy solution, say many, is simply to fortify flour with vitamin B12 as well.

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