Thursday, April 06, 2006

Mass Medication of the Population

Mandatory folic acid fortification of bread in the UK will be recommended by the UK's Food Standard Agency, according to FoodNavigator/Europe... but the "Consumers for Health Choice" (CHC) are not happy about it.

The fortification is being recommended in an effort to reduce the incidence of pregnancies affected by neural tube defects (NTDs) such as spina bifida and anencephaly which are the most common NTDs. "Both conditions occur in the very early stages of pregnancy, often before women are aware that they are expecting."

Dietary folate occurs naturally in foods such as grains, lentils, chick peas and green leafy vegetables, and is known to reduce the risk of these conditions.

Folic acid, on the other hand, is a synthetic form of the nutrient which, according to the National Council on Folic Acid in the US, is actually better absorbed by the human body.

In a document published in advance of the meeting to recommend folic acid fortification, the FSA indicated: "Bread would be an appropriate vehicle because it has a relatively uniform consumption across subgroups of the population."

According to the FSA, this would mean that folate consumption would increase in a predictable way across the population.

"The preferred point of fortification would be at the milling stage (with the exception of wholemeal flour), rather than at the bread-making stage. This is because there is already a requirement in place to fortify milled flour with iron, calcium, thiamine and niacine, so the new requirement would build on existing technology and regulation." -- FoodNavigator

According to the document, mandatory fortification would not replace the advice that women supplement their diet with folic acid, but rather complement this advice.

"This is not the first time that the FSA has considered mandatory fortification. In 2002 SACN opted not to adopt it because of concerns that folate consumption in excess of 1000 micrograms per day could delay the detection of vitamin B12 deficiency in older people, which can have severe neurological consequences." -- FoodNavigator

However some of the latest research indicates that B12 deficiency would be masked only with folate consumption of more than 5000 micrograms per day. I haven't seen the source of this research yet, so I'm unable to provide the full details of who completed it and/or where you can find it.

CHC believes the B12 deficiency issue in older people has still not been fully addressed. They contend that better education for women of childbearing age, particularly those who become pregnant and/or are likely to become pregnant, is a better way to go than mass medication of an entire population.

"We feel what is needed is better education of women of childbearing age about the consequences of not consuming enough folate. We should still have the choice if we are not in that group."

Mandatory fortification of flour with folic acid is already in place in several countries, including the US, Canada, and Chile.