Should Folic Acid be added to Flour?

folic acid added to bread

Should Folic Acid be added to Flour?

At the end of September the UK Government announced that folic acid is to be added to UK flour in a bid to help prevent spinal birth defects including spina bifida in babies in a process called fortification.  It is estimated that by adding folic acid to non-wholemeal wheat flour and products made with flour such as bread it will help prevent around 200 neural tube defects every year which is around 20% of the total number.

Fortifying foods is nothing new in the UK, and since the Second World War flour has been fortified with calcium, iron, niacin, and thiamine.  It’s also not even new for foods in the UK to be fortified with folic acid as many breakfast cereals already are.

In relation to folic acid the UK is someway behind the rest of the world with over 80 countries already fortifying flour with this including, Australia, New Zealand, and Canada with the US going first back in 1998.

So what is folic acid and why is it important?

You may hear two different names mentioned in relation to this topic, one being Folate and the other Folic Acid.  So are they the same thing? Simply put, folate is a naturally occurring vitamin found in some foods and folic acid is the synthetically produced version.  Folate is actually a member of the B vitamin family and is sometimes referred to as vitamin B9.

The reason for folic acid being added to flour is because the vitamin is known to be critical in ensuring the correct development of the neural tube in the foetus.  This is the part where the baby’s brain, spinal cord, spinal nerves, and backbone develop.  For this reason the NHS already recommend that women take 400 micrograms of folic acid a day as a supplement before pregnancy and until 12 weeks into pregnancy.  As many pregnancies in the UK are unplanned, fortifying foods can help get essential nutrients into people’s diets when they won’t be thinking of taking the recommended supplements.  A number of women also aren’t aware they need to take the supplement, forget, or aren’t aware of the importance.

As well as the key reason around foetal development, folic acid is also vital for many functions within our bodies throughout our lives.  As a B vitamin its main function is as an enzyme, like other B vitamins.  This means it helps to convert compounds into usable forms within the body. Folic acid is essential in enabling our DNA (our genetic code for every cell in our body) to replicate properly and ensure healthy cell formation in every part of our body and includes producing and maintaining healthy blood cells, our immune system as well as our tissues and organs.

Which flours are included?

This ruling will only apply to non-wholemeal wheat flour.  Gluten free and wholemeal flours will be exempt.  Wholemeal flour does not need to be fortified with folic acid as the wheat bran and wheat germ that are included in the final flour are naturally occurring sources of vitamins and minerals including folate.

By adding folic acid to the flour it means that all products made with the flour will be fortified included popular items such as bread.  It is important to do this as over 99% of British households buy bread and more than a quarter of all grocery products found in supermarkets contain flour.

Can you get folic acid from foods?

Folic acid is a synthetic form of the naturally occurring vitamin folate which is found in a number of foods and so for most people eating a healthy balanced diet will provide enough unless they are trying to get pregnant or going through pregnancy in which case supplementation is recommended.

Some of the key food sources include:

  • Green Vegetables– avocado, asparagus, spinach, broccoli, cos lettuce, kale, cabbage, peas
  • Pulses, lentils, chickpeas, brown rice
  • Bananas, oranges
  • Yeast extract
  • Liver (but avoid during pregnancy)

Some foods such as breakfast cereals are already fortified  with folic acid.

Coking and processing of vegetables can destroy folate, so that is something to be aware of, and it is particularly susceptible to heat and light and so is impacted in cooking, this is why folic acid, the synthetic version is used in fortifying foods.

Folate in Food

What are the problems with fortifying foods with folic acid?

There is always a concern that people can get too much of a good thing, and for those eating a healthy balanced diet they should easily be getting their required vitamin and mineral intakes and so fortified foods could take them over the recommended levels.  You may also get people that are taking folic acid supplements and then also eating fortified foods, so that could take them close to the upper recommended limits.

The way your body processes folate and folic acid does differ with almost all the folate from your food being digested in the gut and broken down and then absorbed into your bloodstream.  With the folic acid you get from fortified foods and supplements, very little is broken down into its active form in the gut and the majority requires the liver and other tissues to convert it.  This can mean that too much folic acid through supplements and fortified foods can lead to unmetabolized folic acid (UMFA) to collect in your blood which has been linked to various health issues.

Can high levels of folic acid mask a vitamin B12 deficiency?

The main concern is that high levels of folic acid can mask a deficiency in vitamin B12.  Vitamin B12 is used to make red blood cells and maintain good heart, brain, and nervous system function.  A deficiency in B12 can reduce your brain function and lead to permanent nerve damage if left untreated.  Folate and vitamin B12 are used by the body in very similar ways and so show very similar symptoms.

Other health concerns linked with high folic acid supplementation

In people that already have low levels of vitamin B12 excess levels of folic acid has been shown to potentially speed up age-related mental decline.  This was not seen in people with normal levels of B12 though.

There has been some suggested links to a role in increasing some cancers.  Folic acid in adequate levels has been shown to protect healthy cells from becoming cancerous, however, exposing cancerous cells to folic acid may increase their growth or spread.  The research on this is very mixed with very few studies reporting the link to an increased risk of cancer.

Its also key to remember that there is no know risk at all of eating folate-rich foods, only health benefits.

So what does this all mean?

With low levels of folate in the blood being linked to an increased risk of birth defects as well as health issues including heart disease, stroke and even some cancers, the UK government have decided that the benefits of fortifying flour with folic acid outweigh any potential risks.

The risks of getting too much folic acid or folate are relatively low and the foods that are being fortified are those aimed at people not getting all their vitamin and minerals already through a healthy balanced diet.

If you do ever have concerns about your vitamin intake, then you can always speak to a Nutritional Therapist.  A qualified Nutritional Therapist such as Helen from Helen Jane Nutrition will be able to discuss your current dietary intake, make suggestions on what foods to include and will also have access to private lab testing to assess at your current vitamin and mineral levels.

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