Proposals to make consumers eat synthetic vitamins in bread have been shelved because the benefits in reducing the number of babies born with birth defects might be outweighed by the risks to older people.
The board of the food standards agency yesterday decided not to recommend the compulsory fortification of flour with folic acid while the overall health effects on the population remained uncertain.
Members recognised the potential value in cutting by 41% the number of birth defects, still births and abortions arising from inadequate consumption of folic acid by pregnant mothers, but were worried that increased consumption by older people through their bread might help mask other vitamin deficiencies in around 365,000 consumers over 65.
These could lead to problems of the nervous system including tingling in hands and feet, loss of balance, memory loss and confusion.
The agency wanted more research and more information from ministers on the possibility of increased screening of older people by GPs before returning to the issue. Consumers' organisations have also been concerned that people would have no choice.
The United States, Canada and Chile have introduced mandatory fortification.
Brian Wharton, of the Institute of Child Health in London, estimated such a regime in Britain could prevent about one child being born with spina bifida or other neural tube defect per 1,000 births against 50 in 1,000 people over 65 being put at nutritional risk unless there was a screening programme. The statitistics looked very one sided, he said.
Folic acid is a synthetic form of compounds that occur naturally in foods, especially green leafy vegetables, potatoes, milk and dairy products. It is found in most breakfast cereals already but in little bread. Women of child-bearing age are routinely advised to take supplements and that would not change even if folic acid were added to flour at the rate of 240 micrograms per 100g.
Health officals are worried that extra folic acid might, in older people, mask lack of vitamin B12, also essential for the formation of red blood cells, whose shortage can lead to neurological problems.
The food agency conducted a wide ranging consultation on the issue, with 59% of respondents supporting compulsory fortification and 30% against it. A spokeswoman said yesterday: "The board have agreed not to recommend mandatory fortification of folic acid in flour but they will be taking forward some related issues with ministers... We will be coming back to this in the fairly near future. At the moment we need more information on this issue." This would include the results of a study in Chile.
The latest decision in a long-running debate, which has been compared to that over water fluoridation, was welcomed by Sue Davies, principal policy officer of the Consumer's Association. Issues that needed attention included "effective ways of monitoring of possible B12 deficiency if folic acid were added to flour, possible long-term effects of high doses of folic acid for the whole population and the issue of choice. Consumers would need an alternative if they don't want to eat fortified products."
Andrew Russell, executive director of the Assoication for Spina Bifida and Hydrocephalus, said the result was disappointing. "We have been rooting for 10 years for statutory fortification so flour would have folic acid just as it now has calcium, iron and vitamins. It is very unlikely people would get enough folic acid to mask B12 deficiency."
The industry has made clear that fortification is a decision that only government can take and fund. Voluntary schemes are unlikely while there are health concerns.
