What is folic acid, and why are New Zealand's bakers up in arms over it?
Folic acid, or folate, is a member of the vitamin B family. Together with vitamin B12, folate is essential for the formation of normal red blood cells and for DNA synthesis. Dietary sources for folate include citrus fruit and raw, leafy vegetables.
Folate deficiency, like vitamin B12 deficiency, produces a type of anemia. Possible sources of the vitamin deficiency can include:
- Inadequate amount of raw, leafy vegetables or citrus fruit in the diet;
- Overcooking vegetables (folate levels in food are greatly reduced by excessive cooking);
- Drinking excessive amounts of alcohol (interferes with folate absorption by the body);
- Interference from certain pharmaceuticals;
- Pregnancy and breast-feeding; and
- Kidney dialysis.
An individual whose folate level is low for any of these reasons can take an oral supplement to correct the deficiency. Often, though, a healthy woman, who has not yet realized that she is pregnant, may be lacking in folate without realizing it. And this can have a serious effect on the health of her unborn baby.
Folate deficiency during the first three months of a woman's pregnancy – and even during the six months prior to her becoming pregnant – may result in birth defects such as spina bifida – a faulty or incomplete formation of the spinal cord and spinal column.
The connection between low folate levels and defects such as spina bifida has been known for at least 15 years. The debate over how best to ensure that women of childbearing age receive enough folate to prevent neural tube defects has been going on ever since the link was established. Which brings us back to the New Zealand bakers.
The previous government of New Zealand, led by Helen Clark, had decided to mandate the fortification of most bread with folic acid. The Clark government announced this policy change after the existing program – to fortify only certain brands of bread – proved ineffective. But, according to a recent poll reported by The New Zealand Herald, 87% of New Zealanders don't want their bread fortified with folic acid. In the face of this public opposition, the current government has promised to take a second look at the policy.
The Bakers Association is fighting the planned fortification mandate, which puts the onus on individual bakers to add folic acid to each batch of bread dough, rather than requiring millers to fortify their flour, as most other countries have done.
In its fight against fortification, the Bakers Association has claimed that adding folic acid to bread would make it less safe, calling the program ". . . a mass medication experiment that won't work." The comment was echoed by the chief executive of the Food and Grocery Council, who described fortification as ". . . a medical experiment of grand proportions." The Herald article also referred to recent studies that suggest a link between folic acid fortification and increased risk of colon cancer.
The "experiment" already has been underway for more than a decade in the United States and Canada, and more than 50 other countries also have adopted folate fortification.
This map, provided by the Flour Fortification Initiative, illustrates the distribution of flour fortification mandates worldwide. Dark blue countries mandate fortification of at least one type of flour; countries shown in light blue have a policy of voluntary fortification; yellow indicates that a policy is in the planning stages.
If the Bakers Association is correct and folate fortification causes colon cancer, the world is in for a major outbreak of this disease. A recent study from Chile suggests that colon cancer has increased in that country since mandatory flour fortification was implemented. In addition, a Dutch study released last year indicated that cancer cells in lab culture grew more rapidly in the presence of high concentrations of folic acid. But US colon cancer rates fell by 10% between 1999 and 2005, from 55 cases per 100,000 people in 1999 to 49.5 cases in 2005 (the most recent year for which CDC data are available).
In both Canada and the United States, folic acid fortification of flour has been mandatory since 1998. And this policy has born fruit. By 2007, the United States had experienced a 26% reduction in the incidence of folate-related birth defects; Canada documented a 42% drop. All at a cost of just pennies per person.
Overlooked in the folate debate is a recent suggestion that folic acid fortification of flour may be linked with increased rates of autism. Here again, though, the evidence is not clear-cut. Autism rates have been rising steadily in the United States since the 1980's – well before folate was added to flour.
Nevertheless, the New Zealand government is correct to reexamine its position. It is wrong to place the onus on individual bakers to fortify their bread. This would lead to erratic fortification levels and an enforcement nightmare.
If fortification is desirable – and we believe that it is – the place to fortify is at the flour mill.