The new legislation requires millers and flour producers in the UK to fortify non-wholemeal wheat flour with folic acid by the end of 2026.
England and Northern Ireland have already laid out legislation, with Wales intending to lay similar legislation soon.
Benefits of folic acid
Folic acid deficiency is a leading cause of neural tube defects in babies, including spina bifida. Increasing a woman’s intake of folic acid can help prevent these serious and debilitating conditions.
Flour is already fortified with calcium, niacin, thiamin and iron to improve public health and the move to include folic acid could help to reduce neural tube defects by 20% in the UK and improve the health of pregnant women.
The big debate
Pressure had been mounting to introduce folic acid fortification for some time. Similar policies already existed in countless other countries across the globe but not the UK.
In 2000, 2006 and 2009, Government scientific advisers reviewed the available evidence, including potential adverse effects for some groups, and each time recommended mandatory fortification of flour with this vitamin. However, action was not taken.
In 2015, Government advisers wrote to UK health ministers, stressing the safety of folic acid fortification in other countries, associated improvements in folate status and falls in NTDs (for example, by 28% in the US). They emphasised that folate status of UK women of reproductive age had fallen in the interim, possibly linked to less voluntary fortification in anticipation of mandatory provision.
In response to a request from Food Standards Scotland (FSS) in 2016, Government advisers were asked to look at the new evidence since 2009 and, in 2017, reported finding nothing substantive to justify a change to their original advice or to the upper limit of 1mg/day.
A subsequent report, published in January 2018, which include representatives from the Wolfson Institute of Preventive Medicine and Queen Mary University of London, called the omission of folic acid a ‘tragedy’.
A public consultation finally took place in 2019, leading to the announcement on 20 September 2021 that legislation would follow.
‘A straightforward yet impactful’ move
Commenting on today’s news, said Ian McWatt, deputy chief executive of FSS said: “Fortifying flour with essential nutrients is a straightforward yet impactful way to help reduce neural tube defects.
“For decades, fortified flour has strengthened public health, and these new regulations aim to give children across the nation a healthier start.
“Over the next two years, manufacturers will have time to adjust both the composition and labelling of their products, ensuring a smooth transition.”
It is estimated that half of all pregnancies in the UK are unplanned. The new flour regulations should help provide women with a higher baseline intake of folic acid, before and during pregnancy.
“We welcome the announcement by the Scottish Government today that folic acid will be added to flour from 2026 onwards. Spina Bifida Hydrocephalus Scotland has campaigned for folic acid fortification for over 30 years, and this decision will have a life-changing effect for many future parents and children across Scotland,” said Lawrence Cowan, chief executive of Spina Bifida Hydrocephalus Scotland.
“Adding folic acid to flour will give women and their unborn children the best possible opportunities to be healthy. Folic acid fortification has proven effective in other countries, and in the UK this measure could prevent around 200 pregnancies affected by neural tube defects. It is important that we keep to the proposed timeline for introducing this legislation to ensure that we can have the broadest impact on families in Scotland.”
It is important to note that the NHS still recommends women who are trying to get pregnant or newly pregnant to continue to regularly take the recommended dose of folic acid supplements. The fortification of flour is intended to support, not replace, this advice.
Public health minister Jenni Minto added: “We have closely collaborated with Food Standards Scotland, the UK Government and other devolved Governments to introduce a measure which strengthens public health. We will continue to engage with the industry on implementation to ensure the best outcomes.”
