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Health: Folic Acid Fortification

Volume 753: debated on Wednesday 2 April 2014


Asked by

To ask Her Majesty’s Government when they expect to be able to make a decision in respect of folic acid fortification of white bread flour as part of a policy to reduce pregnancies affected by neural tube defects.

My Lords, we have previously stated that we were waiting for data on the folate status of the population from the National Diet and Nutrition Survey before making a decision with respect to fortification of flour with folic acid. The noble Lord is aware that delivery of these data has been significantly delayed. However, we will make a decision by Easter and will communicate it as soon as possible thereafter.

That is very good news because the congenital anomaly register, which the Minister will be aware of, currently shows that, on average, every week in England and Wales, 13 pregnancies are terminated due to neural defects and three babies are born with spina bifida and other conditions. Two-thirds of those tragedies could be avoided by fortification. Although the delay in the checking of samples is to be criticised in some ways, is it not ironic that British blood samples have been sent to America for checking and delaying, when America has fortified flour since 1998 based on the UK’s Medical Research Council’s work in the 1990s? When are we really going to get a decision so that we can use this for the benefit of our own people?

My Lords, we will announce a decision by Easter. I am aware, as the noble Lord is, of the impatience that many people have shown about this matter. However, it is right that the Government balance both the risks and the benefits of a policy that would see the mandatory fortification of a staple food. I think that that is a responsible course to take.

My Lords, is my noble friend convinced that the evidence for introducing folic acid into white bread flour is irrefutable, given the fact that successive Governments have tried to introduce fluoride into water for all of us but have failed to do so?

My Lords, there are risks associated with the fortification of flour with folic acid. That was pointed out by the scientific committee and was why its recommendation was conditional on certain things taking place. As it pointed out, there is a potential for significant numbers of the population to be pushed above the guideline upper limit for folic acid. We have to take those issues seriously in reaching a balanced decision.

My Lords, does the Minister agree that it is time for this important public health development and this important contribution to preventive medicine to be enacted, as it has been in many other countries? I am aware that there are likely to be those who object to this addition to flour. Surely it would be possible to meet those objections of a minority if a limited amount of bread free of folic acid were to be marketed to meet that concern.

My Lords, I note the noble Lord’s helpful suggestion but it is important that the Government take a decision on folic acid that is right for our own population, rather than anyone else’s. It is worth remembering that no other country in the European Union has taken the decision to fortify flour with folic acid. We need to do this by evaluating the risks and the benefits, as I said, based on the most up-to-date data we can get.

My Lords, we know that 50 countries have introduced folic acid. On the fluoridation question, the legislation is for local people and local authorities to decide, so there is a clear difference. It is clear that the Government have already briefed out that they will agree to this. We are going off on a very long Easter Recess. Joy would be unconfined if the noble Earl told us now what we know the Government have agreed to. Why does he not come clean on it?

My Lords, pending that decision, and even with the fortification of flour, the fact is that not all women planning to get pregnant will have the right level of folic acid. Are the Government planning a media campaign to encourage mothers about this? I mean not just the information on NHS pages but radio and magazine advertisements for young women so that they start to think about it when they begin to consider having their families.

There is a range of routes whereby we ensure that, as far as possible, women are advised on folic acid intake, particularly those women of childbearing age who may be thinking of starting a family. That includes the Start4Life information service and other media routes. I am not aware of specific media campaigns in this area, but if I can be enlightened on that I will write to my noble friend.

The Minister commented that no other European country has adopted fortification. Does he agree that the reason for that is that no other European country has the same incidence of neural tube defects as we have here in the United Kingdom? The incidence is far greater in the United Kingdom.

That is an issue that we will of course weigh up as we look at the risks and benefits and take a decision, as we will in the next few days.

My Lords, the scientific committee pointed to several risks. One is that an overdose of folic acid may mask vitamin B12 deficiency, particularly in the over-65s—and this may be an issue in which a number of us wish to declare an interest. The committee also pointed out that although there was no specific evidence of a link to bowel cancer, there are nevertheless experts who believe that the evidence is equivocal in that area, and we need to take the balance of opinion very seriously.