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Folic Acid

Volume 798: debated on Tuesday 18 June 2019


Asked by

To ask Her Majesty’s Government, further to the responses by Baroness Manzoor on 9 January (HL Deb, col 2212) and Baroness Vere of Norbiton on 19 March (HL Deb, col 1357), when they will commence the consultation on the mandatory fortification of flour with folic acid to help prevent foetal abnormalities, as announced on 22 October 2018.

My Lords, I am pleased to confirm that, as announced by the Parliamentary Under-Secretary of State for Health on 13 June 2019, the UK-wide consultation is now live and will run for 12 weeks. I thank the noble Lord, Lord Rooker, for his continued support on this important issue.

My Lords, in the current circumstances Ministers are to be congratulated on keeping to the commitment on the consultation. I will raise two brief points, neither of which is covered in the consultation or the impact assessment. First, during that consultation, will Ministers consider having discussions with some of the 80 other Governments around the world who do fortification? The diets may be different but some of the successes have been quite spectacular. Secondly, will Ministers point up one of the benefits of reducing neural tube defect pregnancies via fortification, which is the massive reduction in terminations? Since advice was first given in 2007, at 80% terminations for pregnancies, there have been 10,000 terminations and 2,400 live births of babies with a lifelong disability. These figures could be halved with fortification, so it is worth talking them up.

The noble Lord makes two very practical and helpful suggestions, for which I thank him. We have already taken into consideration the experiences of other countries which have existing folic acid fortification policies in place and, yes, we will consider extending those discussions internationally—bearing in mind, as he mentioned, that diets and behaviours differ significantly between regions. We clearly want to get this right, so why would we not talk to other countries? Increasing folic acid intake is likely to have a significant benefit by reducing the number of terminations, miscarriages and neonatal deaths as a result of neural tube defects, with all the trauma associated with that. He mentioned an 80% reduction; the numbers that I have been given suggest a 70% reduction but we can agree that it is a very major one. We have seen in the US a reduction of around 25%, but in Chile it has been closer to 50%. I thank him for his suggestions.

My Lords, I cannot be alone in having followed and admired the efforts of the noble Lord, Lord Rooker, on this situation over what seems like many years. Can my noble friend the Minister explain why we are delaying with the consultation? It just seems so patently obvious that this is the right way to go. Why can we not at the same time tell the manufacturers to get on with it and include folic acid at once, so that the lives of hundreds of babies can be saved and likewise the heartache of new parents?

I understand my noble friend’s impatience but, while the proposal to include folic acid in flour may appear simple and straightforward, the practical considerations are more complicated. We are obliged to consult on proposed changes of this nature to make sure that we understand the views of all stakeholders and the public before we can take an informed decision on the best way forward. I appreciate her frustrations at the delay, but I hope that she will agree that 12 weeks is a price worth paying for getting it right.

My Lords, I too am delighted that the consultation has finally been announced, and that many royal colleges have come straight out and welcomed the move. I join others in applauding the tireless work of the noble Lord, Lord Rooker, in this instance. What will the Minister’s department do to inform the public that the consultation will take place, and what efforts will it make to reach hard-to-reach women and women’s groups—Mumsnet and the WI are two that come to mind quickly?

The noble Baroness makes a helpful point. The consultation is available on GOV.UK, which I appreciate is not the most obvious place, but I say this in case noble Lords are interested in having a look at it. More seriously, the department is working closely with a number of charities and will have a big focus on social media in order to reach all the groups to which she referred. More broadly, as for industry stakeholders, the department is working with the Food and Drink Federation and the National Association of British and Irish Flour Millers.

My Lords, notwithstanding the many positive impacts of fortification, concerns have been raised that increased levels of blood folate from fortification might impact the efficacy of anti-folate medication such as methotrexate, which works in chemotherapy by blocking the action of folic acid. In 2006 the SACN said that there was insufficient human data to say conclusively whether this is the case, and the 2017 SACN update makes no mention of anti-folates. Can the Minister reassure the House that there is now sufficient evidence to rule out conclusively any adverse impact of mandatory fortification on patients who are on methotrexate?

I may need to write to the noble Baroness about the specific medication. More broadly, she is right that the Scientific Advisory Committee on Nutrition has looked at these issues. Also, Food Standards Scotland has updated the guidance. They support the mandatory inclusion of folic acid as long as it is combined with a reduction in the level of supplements such as those that exist in breakfast cereals. In the consultation the data is set out about the percentage of people whose intake might be above a tolerable threshold, and it is extremely low—between 0.5% and 1%.

We must be sure that the right dose of folic acid is applied. The Americans did not put enough folate in; their dose was probably half what it should have been. Will the Minister ensure that the right dose is applied here?