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Folic Acid

Volume 805: debated on Thursday 3 September 2020


Asked by

To ask Her Majesty’s Government whether they have yet been able to form a conclusion on the proposal to add folic acid to flour following the consultation between 13 June and 9 September 2019.

My Lords, there are about 1,000 births with NTDs each year. Folic acid is a valuable prophylactic. We recognise that around half of the 700,000 births each year in this country are unplanned; some of mine were. Therefore, adding it as a supplement to some flours potentially offers great value.

My Lords, that is a deplorable Answer. I at least expected an answer to the question. I wanted a date. Would the Minister discuss this with the Prime Minister, who takes an interest in issues only where he has personal experience, such as Covid and obesity? Thankfully, he has no experience of babies born with a lifelong disability, which is what my question is about. Does the Minister recall that the English Government consulted on how, not whether, to implement a policy agreed by the three devolved Governments and the Daily Mail and operated by over 80 other nations? No action is like having a vaccine and not using it. We must do better.

My Lords, I pay testimony to the good work of my noble friend Lord Rooker on the campaign for mandatory fortification of flour with folic acid. He introduced a Private Member’s Bill and his work has been earnest. My personal experience is that my cousin James was born with an NTD; he survived two weeks and, sadly, passed away. Therefore, this is a matter that has my personal commitment. However, I am not in a position to give him the date he wishes, but we will come back to the House and answer his Question in due time.

I welcome the Minister to his three and a half hours at the Dispatch Box. I first raised this matter as president of the British Dietetic Association, the trade union that represents dieticians. There is overwhelming evidence in support of adding folic acid. As long ago as 1 March 2018, I was promised that the Government would be looking at a date for this to be done. I join the noble Lord, Lord Rooker, in being very disappointed about this. I ask the Minister to get on with this, please. As long ago as March 2018, we were being promised a date and we still have not got one. Please take some action.

My Lords, I completely accept the urging of my noble friend Lord Balfe on this matter. He is entirely right. There is very strong scientific evidence in this area; the Government accept that, and this is why they have launched a consultation, which was due to be published earlier this year. However, Covid has blown us away and that is why the announcement has been delayed. The Government have listened to the scientific evidence, which is very persuasive, and the decision will be made when the time is right.

My Lords, this is the fourth occasion that I have supported this Question put down by the noble Lord, Lord Rooker. Every time, there has been a disappointing Answer. As an obstetrician, I have seen many, many pregnancies result in serious spina bifida and anencephaly. Previously, the Government have used the excuse that overdosing might result if we put folic acid in flour. Would the Minister confirm that the recent research does not support that view?

My Lords, the consultation on the proposal to fortify flour ran for 12 weeks from 13 June to 9 September 2019 and was undertaken on a UK-wide basis. The pilot ran extremely successfully; the use of the supplements by the flour manufacturers was affordable and their implementation of the pilot was achieved without much disruption, and it was an encouraging experience that gives us good evidence for taking this matter forwards.

My Lords, the science is clear that folate supplementation is absolutely safe and a remarkably effective public health measure. Does the noble Lord agree that further delay would be unconscionable, especially for the children still being born with spina bifida?

My Lords, delay is frustrating. I completely share the noble Lord’s frustration. Unfortunately, we are handling an epidemic and, once we have got plans in place for the second wave, we will turn our attention to this important and valued matter.

My Lords, I support adding folic acid to flour and, as other noble Lords have all said, the sooner, the better. Has the Minister also considered action using Instagram influencers to encourage young women who diet to use leafy green vegetables, such as spinach, which contains B-vitamin folic acid? Would the Minster agree that, while “Eat your greens” might be a call from the past, it is cheap and still relevant today?

My Lords, I entirely endorse the noble Lord’s appeal for us to eat our greens. The concern with this specific matter is unplanned pregnancies, and the suggestion of putting folic acid into flour is to target those mothers who may need the additional supplements at a time when they do not realise they need them.

My Lords, we on these Benches and across the House share the deep frustration of my noble friend Lord Rooker about the delay on this vital issue. When the consultation was announced in June last year, the Government also promised that the results would be dealt with speedily and would go hand in hand with major efforts to step up awareness raising, particularly among at-risk groups, such as Afro-Caribbean women and women under 20 years old. What actions have been taken? What assessment has been made of the reason for the stubbornly low take-up of folic acid supplements? What measurable impact has awareness raising had on reaching at-risk groups or ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

My Lords, the noble Baroness did, in part, answer her own question. Work to improve the diet of pregnant mothers has progressed impressively, particularly among at-risk groups. However, it is those mothers who do not know that they are pregnant that this measure particularly targets, and that is where its inherent value is. This is why we have conducted a consultation and are looking to make a decision on it in the near future.

May I congratulate the noble Lord, Lord Rooker, on his importunity in promoting the addition of folic acid to flour? Folic acid is essential to prevent spina bifida and anencephaly, which occur in utero before the lady knows that she is pregnant; hence the importance of putting it into flour, as they have done in the United States for years without any problems. There really can be no possible excuse for delaying the implementation any longer. Preventing this distressing condition is so essential and costs so little. Therefore, can we have a date for when it will be put into practice?

My Lords, I entirely endorse the insight of my noble friend Lord McColl. The United States, Canada and Chile were the first three countries to introduce mandatory fortification, and I note that studies demonstrate a decline in NTDs of between 20% and 25%. These are encouraging statistics and the Government recognise them.

My Lords, the 2006 SACN report Folate and Disease Prevention found that there was insufficient human data to say conclusively whether increased levels of blood folate from fortification might impact on the efficacy of anti-folate medication, which acts in chemotherapy by blocking the action of folic acid. The 2017 update is silent on this issue. Can the Minister clarify whether the absence of a reference to this issue is because there is still insufficient data, or is it because research has ruled out any adverse impact of mandatory fortification on those patients taking anti-folate medication?

My Lords, I am not aware of any conclusive scientific evidence that contradicts the benefits of folic acid. As I said, the demographic data would seem to suggest that experiences in other countries have been benign. Longitudinal studies take a very long time to emerge and, therefore, we are not expecting a massive change in that data. However, back at the department, I will ask if any science has emerged and I will write to the noble Baroness if I can put my hands on anything.

I of course join other noble Lords in pressing the Minister to implement mandatory fortification as soon as possible—it really is time—but if he needs additional motivation, can I point to the potential wider benefits in addition to vital prevention of NTDs: reducing anaemia caused by folic deficiency in older adults, for example? Given the inequalities associated with these deficiencies, is the Minister confident that such wider benefits have been fully considered? If not, will he commission the relevant research as a matter of urgency?

The noble Baroness is entirely right to explain and expand on the wider benefits, but the benefits in respect of NTDs are extremely persuasive in themselves and the consultation focuses on them. I understand that it is an analysis of those benefits that will form the basis of our decision-making.