To fortify or not to fortify - Scotland’s big question

8/16/2019 To fortify or not to fortify - Scotland’s big question

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T fortif o no t fortif

Can you tell our readers a little about whyfortifying

our with folic acid needs to be considered in Scotland -

what does it mean to fortify our with folic acid in your

view? Where has it been successful/unsuccessful?Fortifying our with folic acid will be a very

effective way to reduce the number of babies

who are born with neural tube defects like

spina bida. The folic acid could be added

to our during the manufacturing process

relatively easily, and this would go some way

to increasing folate levels among the general

population. Folic acid is tasteless, entirely

safe within recommended intake levels and is

already included in many foods like breakfast

cereals.

Folic acid is naturally present in grain, andthe manufacturing process removes it along

with other vitamins and minerals - niacin,

thiamine, iron and calcium - which are

currently added back in to our. This is clearly

labelled on packaging. Folic acid is simply a

water soluble vitamin like niacin and thiamine

which are B vitamins – low levels of which can also cause

signicant symptoms and long term conditions.

There are 78 countries around the world that already have

mandatory fortification of flour. The USA has done it for

the past eight years, with no adverse effects on health.

According to Spina Bifida Hydrocephalus Scotland, neural

tube defects have reduced by between 27 percent and 50

percent in countries where mandatory fortification has been

introduced.

What major health benets will mandatory folic acid

fortication tackle and why is it being considered for

Scotland?

The Scientic Advisory Committee for Nutrition estimates

that around 50 pregnancies are affected by neural tube defects

every year. This is a particular concern in some of our more

deprived communities, where rates of unplanned pregnancy

are higher. Within the UK, folate levels tend to be lower in

Scotland and Northern Ireland, so we have a particular interestin wanting to take action. It’s important to note that these are

life-long conditions, causing families signicant distress and

placing an additional and unnecessary cost burden on our

NHS.

Scotland’s big question

Discussions unfolding from the start of this year have revealed thatScotland is edging ever closer to a decision some 16 years in the

making, whether or not to fortify our with folic acid.

As concerns rise over the potential for an increase in

birth defects, Scotland moves towards mandatory

fortication, as Westminster continue to delay their

decision.

The uncertainty surrounding the issue of fortication has led

to a reduction of the amount of folic acid added to products bycompanies who voluntarily fortify their foods,

in order to comply with regulations should

fortication be implemented. This has led to

mounting concerns of the level of folic acid intake

across the UK.

Folate, from the family of B-Vitamins, occurs

naturally in foods such as nuts and green

vegetables. Folic acid is a synthetic form of

folate, often used for food fortication and in

dietary supplements; it plays a pivotal role in the

prevention of birth defects, specically neural

tube defects (NTD) such as spina bida.Since 1992 advice to women UK wide has

been to begin to take folic acid supplements

while trying to get pregnant to reduce the risk

of NTD, but studies have shown that as little as

28 percent of women take the correct dosage of

400 micrograms three months prior to pregnancy,

following this through until the 12th week of pregnancy.

As the required amount of dietary folate intake does not

appear possible through diet alone, women who have unplanned

pregnancies, as well as the those who have not taken the required

supplement at the correct time, are at greater risk of NTD. It is

believed that as many as 50 percent of births in Scotland are

unplanned, expounding the need for the addition of folic acid into

diets.

A study published in December 2015 concluded that the failure to

implement mandatory fortication at the same time as the US in 1998

led to an estimated 2000 children being born with NTD, and ignoring

it further could lead to an additional 150 children born with NTD year

on year; where the US has seen a decrease of children born with NTD

of 28 percent.

Extensive research has been carried out by a plethora of scientic

bodies including the Scientic Advisory Committee on Nutrition

(SACN), who were looking into potential adverse effects of folic

acid. The conclusion of this research culminated in a collective call

for fortication.In a report to UK health ministers last autumn, ofcials at SACN

testied that where mandatory fortication has been implemented in

nearly 80 countries worldwide, none had not reported any adverse

health conditions as a result of fortication.

Milling and Grain speaks to

the Scottish Health Minister

Maureen Watt aboutScotland’s push to fortify our

50 | March 2016 - Milling and Grain

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How long has the Government, in both Scotland and

the UK, been discussing this topic and what were some

of the considerations evaluated?

The UK Government has consistently delayed introducing

legislation on this issue since it was rst raised by the Scientic

Advisory Committee on Nutrition in 2007. The UK Government

position was to await the outcome of the population blood folate

status results. These were published on 20 March 2015. A

decision was then delayed until parliament returned after the

general election and we are still waiting.

As part of their remit, Food Standards Scotland (FSS) is

currently considering the scientic and regulatory aspects of

fortication of our with folic acid. Before FSS was created, the

Food Standards Agency had considered this and provided advice

to us in 2007 and 2014 in support of fortication with a view to

reducing the risk of congenital neural tube defects.

There is always some resistance to the introduction of

our fortication. How have you addressed the most

important ones of these? Why has there been a delay in

reaching a decision on this issue?

To maximise the impact of mandatory fortication, and inline with recommendations from SACN and Food Standards

Scotland, we believe that a UK-wide approach would be

most effective. Indeed, Wales and Northern Ireland have

expressed their support. Unfortunately, the UK Government

has consistently deferred their decision and in response to my

latest letter, they have again refused to commit to mandatory

fortication. With every delay more babies are put at risk,

which is why we must act now.

Food fortication has been a contentious issue for some

time, why is Scotland choosing to act now? And what

would your advice be to other governments considering

the introduction of our and/or rice fortication?

We have been pursuing a UK-wide approach as our preferred

option. However, should the UK government decide not to act I,

along with my counterparts in Wales and Northern Ireland, will

consider how we might progress this. I believe there is strong

evidence in favour of mandatory fortication.

The food and drink federation have said they believe

most manufacturers would favour a harmonised

approach across the UK on mandatory folic acid

fortication, but with the UK seemingly ‘dragging its

heels’ what do you think about this statement? – Is

there time to wait for a nationwide decision?

It’s encouraging to see that the Food and Drink Federation want

a UK-wide approach – we agree with them. We still believe that

"her ar 78 countrie aroun thworl tha alread hav mandator fortificatio o flou. Th SA ha

don i fo th pas eigh year, wit n advers effect o healt"

Milling and Grain - March 2016 | 51

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this is the best way forward, and it is not too late for the UK

Government to make this decision.

With some companies voluntarily fortifying foods, for

example some breakfast cereals and certain spreads, is

mandatory fortication really necessary?

Yes, because not all women eat the foods that are voluntarily

fortied. It is better to use fortied our in order to increasefolic acid in products which are more widely consumed by

women of childbearing age. The statistics show us that 14.8

percent of women of childbearing age in Scotland have red

blood folate concentration below the WHO threshold. This

is well above the UK-wide average of 11.3 percent and it’s

especially low in lower-income groups where the problem

is made worse by the relatively higher number of unplanned

pregnancies.

Bread has been a staple food in these islands for centuries, and

it still is. That’s why fortication of our is such an effective way

to increase folate levels across the board.

What would be the implications of Scotland going

ahead with mandatory folic acid fortication, how

would businesses who export to the UK and beyond

deal with this?

A full consultation with industry, and a business impact assessment,would of course be a part of any mandatory fortication.

What would the ideal outcome of these ongoing

discussions be?

Our ideal outcome is for the UK Government to agree to take

this forward so we can have a uniform approach across all four

nations. This would prevent many families from having to go

through the heartache of being told their unborn child has spina

bida.

52 | March 2016 - Milling and Grain

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To fortify or not to fortify - Scotland’s big question