The issue of food fortification has certainly got many people hot under the collar in recent months in New Zealand! There has been a real furore over the whole idea of fortifying bread with folic acid (a harmless B vitamin), although mandatory iodine fortification is going ahead.
The term fortification describes the addition of nutrients to food to levels above those normally present, the idea being to benefit population groups who may have inadequate intakes. In relation to folic acid, this is an important nutrient for women who are pregnant. The foetus rapidly develops spine and nerve cells in the first few weeks of pregnancy, and inadequate levels of folic acid at this time increase the risk of the baby developing a neural tube defect, resulting in spina bifida.
Despite recommendations for women in New Zealand to take a folic acid supplement, many women fail to increase their intake of folic acid, and fortification of bread would go some way to supplementing the diet. Many other countries have implemented mandatory fortification of folic acid, significantly reducing the number of neural tube defects.
But are there ongoing issues? Well, the suggestions that folic acid may increase risk of cancer have been refuted by expert opinion sought by the Science Media Centre (SMC). There is some ongoing concern, however, about risk of folic acid masking deficiency of vitamin B12. Deficiency of vitamin B12 can cause nerve damage and anaemia, and folic acid can mask ongoing damage to nerves — this may be a particular problem among older people and vegetarians, who may have poor vitamin B12 status, although ongoing monitoring of these groups would detect such problems if they occurred. The Paediatric Society certainly strongly supports the mandatory fortification of bread with folic acid.
Many foods in New Zealand are voluntarily fortified with a variety of nutrients; however, it is the mandatory nature of the proposed folic acid fortification that seems to have caused such controversy. I think it would be a good idea for any future policies on fortification to be accompanied by an education campaign to ensure everyone is aware of the risks and benefits of fortification and the reasons behind it. Commentary should be lead by the experts in this area within the scientific community, so debate is rational, well-informed and evidence-based.
I am please that iodine fortification is going ahead, and this has been seen as a positive move by experts in New Zealand, as reported in a recent SMC Science Alert. Poor iodine status is a real issue in New Zealand and may have potentially adverse effects on vulnerable members of our community. It is particularly important for pregnant women to ensure an adequate iodine intake (especially those who plan to breastfeed) — good sources of iodine include fish, eggs and dairy products, and hopefully later in the year there will be a supplement available that is suitable for pregnant women.
Folic acid fortification has been delayed for now. The Minister for Food Safety, Kate Wilkinson, deferred the commencement date requiring the mandatory fortification of bread with folic acid in New Zealand until 31 May 2012. In the meantime, bread manufacturers have indicated that they will voluntarily increase the range of breads that have added folic acid. It’s certainly a good idea for any woman of childbearing age, whether actively planning to conceive or not (50% of pregnancies are thought to be unplanned), to include good sources of folic acid in the diet (e.g. fortified breads and cereals, beans and legumes, citrus fruits and juices, spinach and Brussels sprouts). For women actively trying to conceive, for four weeks prior to conception, and during the first 12 weeks of pregnancy, a folic acid supplement of 800 micrograms/day is recommended by the Ministry of Health.