Is food fortification good or bad?

By Amanda Johnson 01/10/2009 5


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.


5 Responses to “Is food fortification good or bad?”

  • Suggesting that folic acid is a harmless B vitamin ignores that fact that any substance, in sufficient quantity can be harmful. While your expert (s?) do not believe excess folic acid is harmful, there is overseas research suggesting it has the potential to increase the occurence of prostate cancer in men. I think the voluntary production of some bread ranges containing folic acid is a better approach than compulsory mass medication.
    It is interesting that the addition of iodine has received little press. I wonder if there are any conditions where iodine in the diet could be harmful?

  • I agree that anything in excess can potentially be harmful; however, adverse effects from folate/folic acid are very unlikely in the amounts that would be consumed from foods or fortified foods.

    Of course, it’s important to distinguish between folic acid consumed as supplements and folic acid consumed from fortified foods – the level of intake from the former is likely to be higher.

    I do agree that before any mandatory fortification goes ahead it is important to review all the available scientific evidence on risks and benefits in different population groups.

  • “there is over­seas research sug­gest­ing it has the poten­tial to increase the occurence of prostate can­cer in men”

    But it’s apparently in men who took 1 mg in supplements or more a day, and that would be on top of dietary folate/folic acid. The other side of the coin was that those who simply got adequate levels were fine, and even had a lower risk. One thing I’ve been disappointed with is that the health minister didn’t apparently take advice and issue a proper statement on the science and put it into perspective. I’d also expect a ‘dr’ to do the same, rather than apparently relying on media headlines.

    My understanding of this is that NZ is generally low, and any fortification is unlikely to give anyone excessive levels even though it’s pretty much all over now until they review it again. In fact it’s likely pregnant women would still need supplementation in any case. Maybe it would have been better just to add to flour with exceptions for places like small bakeries that do specialised breads like they do overseas. I find it strange that many people that promote supplements on the basis that our diet is “deficient” strongly opposed this as “mass medication” but it’s a vitamin same as the stuff put into their expensive pills they take. I think the reason why iodine isn’t being much of an issue is that salt has been fortified for years and it isn’t such an issue with something that is already being done.

  • In addition, the studies in which cancer was posited as a risk, were very small, and my understanding of the papers was that there were the slightest of worries that it might affect the size/grwoth of prostate cancer in men who already had it, rather than increasing its occurrence.

    However, since then there has been research done which is able, quite confidently, to say that no such link has actually been found – folic acid fortification is mandatory in a number of countries and, considering that New Zealanders are naturally deficient in it, could do some good.

    The NZ Herald has written about the issue most recently. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10604921

  • The Herald article doesn’t state that risks associated with folic acid have been completely eliminated but then without looking at the primary literature it is hard to determine if they have interpreted the various research and reports accurately.
    However, even if one assumes that there is no risk, the idea of adding it to bread in order to provide potentially pregnant women with folate is flawed. The recommended dosage is too low and would be variable from individual to individual. A better approach would be to provide women with access to folic acid as supplements, a more direct and reliable approach in terms of getting the right dosage.