Positives & negatives of fortification
Posted by kathryn in Folate
Fortification is always a controversial policy. Food Standards Australia New Zealand ( FSANZ ) have led the move to mandatory fortification and have been considering this issue since May 2004. In their opinion, mandatory fortification is the most effective, the safest and most economically viable way to reduce neural tube defects.
On the other hand, the Australian Food and Grocery Council , who represent food manufacturers, have stated that reducing NTDs requires a public health solution, not medication of the food supply. They believe most consumers are against fortification and it may lead to a rise in food costs.
It should be noted, the current scheme is much more modest than the original proposal, which was to fortify all flour with folic acid. This would have affected bread, but also cakes, pasta, biscuits, muffins, pastries, pies, pancakes, doughnuts, etc.
Public health campaigns, aimed at changing peoples’ dietary habits are expensive and difficult to implement. It takes a lot of money to reach and persuade all the people you need to target. Moreover, many find it very difficult to make changes to their diet. Fortification bypasses these problems.
However, adding a nutrient to the food supply, via a common food, doesn’t just reach the target audience. It’s not just women who are about to fall pregnant who eat bread, almost the whole population does. While one group benefits, it’s difficult for others to avoid fortified foods, unless they pay the extra for organic bread (or make their own).
Supplementation & education
It’s important to note that fortification is not expected to work by itself and this has certainly been the case overseas.
In the US, despite mandatory fortification since 1998, there has only been a 25% reduction in NTDs and women can still be folate deficient at the time they fall pregnant.
While mandatory food fortification is being introduced here in Australia, if you want to fall pregnant you cannot rely on food sources alone to give you adequate folate. You still need to take a supplement.
Consumer education is still at the heart of NTD prevention. The message about NTDs and folate needs to be promoted from all angles and the campaign needs to be long-term. It’s not just the responsibility of doctors, but effective folate use needs to be promoted Australia-wide by the media, GPs, naturopaths, pharmacists, nurses, other health professionals, nutrition education and food labelling.
What do you think about fortification? Will you be avoiding fortified breads, or does it make no difference to you?
Reminder
Q & A Thursday is tomorrow – let me know if you have any questions about food, nutrition and health, either by sending an email or leaving a comment.
27 June, 2007
Comments
When we found out we were having twins, the doctor told us that Folic Acid in Australian diets were one variable increasing the chances of naturally occurring multiple births.
I found this link stating it doubles the chances!
http://news.bbc.co.uk/1/hi/health/1456028.stm
Twins are great and there seems to be lots more of them around. Should we thank Kelloggs & TipTop???....hehehe
Personally, I think that fortification is a bad thing.
Firstly, if you don’t dose people up sufficiently through the fortification, it just makes people more complacent about making sure they’re getting enough of the appropriate nutrient. “Oh, my bread has folate in it, so I’m covered, even though I don’t know how much folate I’m actually getting or how much I need”.
Secondly (and this is probably a bit more controversial) I think it suffers from the same objections people have to GM foods—while it all looks OK, you might end up with effects that you didn’t expect. I’m far happier about eating folic acid fortified foods than I am eating wheat with a pesticide-producing gene, but that whole “muckin’ with mah tucker” thing makes me a bit uncomfortable. Still, since I occasionally eat heavily-processed and fortified breakfast cereals, I guess I can’t complain too much.
That being said, I’m fairly happy to trust FSANZ that they’re not going to do something that doesn’t have a reasonable cost-benefit ratio, and presumably folate overdosing isn’t a major risk, so I won’t be turfing regular bread from my diet.
It will be interesting to see what happens in Australia and how people take to it because the same suggestion has just come up for debate again in the UK after being rejected five years ago. The big arguments against it here are the partly the whole personal choice thing and also the worry that it will lead to B12 deficiency going untreated in some elderly people. I’m kind of with Feel the Love on this one though – I might have a few reservations but it’s a lot less of a worry than some of the other stuff going on and may do a lot of good!
Andrew, yes there is a reasonable amount of evidence that increased folate, through our diets and supplementation, is leading to an increase in twins. It’s interesting that something specifically needed in pregnancy (ie to prevent neural tube defects), also affects pregnancy in other ways (ie through an increase in the number of twins).
FTL and Sophie: I personally believe the less we do to the food supply the better. Having a child affected by NTDs must be devastating for the family involved and most can be avoided by increasing the folate status of mothers-to-be. However fortifying bread-making flour with folic acid seems a rather blunt instrument, especially given women still need to take folic acid supplements to ensure they’re getting enough to prevent NTDs.
In the submission process concerns were expressed about the long-term health effects of widespread fortification. The original proposal to fortify all flour would have delivered much higher levels of folic acid to some members of the community. Concerns were particularly expressed about the effects on children.
The possibility of high doses of folic acid masking B12 deficiencies, especially among the elderly was raised. In their proposal the Australian Consumer Association called for fortification to be accompanied by increased screening of the elderly. My understanding of this issue is that, at the moment, it’s a theoretical concern. In the US, were folic acid fortification was introduced in 1998 there’s no evidence of a rise in B12 deficiency.
Leave a comment