To think it's a disgrace that the UK still doesn't add folic acid to flour?

[LisaSimpsonsbff]

I'm a long-term obsessive user of the conception forums and I was a bit shocked this morning to see two separate posts in which it was clear that posters thought the advice to take folic acid before pregnancy was to help you conceive (and therefore not important if you weren't having problems there) rather than its actual purpose: to lower the risk of birth defects. That made me a bit curious about how many women take it, and I was shocked to find how few it is (fewer than a third): www.theguardian.com/uk-news/2014/feb/19/folic-acid-less-third-pre-pregnancy-guidelines-spina-bifida. The worst part, I think, is this:
The study also showed strong ethnic variations, with only 17% of Afro-Caribbean women, 20% of south Asian women and 25% of east Asian women taking folic acid, compared with 35% of white Caucasian women.

Just 6% of teenagers under 20 attending the antenatal clinics had taken the supplements, while 40% of older women aged 35 to 39 followed the guidelines.

Presumably a large part of that with the teenagers is the likelihood that their pregnancies were unplanned, but the health inequality here is really awful - it shouldn't be the case that some women and babies are so much more at risk of suffering these problems than others, whether through a lack of knowledge or through being less likely to plan their pregnancies.

I think we could do with a stepped-up public campaign on folic acid, but that obviously doesn't help women with unplanned pregnancies, and realistically no campaign is ever going to get across to everyone.

To me the argument for putting folic acid in flour, as they do in the US, is incredibly clear-cut. And yet the government decided against this: www.ifglobal.org/en/37-temp-news/4768-uk-government-says-no-to-mandatory-fortification-of-flour-with-folic-acid-2. So - and this is a genuine question - am I missing something? What's the argument against?

Or people ttc could just takr a tablet.

Why should everyone have to have?

But what is the downside

Or people ttc could just takr a tablet.

But what about the many people who get pregnant without planning to? As far as I can see it doesn't do anyone else any harm (the evidence from the US, where they've been fortifying for years, seems to show that it doesn't increase cancer rates as some people claim), and it does a significant minority of the population considerable good?

I think this is an absolutely awful idea. I think it is the start of a very slippery slope towards treating women as "pre-pregnant".

yabu
I don't want my food unneccessarily medicated

But what is the harm

According to the neurologists I work with all women of child bearing age should take folic acid as you need to take it for 3 months prior to conception for it to have any real benefit. Also taking it for a year prior to conception can reduce risk of prematurity. I have stopped taking it now as DH has had a vasectomy and I have a coil so I think we are pretty safe. If that weren't the case though I would be taking it up to menopause. So no YANBU.

I prefer my flour unadulterated.

I think it is the start of a very slippery slope towards treating women as "pre-pregnant".

How is it? If I'd suggested that all women take folic acid from their teens then I'd see how that was the case. But giving it to the whole population isn't telling women they have to do anything different; it's just giving a baseline level of protection.

I would imagine that the argument against is that it would push up the cost of flour and anything containing flour and that rises in the cost of staple foods are difficult to justify when the incidences of babies born with problems associated with lack of folic acid are low particularly when (in theory) all expectant mothers receive free healthcare that will include advice that they should be taking it.

Like you I'm amazed at the amount of posts I've seen (not just on here) from people who think that women should take folic acid to increase their chances of conceiving.

Isn't breakfast cereal fortified with folic acid?

Yes and in some areas water is fluoridated

Also given the food standards in the US, it would be very hard to see the effect of fortifying flour over all the other things they allow in food or to be given to livestock.
Now maybe stop saying people don't need multi-vitamins and actually encouraging their use might help.

I prefer my flour unadulterated.

But flour is already fortified with calcium, iron, niacin and thiamine.

Although actually I'm not sure about putting it in flour. I do think teenage girls should be given the information in school however.

Folate is thought to mask B12 deficiency, which can lead to neurological problems in undiagnosed B12 deficiency - usually elderly patients who put it down to old age

Thank you, thats interesting

(in theory) all expectant mothers receive free healthcare that will include advice that they should be taking it

But the medical advice is that you should be taking it for three months before conception, and women in this country aren't routinely advised to see their doctors before TTC as they are in some places (which is probably for the best, as it would be a massive waste of the GPs time most of the time - but I guess it could mean they could advise about folic acid). And we still come back to the huge percentage of unplanned pregnancies.

While there are studies saying the following, then no, it shouldn't be added to all flour thank you very much:

"In women of childbearing age, folic acid supplementation has a demonstrable and meaningful benefit, reducing the incidence of neural tube birth defects. Its use in this population is evidence-based and demonstrably effective. And for treatments for conditions like end-stage kidney disease, folic acid may be of benefit. But when we look at the use of folic acid for primary prevention, the data are less clear. In children, men, and women beyond their childbearing years, supplementation in the absence of deficiency has no demonstrated health benefits, and there are worrying signals that it may raise cancer risks, possibly by “feeding” existing cancers."

How much bread/flour would you have to eat? With the popularity of low carbing, people may still miss out.

I do eat bread, but never eat breakfast cereal so get no benefit from whatever they put in that.

there are worrying signals that it may raise cancer risks, possibly by “feeding” existing cancers.

The US evidence apparently does not support this. These scientists (who are, admittedly, arguing for folic acid fortification) say:
the addition of folic acid to flour is “remarkably safe” and fears that it might increase the risk of cancer are not substantiated by the evidence. : www.qmul.ac.uk/media/news/items/smd/168872.html

ItsALard As someone who has been diagnosed as B12 deficient and am on pills for life but have already suffered some neurological damage and memory lapses (and I'm 43), it's another good reason not to add folate that isn't naturally occurring in things. B12 deficiency is becoming a considerable issue.

According to the neurologists I work with all women of child bearing age should take folic acid as you need to take it for 3 months prior to conception for it to have any real benefit. Also taking it for a year prior to conception can reduce risk of prematurity.

So why isn't this advice widely publicised?

Why have I never heard this? Despite being under a fertility clinic?

How much bread/flour would you have to eat? With the popularity of low carbing, people may still miss out.

Yes, I did think about that - that the proportion of people eating flour is probably now quite a bit lower than the past, so it's not as good a way of getting nutrients to everyone. It would surely help, though?