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?

Thank you so much for all the responses by the way - I'm finding it really interesting. I genuinely thought this was a totally obvious public health step, so it's surprising but interesting to see how much resistance this is - which helps, in turn, to show why the UK government decided against, despite the recommendations of the BMA.

First if all, the fortification of UK flour replaces what is lost from the wheat during the milling process. It isn't adding a new chemical that wasn't there originally. It is a completely unrelated issue to folic acid.

I don't think that's true of the calcium added, is it?

No, it shouldn't be added to flour. If a woman is trying to conceive it's down to her to make sure that she takes folic acid, it shouldn't be forced on the rest of us.

Why should every woman of child bearing age have to take folic acid? I'm in that age group but have no intention of having children so why should I have to take something I don't need and that can mask other problems?

Folic acid is a natural vitamin it isn't medicating anything i am sure it does no harm and it a possible bit of good.

B12 deficiency being masked by folic acid is why it isnt added. People dont know they are at risk til its too late.

If a woman is trying to conceive it's down to her to make sure that she takes folic acid

And the babies of unplanned pregnancies?

mrsjay thats the point. It does.

is this a taat? the woman in question in the conception board didn't refuse or ignore your advice. Not sure why you all deemed it right to jump down her throat just because you have been in the ttc journey longer than her.

Not my problem if they aren't TTC. My health is of no less importance so why should I be medicated in case someone has an accident. How about if people want children they take folic acid, if they don't then they aren't forced to take it?

is this a taat? the woman in question in the conception board didn't refuse or ignore your advice.

I did wonder afterwards whether I should have omitted the reference to that thread, but I really don't think this is a TAAT - I included no details of that thread, didn't criticise her at all and this isn't a thread about 'why don't people know about folic acid?' it's about 'why don't we add folic acid to flour?'. I only mentioned that thread (and another one) because it was why I first started thinking about the issue: I didn't realise before that there were women who thought that folic acid was an optional extra for TTC like ovulation tests.

I thought that if you continue taking folic acid so many weeks after conceiving then it can pose risks to the baby?

Not sure it's true but the doc told be to stop taking them for that reason.

I just think a low dose supplement might be beneficial if a woman found herself pregnant for her baby development of course it is personal choice to take any kind of vitamin. I feel quite strongly about folic acid for obvious reasons i was part of research into possible causes of NTD for 15yrs my blood was tested so im a huge advocat of folic acid

Not my problem if they aren't TTC.

But it doesn't cause health problems for the women themselves (though obviously having either a child with a birth defect or a pregnancy that has to be terminated for medical reasons is likely to affect them greatly); it can cause serious and permanent disability in the child, and it's not up to them whether or not they were planned.

Is there any evidence that adding folic acid to flour would actually bring about a significant reduction in babies born (or indeed terminated for medical reasons) with neural tube defects? And how much fortified flour would you need to consume to have a protective effect?

The statistics showing how few women take folic acid before and after falling pregnant do seem alarming, but equally we don't seem to be experiencing a spike in neural tube defects (correct me if I'm wrong) so I'm on the fence.

Yes your Dr was right you just take it first trimester

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

No it's the opposite of that as men are also expected to take it. Unlike expecting all women to go around taking prenatal vits

MrsJayy You say you are sure it does no harm. Quite a lot of scientists and health professional say it may or might do harm to some people. How come you're sure but they aren't? I'm more inclined to go with their thoughts than yours.

we should be campaigning for our food to be as natural as possible - not used as a carrier for government to feed the population with supplements they consider appropriate - if you want a supplement, take it as a supplement - the vast majority of the population are not women trying to have a baby - so why would you feed an additional supplement to children / OAPs / men / etc.

The evidence seems to suggest that it does bring about a significant drop in neural tube defects:

The researchers aimed to estimate the number of pregnancies with neural tube defects that would have been prevented had the UK followed the US’s example in 1998 and adopted a policy of fortifying flour with folic acid. To do this, the researchers used data on the number of diagnoses of neural tube defects and associated terminations of pregnancy for the period 1991 to 2012.

Unlike the USA which saw significant changes, there was no significant change in the UK in prevalence of pregnancies with a neural tube defect between 1998 and 2012, nor were there any significant changes in the prevalence of spina bifida, anencephaly with or without spina bifida, or encephalocele.

The researchers estimated that there would have been 2014 fewer pregnancies with a neural tube defect in the UK had the US policy been adopted: 1,798 fewer in England and Wales; 152 in Scotland; and 64 in Northern Ireland. This equates to an estimated fall in prevalence of 21 per cent between 1998 and 2012.

In the USA, the prevalence of pregnancies with a neural tube defect has fallen by around 23 per cent since 1998, and in Chile, where the level of flour fortification is even higher, the prevalence has fallen by 36 per cent.

So it's not rising in the UK, but it could be falling if we'd made the same choice as other countries.

Isn't it in most multi vitamins anyway? I switched to pregnancy vitamins as soon as I had a positive test result but noticed that the multi vits contained folic acid as standard.

I don't think many people take a daily multi bit though do they. I always have but I think I'm a minority.

You say you are sure it does no harm. Quite a lot of scientists and health professional say it may or might do harm to some people. How come you're sure but they aren't? I'm more inclined to go with their thoughts than yours.

Well, the BMA thinks it should be added and I'm pretty inclined to trust them

Sorry, didn't give a link to the stats about dropping in US and Chile: www.qmul.ac.uk/media/news/items/smd/168872.html

A lot of flour in the UK is fortified anyway (example), so we might as well add folic acid.

for those of you saying it's no harm (thankfully the minority on here!) - it's toxic for people with a MTHFR gene mutation (which could be up to 50% of the population though most of us don't know it). Folic acid has also been implicated in the increased prevalence of tongue tie so certainly not harmless.

I was going to mention B12 but ItsALard beat me to it. I think if you take supplements, you risk not absorbing other essential minerals and vitamins. I am not a scientist.
I'm not sure how it works but it's something like too much of one (e.g. calcium) can cause a deficiency of another (e.g. copper). I'm sure I read somewhere that too much folic acid can cause B12 deficiency.

If there's an expert out there, feel free to correct me.