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?

Sorry, cross post with DCFlemingreportingforduty.

There are risks to consuming high levels of folic acid. It is not the same as folate, or vit B-9. It is metabolised differently.

I'm not so sure I accept what you say as true. It might be but I wouldn't want to risk it. If anyone who is qualified to answer wants to persuade me, go ahead, and link me some proof. I'm not trying for a baby but I do worry about vitamin b12 levels.

What if I don't want folic acid in my flour? The onus is on pregnant women to take care of themselves-it's not hard, the information is readily available on the internet and will be shoved down their throats by their midwives anyway. A lot of food products such as breakfast cereals have it added anyway. There is such a thing as too much government intervention.

Lisa, it was directed towards the PP who wrote: "all women of child bearing age should take folic acid ..."

Ah, right, ok then - as I said genuinely wasn't sure if it was directed at me, and just wanted to respond if it was. Sorry if that seemed hostile - I completely agree with you!

Why does it need to be added to flour? There are plenty of foods with high folate levels which don't come with the risks of taking folic acid. People shouldn't be forced to eat synthetic vitamins if they don't want to.

the information is readily available on the internet and will be shoved down their throats by their midwives anyway

The thing is, that's not working. The majority of pregnant women aren't taking folic acid before they conceive, despite the information being available - and since its big benefits come before week 6 of the pregnancy, it's too late by the time most women will first see a midwife.

The 'all women of child bearing age' is what neurologists I work with have said, I knew nothing about folic acid before meeting them. It is an understandable view point for them I think as they will be treating neural tube defects in a daily basis. We tend to feel most strongly about the things we have personal experience of.

My personal opinion is that if you are sexually active and would not terminate if you conceived then it is a good idea to take folic acid daily. If not sexually active, or would terminate or have been sterilised/partner has then it's not necessary. I did modify my comment to say I think educating teenagers is key rather than adding it to foods.

People shouldn't be forced to eat synthetic vitamins if they don't want to.

Do you oppose the current fortification of white flour, then? That seems to be to be quite uncontroversial, but I wonder if that's just because people don't know?

I really think that there are other food practices to be more excited/worried about tbh.

Re folic acid why not get excited that in other countries 5mg daily supplement is recommended and dispensed to pregnant women?

Let's take the population of the UK down to 10 for argument's sake.

I am of course assuming numbers here, but let's say:

2 of them are children
4 of them are OAPs/post menopausal
2 of them are adult men
2 of them are adult women of childbearing age...

...Of the two women:
1.25 of them don't want any children and/or have finished their families.
0.25 of them can't have children for medical reasons

That leaves 0.50 of the population who are the right age, sex and actively want (or are not opposed) to getting pregnant.

And you think we should medicate flour for all 10 of them?

I am 40+. Have never wanted kids, never been involved with pregnancies etc. Yet even I know folic acid is the thing you start shovelling down your neck as soon as the will/lack of opposition against getting pregnant raises its head. Why should we foist upon the many that which is readily available, known about* for the few

(* its not like Fight Club - information is so readily available, its hard not to know!)

It's all too thin end of the wedge for me.

Sick of being told what to do as a woman. Pregnant or not a woman can decide for herself.

I am 40+. Have never wanted kids, never been involved with pregnancies etc. Yet even I know folic acid is the thing you start shovelling down your neck as soon as the will/lack of opposition against getting pregnant raises its head. Why should we foist upon the many that which is readily available, known about for the few*

But it clearly isn't well enough known. Most women aren't doing this (and I really do think this has to a lack of knowledge - it isn't like, say, not following exercise guidelines where you might know but want to do it, taking folic acid is so easy that I don't think anyone can't be bothered), and - and this really is my big concern - it seems to be very unequal across different groups in society. I don't think that's an ok situation.

Everyone needs to take responsibility for eating a healthy diet. Full stop. And yes, you can still do this on a tiny budget.

"I think that undermining women's autonomy is too big a price to pay for better infant health"

But you are suggesting that everyone, including people who aren't in child-bearing be forced to either give up flour or consume folic acid.

Surely it makes more sense to encourage everyone to eat more greens. In fact maybe the ethnic minorities you refer to intelligently eating a better diet instead of relying on industrial fortification of processed foods. All these foods are delicious: www.globalhealingcenter.com/natural-health/folic-acid-foods/

OP You're clearly very passionate about this for some reason but you simply can't say impose on the entire population something that will benefit one specific group of people but potentially endanger another specific group of people (the masking of the B12 problem) and potentially endanger the majority (if the cancer and other issues do turn out to be a possibility, no matter how small).

Just how beneficial do you think the small amount of folic acid added to flour will be, exactly? And how will you persuade women not yet pregnant or hoping to be pregnant or already pregnant to eat lots of flour, as opposed to lots of fresh vegetables?

Yes, I'm also surprised at my new-found passion about this! As I say, it was really something I just suddenly became interested in - I had previously thought that nearly everyone took folic acid if TTC. I do know someone with a child with spina bifida that may have been prevented if she'd taken folic acid, so maybe that has affected me.

Clearly there would be a lot of opposition to this, and I understand much more now why the government blocked it. I would point out, though, that 80 countries do do this, so it isn't simply impossible and nor is it obviously wrong.

Lots of countries do all sorts of things that we wouldn't. That doesn't necessarily make it right.

And how will you persuade women not yet pregnant or hoping to be pregnant or already pregnant to eat lots of flour, as opposed to lots of fresh vegetables?

This. Alongside 5 fruit or veg each day, all pre-menopausal women will also have to have a loaf a day intake.

Just how beneficial do you think the small amount of folic acid added to flour will be, exactly?

I imagine it would be as beneficial as it is in the US or Chile, which have seen 20-30% drops in neural tube defects. Which clearly isn't a total solution to the problem or anything like it, but it is a big step in the right direction.

I think it's worth pointing out that the NHS advice is that pregnant/TTC women don't try to get their folic acid from diet alone as it's too hard to get enough, so I think trying to persuade people to eat enough spinach to have the same effect is a bit of a non-starter.

Lots of countries do all sorts of things that we wouldn't. That doesn't necessarily make it right.

Indeed, which is why I said 'not obviously wrong'. But I was responding to a person who said that you can't fortify food with folic acid to help one group of the population, and I was pointing out that you definitely can.

I was responding to a person who said that you can't fortify food with folic acid to help one group of the population, and I was pointing out that you definitely can

And as has been pointed out (repeatedly) - possible to the detriment of others, with different health problems.

You are quite clearly determined not to get down from your soapbox and will not be swayed. So good luck with your quest.

There are far more important food issues to be tackled. Folic acid in flour is not one of them, IMO

Do you oppose the current fortification of white flour, then? That seems to be to be quite uncontroversial, but I wonder if that's just because people don't know?

I guess most people don't realise. White flour has little nutritional value anyway. Modern wheats have been bred for heavy yield at the expense of nutrients and the processing removes much of what is left.

I now make much of my own bread using spelt or einkorn flour. Much better nutritionally and tastes fabulous.