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Scientists question folic acid fortification
November 05, 2007Scientists at the Institute of Food Research have highlighted possible consequences of fortifying flour with folic acid due to new evidence of how it is absorbed by the body.
In May, the Food Standards Agency's Board agreed unanimously that 'mandatory fortification' with folic acid should be introduced to make sure the number of babies born with neural tube defects is reduced. This means that it would be compulsory to add folic acid to either bread or flour.
Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and green leafy vegetables. Folates are metabolised in the gut, whereas in a paper to be published in the British Journal of Nutrition in October IFR scientists suggest that folic acid is metabolised in the liver. The liver is an easily saturated system, and fortification could lead to significant unmetabolised folic acid entering the blood stream, with the potential to cause a number of health problems.
"Fortifying UK flour with folic acid would reduce the incidence of neural tube defects", said Dr Siān Astley of the Institute of Food Research. "However, with doses of half the amount being proposed for fortification in the UK, the liver becomes saturated and unmetabolised folic acid floats around the blood stream.
"This can cause problems for people being treated for leukaemia and arthritis, women being treated for ectopic pregnancies, men with a family history of bowel cancer, people with blocked arteries being treated with a stent and elderly people with poor vitamin B status. For women undergoing in-vitro fertilisation, it can also increase the likelihood of conceiving multiple embryos, with all the associated risks for the mother and babies.
"It could take 20 years for any potential harmful effects of unmetabolised folic acid to become apparent".
It has already been shown that folic acid forticifation can exhibit Jekyll and Hyde characteristics, providing protection in some people while causing harm to others. For example, studies have confirmed that unmetabolised folic acid accelerates cognitive decline in the elderly with low vitamin B12 status, while those with normal vitamin B12 status may be protected against cognitive impairment. Most over 65s in the UK have low B12 status.
Similarly, dietary folates have a protective effect against cancer, but folic acid supplementation may increase the incidence of bowel cancer. It may also increase the incidence of breast cancer in postmenopausal women.
Since the 1980s a consensus formed that that folic acid is metabolised in the small intestine in a similar way to naturally-occuring folates. This consensus was used to assess the safety of folic acid fortification.
"We challenge the underlying scientific premise behind this consensus", said Dr Astley. "This has important implications for the use of folic acid in fortification, because even at low doses it could lead to over consumption of folic acid with its inherent risks".
Norwich BioScience Institutes
"Fortifying UK flour with folic acid would reduce the incidence of neural tube defects", said Dr Siān Astley of the Institute of Food Research. "However, with doses of half the amount being proposed for fortification in the UK, the liver becomes saturated and unmetabolised folic acid floats around the blood stream.
"This can cause problems for people being treated for leukaemia and arthritis, women being treated for ectopic pregnancies, men with a family history of bowel cancer, people with blocked arteries being treated with a stent and elderly people with poor vitamin B status. For women undergoing in-vitro fertilisation, it can also increase the likelihood of conceiving multiple embryos, with all the associated risks for the mother and babies.
"It could take 20 years for any potential harmful effects of unmetabolised folic acid to become apparent".
It has already been shown that folic acid forticifation can exhibit Jekyll and Hyde characteristics, providing protection in some people while causing harm to others. For example, studies have confirmed that unmetabolised folic acid accelerates cognitive decline in the elderly with low vitamin B12 status, while those with normal vitamin B12 status may be protected against cognitive impairment. Most over 65s in the UK have low B12 status.
Similarly, dietary folates have a protective effect against cancer, but folic acid supplementation may increase the incidence of bowel cancer. It may also increase the incidence of breast cancer in postmenopausal women.
Since the 1980s a consensus formed that that folic acid is metabolised in the small intestine in a similar way to naturally-occuring folates. This consensus was used to assess the safety of folic acid fortification.
"We challenge the underlying scientific premise behind this consensus", said Dr Astley. "This has important implications for the use of folic acid in fortification, because even at low doses it could lead to over consumption of folic acid with its inherent risks".
Norwich BioScience Institutes
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Women of childbearing age can reduce the risk of having a child born with a neural tube defect such as spina bifida by eating enough folate or folic acid. However, folate prevents only about 70 percent of these defects.
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The Canadian policy of fortifying grain products with folic acid has already proved to be effective in preventing neural tube defects.
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Immigrant women may be at higher risk of having a baby with a birth defect
Immigrant women are less likely to use folic acid supplements before pregnancy to prevent spina bifida, particularly those who recently immigrated to the country, according to a new study led by a St. Michael's Hospital physician in collaboration with Statistics Canada, Health Canada and the University of Toronto.
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Scientists discover why teeth form in a single row
A system of opposing genetic forces determines why mammals develop a single row of teeth, while sharks sport several, according to a study published today in the journal Science. When completely understood, the genetic program described in the study may help guide efforts to re-grow missing teeth and prevent cleft palate, one of the most common birth defects.
Children with inflammatory bowel disease have surprisingly high folate levels, study finds
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