The folate debate

We’re consulting at the moment on how to increase young women’s intake of folic acid, to reduce the number of pregnancies affected by neural tube defects such as spina bifida, and I’m looking forward to the debate it will generate.

The consultation raises some important ethical issues, as well as scientific ones, particularly the possibility of mandatory fortification of flour with folic acid, which is what the Scientific Advisory Committee on Nutrition (SACN) has recommended, alongside controls on voluntary fortification. As with any public health policy, we need to balance benefits against risks. It’s important for the Agency to be open about this and involve the public and other stakeholders in finding a way forward that is both evidence-based and acceptable to people, which is what the consultation is all about.

Mandatory fortification of flour with folic acid could reduce neural tube defects by increasing women’s intake of the vitamin before they get pregnant and during early pregnancy.

The number of neural tube defects prevented would depend on the amount of folic acid consumed, but SACN estimates that adding 300 micrograms of folic acid per 100g flour (not including wholemeal) could prevent up to 160 neural tube defects a year. So this would be a clear benefit of mandatory fortification.

However, there are potential risks, which you’ll find explained in more detail on our eatwell website. With older people, for instance, high levels of folic acid can make it difficult to spot vitamin B12 deficiency, which is more common in older people and might in some circumstances have adverse health effects.


I’d be really interested in your views on how we can balance the benefits versus the risks for different age groups. For more information, see the consultation.