Researchers Call for Mandatory Folic Acid Supplements in Flour
Adding folic acid to flour would be a cheap, effective way to reduce the 500 annual cases of neural tube defects like spina bifida in babies in Australia each year.
But despite recommendations by the National Medical Health and Research Council, mandatory fortification has yet to be introduced in Australia, according to an editorial published in the current issue of the Medical Journal of Australia.
The Australian, New Zealand and UK governments will decide for or against mandatory fortification of flour with folate during the next six months.
Co-authors Glen Maberly, Professor of Global Health at the Rollins School of Public Health, Emory University in Georgia in the USA, and Professor Fiona Stanley, Director of the Telethon Institute for Child Health Research in Perth, WA, say Australia should follow the lead of over 40 countries and introduce mandatory fortification.
Professor Maberly says in the 10 years since we have known how to prevent neural tube defects, the simple process of adding folic acid to flour could have prevented up to 70% of the 5000 neural tube defects that have occurred in that time in Australia alone.
Professor Maberly says that while the number of preventable cases in Australia has been reduced by voluntary fortification, this has not occurred across all of society, with resulting inequities.
"The reduction of cases of lifelong disability from neural tube defects has largely resulted from antenatal detection, with pregnancies being terminated (now the leading cause for late-stage termination of pregnancy in Australia and the UK)," Professor Maberly said.
He argues mandatory fortification of flour with folic acid could relieve the considerable emotional and financial costs of the condition.
He says since 1996 there's been mandatory fortification of all wheat flour products in the USA and Canada which more than doubled women's folate levels and reduced the number of neural tube defects by 30 per cent in the USA and 50 per cent in Canada. Mandatory fortification in Chile has led to a 70 per cent decrease in the number of neural tube defects.
Folate can also prevent almost all folate deficient anaemia and can lower the risk of heart attack and stroke. It can also protect against Alzheimer's disease and several cancers.
Perceived risks include the possibility of masking pernicious anaemia (the result of vitamin B12 deficiency) in older people and an increase in certain cancers.
However, there is no link between folate and vitamin B12 deficiencies, and evidence points to an overall reduction in cancer risk.
"The ethical issue here is not what harm the mandatory fortification of flour with folic acid would do; rather, it is the harm inflicted each day that fortification is delayed by those who know how to prevent the damage from folic acid deficiency," Professor Maberly said.
"If the medical community will not rally and become advocates for this public health issue, who will? And at whose expense?" he said.
CONTACT: Professor Glen MABERLY Mobile (USA) 0011 1 404 388 2056
Judith TOKLEY, AMA Public Affairs 0408 824 306 / 02 6270 5471