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20 Dec 2016 - Daily Mail - Folic acid in flour 'would potentially save HUNDREDS of babies from spina bifida', says top professor

By Professor Sir Colin Blakemore, for the Daily Mail


The UK government has recently rejected recommendations to fortify basic foodstuffs such as flour with folic acid in order to reduce the occurence of serious neurological conditions such as spina bifida. 

In this article, leading scientist Professor Colin Blakemore sets out the reasons why he believes this decision is ill-judged, as despite NHS guidance, many women in early pregnancy still have sub-optimal intakes. For a summary of the evidence that increasing folic acid intakes at the population level can prevent neural tube defects, see:
Existing evidence also indicates that low intakes of folate (the natural form of folic acid, or vitamin B9) in early pregnancy may impair cognitive development even in apparently healthy children, as well as raising the risk of some childhood developmental disorders, including autism and language delay. For details, see:

During 50 years in medical research, I’ve had the heartbreaking experience of meeting children with spina bifida and seeing how much they and their parents can suffer.

This is the commonest form of neural tube defect (NTD) — abnormal growth of the brain or spine in the very young embryo. In the most serious form of NTD, anencephaly, the whole brain fails to grow.

These terrible conditions affect more than 1,000 pregnancies each year. Sadly, 80 per cent of these babies die in the womb or are aborted — often an agonising decision for their parents.

Many who reach full term are stillborn or die in their first few years. Those who survive usually end up in a wheelchair because of weakness or paralysis of their legs. And they are unlikely to live beyond their 40s.

Yet cases of these illnesses could be slashed simply by fortifying white flour with an essential vitamin — known as B9 or, more commonly, folic acid — found in wheat but lost during refining.

That’s because the vitamin is essential for cell division, especially in the rapid growth of the brain a month or so after fertilisation.

So why has Health Secretary Jeremy Hunt refused to give the green light to fortification, when scores of leading scientific bodies, including the Food Standards Agency, the British Medical Association, his own Scientific Advisory Committee on Nutrition, and the Chief Medical Officer for England, support it?

As decisions go, Mr Hunt’s position is, frankly, unfathomable.

The Medical Research Council, where I was chief executive ten years ago, has been responsible for many transformative discoveries, not least a ground-breaking, eight-year study of birth defects in mothers who had already had a child with a neural tube defect. The research produced overwhelming evidence that giving folic acid dramatically reduced the chance of such a defect in the next pregnancy.

This result, published in The Lancet in 1991, sent a simple message. Many women don’t get enough folic acid in their diet to protect against neural tube defects, and so adding it to food can save babies’ lives or spare them a life of disability. Since then, nearly 80 other countries, inspired by British research paid for by the taxpayer, have been fortifying flour with folic acid.

In the U.S., which introduced fortification in 1998, it’s estimated that more than 23,000 babies have been saved from NTDs.

Ironically, NHS Choices, an official NHS website funded by the Department of Health, reported a recent study, published in the Lancet, which revealed that 2,000 babies in the UK would have been saved from abortion, stillbirth or a life of disability if Britain had introduced fortification of flour when the U.S. did.

If the chance to save lives doesn’t persuade Mr Hunt, perhaps saving money will. The lifetime cost to the NHS, social services and the parents of a child who lives to adulthood with spina bifida is likely to be more than £500,000.

It’s not that the Department of Health rejects the evidence that folic acid is needed. Since 1992, they’ve recommended that women of child-bearing age should take a folic acid tablet every day.

That’s all very well for informed middle-class mothers who plan their babies. But countless women get pregnant unexpectedly. And it’s essential to take extra folic acid before conception, because it’s needed especially during the first three to five weeks of pregnancy, when the brain makes cells at a prodigious rate — the subject of my own current research.

Perhaps Mr Hunt is wary of Nanny State accusations of mass medication. But the government mandated long ago that white flour must be fortified with iron, calcium and other B vitamins — thiamine and niacin, to prevent illnesses. What’s the difference?

Sceptics may argue we can get folic acid from food, especially green, leafy vegetables. So why should we need more? Well, to reach the Department of Health’s recommended intake of folic acid, women would have to eat four cups of cooked broccoli each day — that’s 875g.

There’s also evidence folic acid would benefit others, too. Folic acid deficiency is not uncommon, especially in older people, leading to anaemia, diarrhoea and depression. It may even cut the risk of stroke and heart disease since it lowers levels of homocysteine, a substance in the blood associated with these conditions.

In justifying the decision not to add folic acid to white flour, the Health Department said it ‘would not be a silver bullet in preventing neural tube defects’. Yet no medicine or preventive action works for absolutely everyone. Are hundreds of babies and millions of pounds saved every year not enough?

For the sake of those babies who are dying unnecessarily, Mr Hunt, you have to think again.

Professor Sir Colin Blakemore is a former chief executive of the Medical Research Council.