Folic acid fortification

Fortification involves the addition of nutrients, such as vitamins or minerals to foods. Fortification can be a way to improve peoples' nutritional intake.

In 2014, the Food Standards Agency reiterated its recommendation of the mandatory fortification of bread or flour with folic acid, to reduce the risk of neural tube defects in foetuses. In Scotland, we’re now responsible for this work. UK health ministers are currently considering the National Diet and Nutrition Survey (NDNS), which collected information on folate levels in participants’ blood. These results were published on 20th March 2015. You can see the results on gov.uk. Ministers are also considering Scientific Advisory Committee on Nutrition (SACN) advice to the food industry to reduce levels of folic acid in voluntarily fortified foods.

Why fortify foods with folic acid

If women take a folic acid supplement before they become pregnant and continue this for the first 12 weeks of pregnancy, they’ll greatly reduce the likelihood of their baby being born with a neural tube defect. However, almost half the pregnancies in the UK are unplanned, and between 700 and 900 pregnancies a year are affected by neural tube defects. Many women don’t ever take folic acid supplements during pregnancy and many others start taking them too late.

There’s strong evidence that consuming more folic acid before and in the first 12 weeks of pregnancy will reduce the risk of neural tube defects, and we know that younger women at a socioeconomic disadvantage have the lowest folic acid intakes. Fortifying bread or flour with folic acid would be an effective way of reaching this section of the population.

Folic acid in the food chain

As well as mandatory fortification, SACN recommended that there are better controls on voluntary fortification (folic acid can be added to a number of foods like spreadable fats and breakfast cereals). SACN also recommends that people who are at more risk of developing certain types of colorectal cancer should seek medical advice before taking more than 0.2 mg of folic acid a day. ‘More at risk’ in this instance means people over 50 and those with a history of colorectal cancer.

For information on the evidence that was considered by SACN, visit The National Archive.