Discussions unfolding from the start of this year have revealed that Scotland is edging ever closer to a decision some 16 years in the making, whether or not to fortify flour with folic acid.

1. To fortify or not to fortify
Can you tell our readers a little about whyfortifying
flour with folic acid needs to be considered in Scotland -
what does it mean to fortify flour with folic acid in your
view? Where has it been successful/unsuccessful?
Fortifying flour with folic acid will be a very
effective way to reduce the number of babies
who are born with neural tube defects like
spina bifida. The folic acid could be added
to flour during the manufacturing process
relatively easily, and this would go some way
to increasing folate levels among the general
population. Folic acid is tasteless, entirely
safe within recommended intake levels and is
already included in many foods like breakfast
cereals.
Folic acid is naturally present in grain, and
the manufacturing process removes it along
with other vitamins and minerals - niacin,
thiamine, iron and calcium - which are
currently added back in to flour. This is clearly
labelled on packaging. Folic acid is simply a
water soluble vitamin like niacin and thiamine
which are B vitamins – low levels of which can also cause
significant symptoms and long term conditions.
There are 78 countries around the world that already have
mandatory fortification of flour. The USA has done it for
the past eight years, with no adverse effects on health.
According to Spina Bifida Hydrocephalus Scotland, neural
tube defects have reduced by between 27 percent and 50
percent in countries where mandatory fortification has been
introduced.
What major health benefits will mandatory folic acid
fortification tackle and why is it being considered for
Scotland?
The Scientific Advisory Committee for Nutrition estimates
that around 50 pregnancies are affected by neural tube defects
every year. This is a particular concern in some of our more
deprived communities, where rates of unplanned pregnancy
are higher. Within the UK, folate levels tend to be lower in
Scotland and Northern Ireland, so we have a particular interest
in wanting to take action. It’s important to note that these are
life-long conditions, causing families significant distress and
placing an additional and unnecessary cost burden on our
NHS.
Scotland’s big question
Discussions unfolding from the start of this year have revealed that
Scotland is edging ever closer to a decision some 16 years in the
making, whether or not to fortify flour with folic acid.
A
s concerns rise over the potential for an increase in
birth defects, Scotland moves towards mandatory
fortification, as Westminster continue to delay their
decision.
The uncertainty surrounding the issue of fortification has led
to a reduction of the amount of folic acid added to products by
companies who voluntarily fortify their foods,
in order to comply with regulations should
fortification be implemented. This has led to
mounting concerns of the level of folic acid intake
across the UK.
Folate, from the family of B-Vitamins, occurs
naturally in foods such as nuts and green
vegetables. Folic acid is a synthetic form of
folate, often used for food fortification and in
dietary supplements; it plays a pivotal role in the
prevention of birth defects, specifically neural
tube defects (NTD) such as spina bifida.
Since 1992 advice to women UK wide has
been to begin to take folic acid supplements
while trying to get pregnant to reduce the risk
of NTD, but studies have shown that as little as
28 percent of women take the correct dosage of
400 micrograms three months prior to pregnancy,
following this through until the 12th week of pregnancy.
As the required amount of dietary folate intake does not
appear possible through diet alone, women who have unplanned
pregnancies, as well as the those who have not taken the required
supplement at the correct time, are at greater risk of NTD. It is
believed that as many as 50 percent of births in Scotland are
unplanned, expounding the need for the addition of folic acid into
diets.
A study published in December 2015 concluded that the failure to
implement mandatory fortification at the same time as the US in 1998
led to an estimated 2000 children being born with NTD, and ignoring
it further could lead to an additional 150 children born with NTD year
on year; where the US has seen a decrease of children born with NTD
of 28 percent.
Extensive research has been carried out by a plethora of scientific
bodies including the Scientific Advisory Committee on Nutrition
(SACN), who were looking into potential adverse effects of folic
acid. The conclusion of this research culminated in a collective call
for fortification.
In a report to UK health ministers last autumn, officials at SACN
testified that where mandatory fortification has been implemented in
nearly 80 countries worldwide, none had not reported any adverse
health conditions as a result of fortification.
Milling and Grain speaks to
the Scottish Health Minister
Maureen Watt about
Scotland’s push to fortify flour
50 | March 2016 - Milling and Grain
F

2. How long has the Government, in both Scotland and
the UK, been discussing this topic and what were some
of the considerations evaluated?
The UK Government has consistently delayed introducing
legislation on this issue since it was first raised by the Scientific
Advisory Committee on Nutrition in 2007. The UK Government
position was to await the outcome of the population blood folate
status results. These were published on 20 March 2015. A
decision was then delayed until parliament returned after the
general election and we are still waiting.
As part of their remit, Food Standards Scotland (FSS) is
currently considering the scientific and regulatory aspects of
fortification of flour with folic acid. Before FSS was created, the
Food Standards Agency had considered this and provided advice
to us in 2007 and 2014 in support of fortification with a view to
reducing the risk of congenital neural tube defects.
There is always some resistance to the introduction of
flour fortification. How have you addressed the most
important ones of these? Why has there been a delay in
reaching a decision on this issue?
To maximise the impact of mandatory fortification, and in
line with recommendations from SACN and Food Standards
Scotland, we believe that a UK-wide approach would be
most effective. Indeed, Wales and Northern Ireland have
expressed their support. Unfortunately, the UK Government
has consistently deferred their decision and in response to my
latest letter, they have again refused to commit to mandatory
fortification. With every delay more babies are put at risk,
which is why we must act now.
Food fortification has been a contentious issue for some
time, why is Scotland choosing to act now? And what
would your advice be to other governments considering
the introduction of flour and/or rice fortification?
We have been pursuing a UK-wide approach as our preferred
option. However, should the UK government decide not to act I,
along with my counterparts in Wales and Northern Ireland, will
consider how we might progress this. I believe there is strong
evidence in favour of mandatory fortification.
The food and drink federation have said they believe
most manufacturers would favour a harmonised
approach across the UK on mandatory folic acid
fortification, but with the UK seemingly ‘dragging its
heels’ what do you think about this statement? – Is
there time to wait for a nationwide decision?
It’s encouraging to see that the Food and Drink Federation want
a UK-wide approach – we agree with them. We still believe that
"There are 78 countries around the
world that already have mandatory
fortification of flour. The USA has
done it for the past eight years, with
no adverse effects on health"
Milling and Grain - March 2016 | 51
F

3. this is the best way forward, and it is not too late for the UK
Government to make this decision.
With some companies voluntarily fortifying foods, for
example some breakfast cereals and certain spreads, is
mandatory fortification really necessary?
Yes, because not all women eat the foods that are voluntarily
fortified. It is better to use fortified flour in order to increase
folic acid in products which are more widely consumed by
women of childbearing age. The statistics show us that 14.8
percent of women of childbearing age in Scotland have red
blood folate concentration below the WHO threshold. This
is well above the UK-wide average of 11.3 percent and it’s
especially low in lower-income groups where the problem
is made worse by the relatively higher number of unplanned
pregnancies.
Bread has been a staple food in these islands for centuries, and
it still is. That’s why fortification of flour is such an effective way
to increase folate levels across the board.
What would be the implications of Scotland going
ahead with mandatory folic acid fortification, how
would businesses who export to the UK and beyond
deal with this?
A full consultation with industry, and a business impact assessment,
would of course be a part of any mandatory fortification.
What would the ideal outcome of these ongoing
discussions be?
Our ideal outcome is for the UK Government to agree to take
this forward so we can have a uniform approach across all four
nations. This would prevent many families from having to go
through the heartache of being told their unborn child has spina
bifida.
52 | March 2016 - Milling and Grain
F
The new original Alveograph
by CHOPIN Technologies
20, Avenue Marcellin Berthelot
92396 Villeneuve-la-Garenne - France
The Alveograph is internationally
recognized and standardized. It is used
daily by wheat breeding, grain storage,
milling and baking industries to measure
the viscoelastic properties of wheat flours.
The new AlveoLab is more accurate and
easier to run. Key steps of the test are now
fully automated to limit the impact of the
operator. Morevoer, dough bubbles are
made in a fully temperature and humidity
controlled chamber.
With the AlveoLab, new test protocols
can be easily designed to meet specific
applications and make the alveograph
analysis an even better predictor of flour
performance.
For more information
flash this code or
visit
www.chopin.fr
pub-alveo-ang-190x132.indd 1 22/02/2016 16:43:49