Fortified foods are marketed as good for us, helping to fill nutritional gaps that can lead to deficiencies and poor health.
However, the government’s recent decision to add folic acid to supermarket bread has become the focus of a heated debate online.
From December this year, a new law will require food manufacturers to add the synthetic nutrients to non-wholemeal flour, meaning certain breads, cakes and other supermarket items will all have extra fortification.
Once the rule is in place, UK millers will be required to add 0.25mg of folic acid per 100g of non-whole wheat flour.
But what exactly is folic acid? Why are people worried and is there any truth to the concerns swirling on social media?
To better understand the conversation, we asked a nutritionist to answer some of the most frequently asked questions.
Many breads you see in supermarkets will soon contain folic acid.
(Drazen Zigic via Getty Images)
What is folic acid?
Folic acid is the synthetic form of vitamin folate, also known as B9.
Folate helps the body produce healthy red blood cells and plays a role in how efficiently our cells divide and grow. It is found naturally in foods such as leafy greens, chickpeas and cruciferous vegetables, with the NHS saying most adults can get all they need from a healthy diet alone.
In early pregnancy, a good level of folic acid becomes especially important, as it helps the baby’s brain, skull and spinal cord develop properly.
During these weeks and months, it can be more difficult for women to get enough folic acid from diet alone, as the body’s demands increase significantly.
This is why the NHS recommends that all pregnant women take 400 micrograms of folic acid every day – from before they become pregnant until their 12-week scan.
Why is the government introducing the new rule?
“Folic acid is added to bread in the UK because folic acid intake is still too low in women of childbearing age and this has real, preventable consequences,” says Rob Hobson, nutritionist and author of Unprocess Your Life.
“About nine out of 10 neural tube defects, including spina bifida (a condition where the baby’s spine and spinal cord do not fully develop in the womb), develop very early in pregnancy – often before many women know they are pregnant.
“Despite years of advice to take supplements, uptake has been spotty in the UK, particularly among younger women and those from lower income backgrounds.”
In England, a study of almost half a million women found that only 31% took a folic acid supplement before pregnancy.
“That’s why there are fortifications,” says Hobson. “It takes years of evidence review, careful modeling of risks and benefits and advice from independent scientific bodies.
“Countries that already fortify flour have consistently seen reductions in neural tube defects, with no clear evidence of harm to the wider population.”
A recent review looking at data from several countries found a clear link between the introduction of folic acid fortification and a reduction in neural tube defects, with Chile in South America seeing a 55% drop in incidence over a decade.
While the new rule goes into effect later this year, some manufacturers have already begun voluntary fortification.
(Lucy Lambriex via Getty Images)
Why is there controversy surrounding the decision?
Much of the controversy online centers around a gene called “MTHFR,” which plays a role in how your body metabolizes folate.
Some people are concerned that if you have a mutation in this gene, you may be less efficient at processing synthetic folic acid, leading to higher levels of the unmetabolized nutrient in your blood.
Online, panic has spread around this “buildup” of folic acid, with claims that it could contribute to everything from immune problems and increased cancer risk to increased depression and fatigue.
However, Hobson believes that these concerns have been largely sensationalized and are not based on sound scientific evidence.
“It’s true that variants in the MTHFR gene are common and can slightly affect how folic acid is processed in the body,” he clarifies. “However, the idea that people with these variants cannot manage folic acid safely, or that fortification is harmful at the population level, is not supported by good quality evidence.
“This argument often comes from unregulated online sources and tends to overlook the magnitude of the public health benefits.”
Fears about folic acid fortification have surfaced on social media platforms.
(Maria Siurtukova via Getty Images)
Can too much folic acid increase the risk of cancer?
Fears about folic acid and cancer seem to stem from early research looking at high-dose supplementation.
Some early studies suggested that very high intakes of folic acid might be linked to a possible increase in certain types of cancer. However, a 2013 meta-analysis of randomized trials looked at these concerns and found that folic acid supplementation did not significantly increase overall or site-specific cancer risk over a five-year follow-up period.
When it comes to your weekly bread, Hobson says it makes sense to keep the level of fortification in context.
“The level of folic acid added to flour is small and tightly regulated,” he recalls. “Even with fortified bread, most people will still be consuming folic acid well below the upper safe intake level. This is very different from taking high-dose supplements.”
He adds: “Claims on social media that fortified bread can ‘slow body processes’ or ‘promote cancer’ are not supported by solid human evidence at the levels used in fortification.
“While very high doses of supplements may overwhelm certain pathways in theory, there is no good evidence that the small amounts used in flour fortification affect metabolism or harm the general population.”
Of course, if you’re really concerned about the new law and meet your daily folic acid requirements through diet alone, you can always opt for whole wheat varieties that aren’t affected by the rule or try making your own whole wheat flour at home. Both are healthy and nutritious ways to increase your fiber intake.
However, if you love nothing more than tucking into a loaf of white bread, Hobson thinks there’s no immediate reason to panic. “The bottom line is that fortification is not about optimizing nutrition for people who are already eating well and taking supplements,” he notes.
“This is about reducing preventable birth defects across the entire population. From a public health perspective, the benefits are clear, the risks have been carefully assessed, and the policy is based on decades of evidence.”