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Give us our daily chemicals ...
Are plans to add folic acid to bread a sensible precaution, or a cavalier experiment with the nation's health? Joanna Blythman reports
Friday May 18, 2007
The Guardian
If you subscribe to the "magic bullet" school of public health, then you won't have any problems with the Food Standards Agency's recommendation yesterday that bakers should be obliged, by law, to add folic acid to their bread or flour. After all, the government already forces millers to fortify the nation's flour with calcium carbonate, otherwise known as chalk. Likewise, all British infant cereals must contain added thiamin (vitamin B1), while margarines routinely have vitamins added to match the levels you would find in butter. And there aren't any riots in the street about that, are there?
The FSA's argument is that since a lack of folic acid before and during pregnancy has been linked to profound disabilities in babies, including spina bifida, adding it to bread must be a good thing. In the words of Andrew Russell, chief executive of the Association for Spina Bifida and Hydrocephalus: "Demographics show that it is the poorest and most educationally underprivileged women who are most at risk of a spina bifida pregnancy." To its critics, however, the FSA seems to have had its ear bent by a paternalistic faction of the health establishment.
The notion of adding folic acid - the synthetic form of vitamin B9, also known as folate - to bread has been bubbling away in government committees for years. The fortification of the nation's food supply with vitamins and minerals dates back to the post-second world war era, when the British population was stricken with diseases such as rickets that were caused by poor nutrition. In those days, the mass-medication of the entire population seemed a pragmatic, last-ditch option. But nowadays, when there is plenty of food on our plates, the blanket addition of vitamins looks more dubious.
In the specific case of folic acid, medical authorities are not united. New evidence has recently been emerging of possible adverse effects. High intakes of folic acid have been associated with a speeding-up in the progress of certain cancers. Folic acid is also known to mask symptoms of anaemia caused by a shortage of vitamin B12, commonly suffered by vegetarians and elderly people.
In the US, the now mandatory fortification of bread was driven by a vocal lobby that organises a highly effective annual telethon, using the slogan "Helping babies, together". But there are concerns that in the rush to save America's babies, older people have suffered. Several studies in the US now suggest that folic acid supplementation is harming vulnerable old people. "We already know that folic acid, given without B12, is creating problems for the elderly," says nutritionist Patrick Holford. "And that's at half the amount that the FSA is proposing to add to British flour." Some scientists are also questioning whether we can blithely assume that synthetically produced folic acid will work in the same way as naturally occurring folate. They are calling for further research.
The other main objection is that fortification is a sledgehammer to crack a nut. The estimate is that adding folic acid to bread will save 120 babies in the UK every year from spina bifida, but for every baby saved, half a million people, male and female, will have to take the added folic acid. "Why not target potential young mothers rather than mass-supplementing the population at large ?" asks Holford.
Others, such as Andrew Whitley, author of Bread Matters: the State of Modern Bread, see mandatory fortification as an admission of defeat, implying that there is no way to get women of child-bearing age to consume enough B9 other than by sneaking folic acid into their bread. "This is just another step into making our daily bread into a repository of 'nutraceuticals'," he says. "It is noticeable that the FSA isn't proposing adding it to wholemeal bread because it already contains it. Why doesn't the FSA just tell people to eat more wholemeal bread?"
When it comes to fortification in general, the philosophical divide between those who would medicate our food, and those who want to keep it natural, is vast. To campaigners for natural and organic food, fortification is unacceptable, just a way of trying to cover up the deficiences of over-processed foods. Calcium carbonate, for example, is routinely added to flour to compensate for the natural calcium destroyed in the modern roller-milling process. As Jessica Mitchell, director of the independent food watchdog the Food Commission, puts it: "Why de-nature bread into sawdust and then chuck in chemicals again to attempt to replace what you've taken out?" The same applies to folate. Half the folate in whole wheat is lost in the milling to white flour.
The reason that vitamin B1 is required by law to be added to infant foods such as baby rice is equally disturbing. Processed cereals used for these products would otherwise be deficient in the necessary B vitamins. "It's pretty bad that our conventionally produced cereals don't have enough natural folate to produce healthy babies," says Lizzie Vann, founder of the babyfood company Organix. "The ideal has to be to eat food grown on properly manured, fertile soil that has loads of naturally occurring nutrients in it."
The debate over folic acid has a clear parallel with mass fluoridation of our tap water. Several local authorities in the UK routinely add to their water the controversial chemical and known toxin, fluoride, in the hope of reducing the number of children with teeth rotten from the over-consumption of sugar. Educating children to eat less sugar is just too difficult, not to mention ineffective, they argue. So bring on the magic bullet - and too bad for all those people with perfectly fine teeth, or those grumblers who say that fluoride increases rates of osteoporosis and hip fractures.
Whether it is fluoridation or fortification, these blanket public health measures are seen by many as the thin end of the wedge - a wedge that runs completely counter to the "choice" and "personalisation" agendas set out by the government in its 2005 white paper Choosing Health.
Where does it all stop? Why don't we medicate our food with everything our bodies might possibly be short of, just in case? Or why not give up food entirely and just eat pills, like the astronauts in sci-fi films? "It's all too James Bond," says Vann. "What we need is not someone telling us what to eat, but better farming methods and lots of public health education".
Are plans to add folic acid to bread a sensible precaution, or a cavalier experiment with the nation's health? Joanna Blythman reports
Friday May 18, 2007
The Guardian
If you subscribe to the "magic bullet" school of public health, then you won't have any problems with the Food Standards Agency's recommendation yesterday that bakers should be obliged, by law, to add folic acid to their bread or flour. After all, the government already forces millers to fortify the nation's flour with calcium carbonate, otherwise known as chalk. Likewise, all British infant cereals must contain added thiamin (vitamin B1), while margarines routinely have vitamins added to match the levels you would find in butter. And there aren't any riots in the street about that, are there?
The FSA's argument is that since a lack of folic acid before and during pregnancy has been linked to profound disabilities in babies, including spina bifida, adding it to bread must be a good thing. In the words of Andrew Russell, chief executive of the Association for Spina Bifida and Hydrocephalus: "Demographics show that it is the poorest and most educationally underprivileged women who are most at risk of a spina bifida pregnancy." To its critics, however, the FSA seems to have had its ear bent by a paternalistic faction of the health establishment.
The notion of adding folic acid - the synthetic form of vitamin B9, also known as folate - to bread has been bubbling away in government committees for years. The fortification of the nation's food supply with vitamins and minerals dates back to the post-second world war era, when the British population was stricken with diseases such as rickets that were caused by poor nutrition. In those days, the mass-medication of the entire population seemed a pragmatic, last-ditch option. But nowadays, when there is plenty of food on our plates, the blanket addition of vitamins looks more dubious.
In the specific case of folic acid, medical authorities are not united. New evidence has recently been emerging of possible adverse effects. High intakes of folic acid have been associated with a speeding-up in the progress of certain cancers. Folic acid is also known to mask symptoms of anaemia caused by a shortage of vitamin B12, commonly suffered by vegetarians and elderly people.
In the US, the now mandatory fortification of bread was driven by a vocal lobby that organises a highly effective annual telethon, using the slogan "Helping babies, together". But there are concerns that in the rush to save America's babies, older people have suffered. Several studies in the US now suggest that folic acid supplementation is harming vulnerable old people. "We already know that folic acid, given without B12, is creating problems for the elderly," says nutritionist Patrick Holford. "And that's at half the amount that the FSA is proposing to add to British flour." Some scientists are also questioning whether we can blithely assume that synthetically produced folic acid will work in the same way as naturally occurring folate. They are calling for further research.
The other main objection is that fortification is a sledgehammer to crack a nut. The estimate is that adding folic acid to bread will save 120 babies in the UK every year from spina bifida, but for every baby saved, half a million people, male and female, will have to take the added folic acid. "Why not target potential young mothers rather than mass-supplementing the population at large ?" asks Holford.
Others, such as Andrew Whitley, author of Bread Matters: the State of Modern Bread, see mandatory fortification as an admission of defeat, implying that there is no way to get women of child-bearing age to consume enough B9 other than by sneaking folic acid into their bread. "This is just another step into making our daily bread into a repository of 'nutraceuticals'," he says. "It is noticeable that the FSA isn't proposing adding it to wholemeal bread because it already contains it. Why doesn't the FSA just tell people to eat more wholemeal bread?"
When it comes to fortification in general, the philosophical divide between those who would medicate our food, and those who want to keep it natural, is vast. To campaigners for natural and organic food, fortification is unacceptable, just a way of trying to cover up the deficiences of over-processed foods. Calcium carbonate, for example, is routinely added to flour to compensate for the natural calcium destroyed in the modern roller-milling process. As Jessica Mitchell, director of the independent food watchdog the Food Commission, puts it: "Why de-nature bread into sawdust and then chuck in chemicals again to attempt to replace what you've taken out?" The same applies to folate. Half the folate in whole wheat is lost in the milling to white flour.
The reason that vitamin B1 is required by law to be added to infant foods such as baby rice is equally disturbing. Processed cereals used for these products would otherwise be deficient in the necessary B vitamins. "It's pretty bad that our conventionally produced cereals don't have enough natural folate to produce healthy babies," says Lizzie Vann, founder of the babyfood company Organix. "The ideal has to be to eat food grown on properly manured, fertile soil that has loads of naturally occurring nutrients in it."
The debate over folic acid has a clear parallel with mass fluoridation of our tap water. Several local authorities in the UK routinely add to their water the controversial chemical and known toxin, fluoride, in the hope of reducing the number of children with teeth rotten from the over-consumption of sugar. Educating children to eat less sugar is just too difficult, not to mention ineffective, they argue. So bring on the magic bullet - and too bad for all those people with perfectly fine teeth, or those grumblers who say that fluoride increases rates of osteoporosis and hip fractures.
Whether it is fluoridation or fortification, these blanket public health measures are seen by many as the thin end of the wedge - a wedge that runs completely counter to the "choice" and "personalisation" agendas set out by the government in its 2005 white paper Choosing Health.
Where does it all stop? Why don't we medicate our food with everything our bodies might possibly be short of, just in case? Or why not give up food entirely and just eat pills, like the astronauts in sci-fi films? "It's all too James Bond," says Vann. "What we need is not someone telling us what to eat, but better farming methods and lots of public health education".
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