Mandatory bread fortification with folate
The Paediatric Society of New Zealand and the Royal Australasian College of Physicians, New Zealand Paediatric & Child Health Division strongly support the mandatory fortification of bread with folate. Folate is essential for human
health and reproduction and the modern New Zealand diet does not contain sufficient folate.
We strongly support the introduction of the new food standard, which will see folic acid added to bread. The
introduction of this standard is the result of over 20 years of research. Fifty-seven countries already have mandatory
folate fortification including the whole of North America.
The recent propaganda campaign has convinced many New Zealanders into believing that they are being “medicated” against
their will. This is not the case. There are benefits for all New Zealanders.
• Folic acid and folate are essentially the same nutrient
• Folate is an essential nutrient which we all need for our bodies to function properly.
• If women have a diet low in folate around the time of conception and early pregnancy, their unborn child is at
risk of the nervous system not developing properly. Doctors call the problems with development neural tube defects of
which the most common is generally known as “spina bifida”. An intake of around 600 micrograms per day in early
pregnancy ensures that the unborn child’s nervous system develops correctly.
• Low folate intake in early pregnancy is also a factor in some congenital heart defects.
• While some women plan their pregnancies and can benefit from education about diet in pregnancy, many do not and
do not realise that they are pregnant until the crucial period of organ development has already taken place. Any
educational campaign will therefore be ineffective. Many studies have demonstrated that such campaigns do not reduce the
birth of affected children nor reduce the number of terminations performed.
• Opponents of mandatory folate fortification correctly point out that there has been a significant drop in the
number of infants born with spina bifida. This is because almost all women have an ultrasound scan in mid pregnancy, and
most infants with spina bifida can be diagnosed by this scan. The majority of women whose infant is diagnosed with spina
bifida choose termination of pregnancy. Most statistics quoted in NZ refer to livebirths and stillbirths only and do not
include the number of terminations performed for NTD’s (Neural Tube Defects.)
• Neural tube defects result in significant costs to the health and disability sectors. These costs can be avoided
if neural tube defects are prevented. These savings will benefit all New Zealanders.
Costs of termination of pregnancy:
Operative costs
Later health problems for those women who have terminations
Costs of care for individuals with neural tube defects:
Multiple operations and hospital admissions
Support in schools
Disability support including respite care for families and provisional of personal care to the individual.
• The cost benefits are clear. In the US it is estimated by the baking industry that folate fortification adds
about 25 cents to the cost of bread per person per year .This is minimal relative to the costs of care for affected
children over a lifetime.
• With regard to the risks of potential negative health impacts, the World Health Organisation (WHO) has noted
that all the recent studies looking at risks of cancer do not relate to flour fortification, but to high dose
supplements. The WHO notes that, at the level of fortification planned140 micrograms/100g of flour there is no evidence
of negative health effects. Folate intake in the quantities the proposed fortification will achieve is protective
against bowel cancer developing, but consumption of additional high dose folate supplements may accelerate the growth of
bowel cancers that are already established. People should seek advice about the value of high dose supplements from
their family doctor.
• Emotive terms such as “mass medication” have created the impression that folate is being added to bread in
attempt to medicate people against their will. Wheat already contains folate. The processing of wheat into flour removes
much of the natural folate. Fortification merely replenishes a natural nutrient which has been taken out by manufacture.
• The suggestion that women would have to eat 11 slices of bread a day to reach levels adequate to prevent neural
tube defects is a distortion of the facts. This would be the case if women were only to eat bread and nothing else. In
New Zealand most women consume about 200 micrograms of folate each day from a wide variety of sources including
fortified foods. This is well below the recommended 400-1000 micrograms recommended as daily intake. Folic acid
fortification in bread will add another 140 micrograms maximum, still below the recommended daily intake. The goal of
fortification is to ensure that those who are about to become pregnant or are in early pregnancy consume sufficient
folate to minimize the likelihood of a baby being born with a congenital abnormality.
Healthy children benefit all New Zealanders. They are the workforce and taxpayers of the future. We need them to care
for us as we age. As a nation, we should warmly congratulate those decision- makers that have looked to the future and
introduced this important public health measure. We are very hopeful that in time the Baking Industry will also take
pleasure in their important role in improving the health of New Zealanders.
ENDS