Why we need folic acid in our flour

If we are serious about our children deserving better, it also makes sense to give our baked goods a little extra goodness.

You could be forgiven for thinking that the recent report by the chief medical officer for England, Sally Davies, covered only one topic – improving child health. The press picked up on the argument that, given the upsurge in cases of rickets, the government should consider providing free vitamin supplements to all children, but there was much more in the report. Davies’s next point, that we should fortify our flour with folic acid, has been ignored for far too long.

This recommendation arguably has much greater potential impact. Boosting folic acid in foods eaten by pregnant women significantly decreases the occurrence of foetal “neural tube defects”, reducing cases of conditions such as spina bifida and anencephaly, in which large parts of a baby’s brain simply don’t form.

The neural tube, which eventually carries the spinal cord and the brain, starts as a groove that deepens and then closes off. A folic acid deficiency can prevent the closing process, leaving nerves exposed. Folic acid provides a “methyl group” – one carbon atom and three hydrogen atoms – that binds to foetal DNA and ensures the genetic instructions are carried out properly, fully closing the neural tube.

We’ve known about the importance of folic acid since a landmark paper was published in the Lancet in 1991. In an experiment involving 2,000 women known to be at higher risk of having babies with neural tube defects, supplements of folic acid prevented between 70 and 80 per cent of the defects. The benefits were so starkly obvious that the experiment was stopped early: it was deemed unethical to continue to withhold supplements from those in the control group.

The test results led more than 60 countries to mandate the fortification of flour with folic acid. The neural tube forms in the first four weeks of pregnancy, before many women know they are pregnant. For full protection, the foetus needs the folic acid right from conception, yet only 37 per cent of women in the UK are taking folic acid supplements when they fall pregnant.

In the US, the fortification of cereal products with folic acid prevents roughly 1,300 neural tube defects a year and forestalls 360 infant deaths. Every year in the UK, 1,000 children are born with a neural tube defect, one and a half times the number of such births in the entire United States. That’s because the UK government advises only that women who might get pregnant should take folic acid supplements – it has consistently ignored scientific advice to put folic acid in the nation’s flour.

Until early this year, the government was able to hide behind claims that folic acid fortification might increase rates of bowel cancer. Those claims were disproved in a Lancet paper in January. The only remaining fig leaf for the government’s current position is a vague concern that one shouldn’t impose medicines on the country.

There is also an economic case for fortifying flour with folic acid. Each spina bifida patient costs the NHS about half a million pounds over their lifetime. In the US, the financial benefits have been shown to outweigh the cost of fortifying flour by 40 to 1. A 2011 costbenefit analysis of fortifying flour with folic acid suggested it would save the UK several million to hundreds of millions of pounds per year.

By all means, let’s get children out into the sun, and taking Vitamin D supplements if necessary: rickets has no place in 21st-century society. But if we are serious about our children deserving better, it also makes sense to give our baked goods a little extra goodness.

One simple change could make a lot of difference to all of us, personally and financially. Image: Getty

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 06 November 2013 issue of the New Statesman, Are cities getting too big?

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You are living in a Black Mirror episode and you don’t care

The Investigatory Powers Bill is likely to become law later this year, but barely anyone is resisting the dystopian surveillance it will bring.

“They’re all about the way we live now – and the way we might be living in 10 minutes’ time if we're clumsy,” explained Charlie Brooker when asked to describe the concept behind his science fiction series Black Mirror. When series three was released on Netflix last week, this sentiment was reiterated over and over. “Omg, it’s just like Instagram!!!!” squealed individuals in their masses after watching episode one, “Nosedive”, set in a world where everyone rates one another out of five after their interactions. The parallel with social media is easy, obvious, and intentional, but it doesn’t teach us much. The real ways in which our world is like a dystopian sci-fi are, in fact, much more boring.

There will be no suspenseful songs or dramatic jump cuts preluding the third reading of the Investigatory Powers Bill in the House of Lords next week. The “snoopers’ charter” is likely to become law after it passed through its House of Commons readings with a few amendments, with 444 MPs voting in favour and 69 against. In short, the Bill will give the government unprecedented surveillance powers, allowing them to intercept and collect your communications, collect a list of the websites you visit and search it without a warrant, and force your internet service provider to help them collect your data.

Even though this is highly comparable to the dark visions of the future offered by Black Mirror, no one cares. Though the Bill faced initial resistance when it was announced in 2015, it has passed through its readings relatively unscathed. Black Mirror should provide a prime opportunity to discuss issues around privacy, but people prefer to compare dystopias to things they already hate. Lord help us all if we take selfies or stare at a device which is simultaneously an encyclopaedia, a newspaper, a book, a map, a bank, a radio, a camera and a telephone for more than ten minutes.

Yet the Investigatory Powers Bill does hold many parallels to the last episode of Black Mirror series three, “Hated in the Nation”. In it, the government use autonomous drones shaped like bees to spy on its people, which are then hacked to murder hated public figures. “Ok! The government’s a c**t, we knew that already,” says DCI Karin Parke, moving on to the real issue – not that the government spies on its citizens, but that the spying device can be hacked by those naughty, naughty citizens themselves.

The hacker – Garrett Scholes – has programmed the bees to kill whoever gets the most votes on Twitter via the hashtag #DeathTo. Then, in a Jon-Ronson-worthy twist, he sets the bees on the people who used the hashtag in the first place. The actual, moral, wake-up-sheeple message of “Hated in the Nation”, then, is that we should be careful who we wish death upon on social media. But it is precisely this freedom that we should be protecting. Under the Investigatory Powers Bill, your emails and search history could be used to argue that you really want to kill Katie Hopkins, rather than were just blowing off steam.

Yet it’s hard to blame anyone for ignoring the Bill, which is off-putting not because it’s not an episode of Black Mirror, but because it is long and confusing. Breaking through the terminology is hard, even in the handy fact sheets provided, and the government can claim transparency while using alienating language and concepts.

“Some of the powers in the Bill are deeply intrusive, and with very little possible justification,” warned former MP Dr Julian Huppert last week, “the cost to all of our privacy is huge.” The good news is that you don’t have to worry about metal bees spying on you, and the bad news is that this is because the government will soon have permission to do it the easy way.


Now listen to a review of the new series of Black Mirror on the NS pop culture podcast, SRSLY:

Amelia Tait is a technology and digital culture writer at the New Statesman.