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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Meet the evangelical Christian persuading believers that climate change is real

Katharine Hayhoe's Canadian missionary parents told her science and God were compatible. Then she moved to Texas. 

During Donald Trump’s presidential campaign, alarm rose with each mention of climate change. Denial, dismissal and repeated chants of “hoax” left no doubt as to his position.

Now President Trump’s withdrawal from the Paris Agreement has been seen as a seminal moment in the fight against climate change - one which many fear could lose the battle ahead of humanity.

But one scientist has been fighting a war of her own on the ground, against those who typically doubt the facts about global warming more than most - the evangelical Christian population of America.

And to make matters even more unusual, Katharine Hayhoe herself is an evangelical Christian who lives in the indisputably "bible belt" of Lubbock, Texas.

The atmospheric scientist has been named one of Time magazine's 100 most influential people and one of Politico’s 50 thinkers transforming American politics. Now she is using her considerable heft to speak to those who are hardest to convince that there is a manmade problem that threatens the Earth’s future.

I meet her at the science and music festival Starmus in Trondheim, Norway, where she is to address the attendees on Thursday in a talk entitled "Climate Change: Facts and Fictions".

Hayhoe was born in Canada, to missionary parents. Her father, a former science educator, showed her that there was no conflict between the ideas of God and science. However, it was something of a surprise to her when she discovered her pastor husband, whom she married in 2000, did not feel the same about climate change. It took her two years to convince him.

What started as a conversation became an organised project when she moved to America's South in the mid 2000s. 

“Moving to Lubbock was a culture shock," she tells me. "When I moved there I wasn’t doing much outreach, but it moved me in that direction.

“Lubbock is very conservative. It’s small and isolated.

“I would say the majority of people in Lubbock are either dismissive or doubtful about climate change. I was surrounded by people - neighbours, parents of friends, people at church, colleagues down the hall in the university - who weren’t convinced.”

So Hayhoe, who works as an associate professor and director of the Climate Science Centre at Texas Tech University, set to work. She began to collect the responses she was seeing to the climate change discussion and prepare her counter-argument.

“When I talk to people who are doubtful, I try to connect with the values they already have," she says. “The greatest myth is the myth of complacency - that ‘it doesn’t really matter to me’.

"But I would say that the second most insidious myth is that you only care about this issue if you’re a certain type of person. If you’re a green person, or a liberal person, or a granola person."

The stereotypes mean that people outside that demographic feel "I can't be that kind of person because that's not who I am", as she puts it.

Hayhoe convinced her husband using data, but rather than repeating a formula, she tries to find out what will resonate with different people: "For many groups, faith is a core value that people share.”

Whether she’s speaking to city planners, water company managers, school kids or Bible believers, Hayhoe says her hook is not the facts, but the feelings.

“I recently talked to arborists," she says. "For them, trees and plants are important, so I connect with them on that, and say ‘because we care about trees, or because we care about water or what the Bible says then let me share with you from the heart why I can about these issues because it affects something that you already care about’.

“My angle is to show people that they don’t need to be a different person at all - exactly who they already are is the kind of person who can care about climate change.”

Hayhoe came to public attention in the United States after appearing in a Showtime series on climate change. She has appeared on panels with Barack Obama and Leonardo DiCaprio, and launched a web series. As well as plaudits, this level of fame has also earned her daily threats and online abuse. 

“My critics think they’re coming from a position of religion, but they aren’t," she says. "They’re actually coming from a very specific political ideology which believes that the government should not have control over people’s lives in any way shape or form - very libertarian, free market, free economy, Tea Party."

She believes that in the United States, faith and politics has been conflated to the point "people can no longer tell the difference". 

“Now it’s conservatism that informs religion," she elaborates. "If the two are in conflict - like the Bible says God has given us responsibility over everything on this earth - then people say ‘oh, we can’t affect something as big as this Earth, God will take care of it anyway’."

Around half of those who attack her on social media identify themselves as Christians, she notes, but almost all call themselves conservatives. 

As a scientist, she’s been preparing data herself - naturally - on her online attackers, with depressingly familiar results.

“As soon as you stick your head out of the trench, you get it. There have been papers published showing that white men disproportionately form up that small group of dismissives. They’re almost all men. When I track my social media comments, I would say that 99.5 per cent of them are white men.

“Out of 1,000 negative comments, I have maybe five from women.”

After the climate change argument moved up a gear - following the Paris withdrawal - Hayhoe admits that she and her fellow scientists are concerned, although she pays tribute to the businesses, cities and states from the US that have committed to following the Paris agreement themselves.

On the subject of the chief white male denier, Trump himself, Hayhoe says she has a discussion point which she feels may convince him to think carefully about his role in the fight against global warming’s impact on humanity.

“I would attempt to connect with the values that he has and show him how acting on this would be in his best interests," she says.

“One guess would be ‘what do you want your legacy to be? What do you want to be known as, the man who destroyed the world, or the man who saved it?’”

Katharine Hayhoe is speaking at Starmus on Thursday June 22. For more details, visit Starmus.

Kirstie McCrum is a freelance journalist. Follow her @kirstiemccrum.

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