Fortifying our bread: a heavy handed approach!

On September the 13, 2009, it became mandatory for millers to add folic acid to bread flour in all Australian states and territories.

This implementation, which was developed by Food Standards Australia New Zealand, has received very little attention in the public sphere. Research has shown that the risk of a baby born with a neural tube defect, such as spina bifida, reduces by up to 70 per cent when the intake of folate is increased one month before and three months after conception. Adding folic acid to bread is regarded as the best way to raise the levels of folate in pregnant women.

Folate is a B group vitamin that is needed for human growth and development and is found naturally in green leafy vegetables along with many other foods, such as salmon and oranges.

The human brain and spinal cord develop from a neural plate which folds and closes to form a tube. Failure of this plate to close results in a neural tube defect, one of which is spina bifida. Neural tube defects (NTDs) are formed in the first 21 days after conception. According to the Spina Bifida Foundation of Victoria, 30-35 Victorian babies are identified annually with spina bifida and of those between seven and 15 survive. There are around 5,000 Australian people with the disabling condition with a further 50 to 60 being born each year.

People with spina bifida have varying degrees of permanent disability including paralysis or weakness in the legs, bowel and bladder incontinence, hydrocephalus and specific learning difficulties. However, many are able to lead full, active and independent lives.

While Australia has commenced its mandatory bread fortification, New Zealand has deferred its implementation due to consumer concern that extra folate in the form of folic acid may lead to more cancers especially of the breast ,colon and prostate.

Australian nutritionist Dr Rosemary Stanton queries the efficacy of the new regulation. Stanton calls it “a second best solution”. Bread was chosen, she explained “because most people eat a couple of slices a day”. “But the problem is that the amount of folic acid in the bread will not be enough to make up for the women who don’t eat enough green veggies so they will still need to take a supplement” said Stanton.

On average 100 grams of bread or around three slices will only provide about 120 micrograms of folic acid when the recommended dose is 400 micrograms each day.

Stanton is not alone in her criticism and is joined by Professor Leonie Segal, a member of Kevin Rudd's National Preventative Health Taskforce who recently told The Australian, that mandatory fortification of bread with folic acid risked turning food into pharmacotherapy, when simpler solutions existed. Stanton has sympathy with this opinion and jokingly adds that she has always had difficulty with the notion that nature depended on humans inventing vitamin factories for our survival. “Ultimately what we should be doing is getting people to eat more vegetables”.

The New Zealand Bakers’ Association is one of the groups who are opposing the adoption of the new food standard. The Association is concerned that the distribution of folic acid cannot be evenly spread among their products. There are also murmurs from certain flour millers in Australia who are concerned about the process of adding folic acid to their flour and think that they could be putting their customers at risk and are intending to abstain from the directive.

Death was the most likely outcome for babies born with spina bifida until the 1950s, when shunts to treat the life-threatening condition hydrocephalus, or “water on the brain”, were first invented. Life saving surgery, diagnostic tools such as CT scanners and new antibiotics and appropriate treatment for bladder problems are just some of the huge improvements from the days when such babies were institutionalised and left to die.

According to The International Federation for Spina Bifida and Hydrocephalus public acceptance of prenatal testing and termination for babies with neural tube defects has resulted in more than 90 per cent of such fetuses being aborted in western countries.

Concerns about cancer and the perplexities of folic acid administration, along with the fact that the numbers of babies born with this disability are in fact diminishing, should cause us to wonder why this all encompassing public policy has been adopted at all.