By PROFESSOR DAVID SMITH
'Fortifying all flour with folic acid is potentially a national health disaster'
Flour could soon be fortified with folic acid to reduce the number of babies born with spina bifida. But here, a pharmacologist and leading authority on folic acid claims many adults could die as a result: Fortifying all flour with folic acid is potentially a national health disaster. Folic acid is the synthetic version of the B vitamin folate. But although it's vital for health, it has a dark side.
Giving extra amounts to everyone in the country ? whether they need it or not ? could lead to more than 3,000 new cases of colon cancer, a rise in prostate cancer and put as many as 150,000 elderly people at risk of anaemia and memory problems.
There is no question that folic acid is important. Pregnant women who don't get enough of it run the serious risk of their baby being born with spina bifida, a horrible condition which means that the spine hasn't closed up properly so that part of the spinal cord is exposed, leaving the child disabled for life and possibly in need of constant care.
The problem is that at present, only about 50 per cent of pregnant women get enough folic acid. Putting it in flour ? as the Food Standards Agency (FSA) is recommending ? is a fairly cheap and easy way of making sure at the start of a pregnancy that all women have adequate levels.
In America, they have been fortifying flour with folic acid since 1996 and the incidence of spina bifida has dropped by more than 20 per cent. In the UK, it's claimed the same move could prevent up to 160 spina bifida pregnancies a year.
A fortification programme might have other benefits, too. Folic acid can protect you against cancer because your cells need it to repair the daily damage to their DNA, damage that can otherwise lead to the disease.
Folic acid is also needed to reduce levels of a substance called homocysteine in your blood (high levels of homocysteine raise your risk of heart disease and strokes). Extra folic acid may cut the number of strokes by 18 per cent, according to research just published in The Lancet. Certainly, deaths from stroke in America have fallen since fortification of flour.
And there's yet another benefit.
My research suggests that keeping down homocysteine may also be a way of cutting your risk of developing Alzheimer's, and I'm currently running a trial in Oxford, giving extra folic acid to elderly people to try to prove it.
So fortification seems to make a lot of sense. Following a favourable report by the FSA earlier this year, the Government is now considering legislating to force food manufacturers to fortify all flour except wholemeal, which is being excluded to give people a choice.
But while I was once a passionate advocate of folic acid, I am now passionate about alerting people to the potential harm it can cause and about the importance of research to discover who will gain from it and who should not take too much.
The more we learn about folic acid, the more it's clear that giving it to everyone has very real risks.
Nearly all medicines involve a balancing act. If you're not getting enough folic acid (good sources include wholewheat, liver, eggs, beans, fruits and leafy green vegetables) then a boost from your daily bread intake could help.
But if your levels are already adequate, then the extra could be damaging. And that's why fortification is such a bad idea. It's like using a shotgun in a crowded place; bystanders are going to get hurt.
While folic acid can protect you against cancer, once a tumour has already started growing, it can switch sides. Cancer cells are greedy for folic acid; it helps them to keep reproducing.
Knowing that, now consider the fact that 20 per cent of middleaged people have pre-cancerous cells in their colon and that most middle-aged men have them in their prostate, too. Forcing them to eat something that is likely to encourage those cells to grow suddenly doesn't seem such a bright idea.
Indeed, when we look at what has happened in the U.S. and Canada, it seems positively reckless.
According to a study just published, fortifying flour over there has been followed by an extra five people in 100,000 developing colon cancer annually. That may not sound a lot but the same rate of increase in the UK would mean an extra 3,000 cases.
In fact, the rate might be higher since the FSA recommends that we fortify flour with more than twice the American amount.
But extra cancer cases won't be the only fall-out. Folic acid performs another of its Jekyll and Hyde routines with the elderly.
Ten per cent of them have low levels of another B vitamin ? B12. This makes them more likely to develop anaemia (not enough red blood cells). They also become confused and their memory gets worse.
Giving them extra folic acid can hide the blood symptoms of low B12, making it likely their deficiency will be missed. The combination of high folic acid and low B12 may also make those mental problems worse. Scaling down from American figures, we can predict that 150,000 elderly people could have more memory problems as a result of fortification of flour in the UK.
And there is one more problem fortification is likely to cause. A whole class of drugs are designed to block folic acid because it makes conditions such as cancer, rheumatoid arthritis and psoriasis worse.
Forcing extra amounts of folic acid on everyone suffering from these conditions might affect their health It is only in the past few years that the dangers of folic acid fortification have become clear. If the Americans had known in 1996 what we know now, they would never have introduced it.
So it is highly irresponsible for the UK Government to even be thinking about it. More research is needed to identify those who might be harmed by extra folic acid and to assess the balance between benefit and harm.
Fortification sets up a grim equation. We have 800 new cases of spina bifida each year, but there are 30,000 new cases of colon cancer and 30,000 of prostate cancer.
Currently, 500,000 suffer from rheumatoid arthritis and 900,000 from psoriasis.
Half a million people, some of whom might be harmed, would be exposed to extra folic acid for every spina bifida baby saved. It's not worth it.
Instead of this cruel equation, we need to be much more sophisticated.
We need to be a lot more proactive about getting folic acid to those who do need it ? it should be freely available to all women of child-bearing age, for instance ? and do a much better job of warning those who could be harmed against it.
Monitoring older people to see who has too little and who needs B12 could make a huge difference to the quality of life of our elderly population.
Just adding folic acid to flour is far too crude. It may seem like a cheap option to gain some health benefits but it could end up costing thousands of people dear.
If it happens, my family will be sticking to wholemeal bread.
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