From Sunday 13 September bread-making flour in Australia must have folic acid, a form of the B vitamin folate, added to it to reduce the risk of babies being born with birth defects such as spina bifida. This means most bread in Australia will contain added folic acid. Flour represented as ‘organic’ is exempt from mandatory fortification.

In Australia, approximately 300 to 350 pregnancies are affected each year by a neural tube defect like spina bifida. With spina bifida, the spinal column does not close properly and the baby is born with exposed nerves and damaged vertebrae. The effects are permanent. The folic acid mandatory fortification standard was developed by FSANZ at the request of the Australia and New Zealand Food Regulation Ministerial Council that consists of health and food ministers from the Australian Federal, State and Territory Governments.

It is still recommended that women who are pregnant, or considering becoming pregnant, should take a folic acid supplement at least one month before and three months after conception to reduce the risk of birth defects.

Further information on food fortification is available here

Feel free to use these quotes in your stories. If you would like to speak to an expert, please don’t hesitate to contact us on (08) 8207 7415 or by email.

Professor Fiona Stanley is Director of the Telethon Institute for Child Health Research, Perth. Along with Carol Bower, Fiona produced the key study which showed that dietary intake of folate in early pregnancy protects against the occurrence of isolated neural-tube defects in infants.

“Mandatory fortification will save hundreds of Australian families every year going through the heartbreak of a termination or birth of a baby with a severe disability.

It is a B group vitamin naturally found in fresh fruit and leafy green vegetables and plays a crucial role in healthy cell growth.

While the primary role of fortification is to ensure healthy pregnancies, there is growing evidence about the broader benefits of folate such as its impact in reducing some cancers and heart disease.”

Professor Andrew Copp is from the Institute of Child Health, London. He was on sabbatical at the Children’s Medical Research Institute (CMRI) in Sydney from June - August, 2009.

“Making folate in bread compulsory is a step in the right direction. There is strong evidence that folic acid prevents the formation of spina bifida if taken during the third and fourth weeks of pregnancy, which is when the spinal cord forms. As this is very early in the pregnancy and is the time when most women are waiting for their pregnancy to be confirmed, folic acid is usually not taken until too late.

For folic acid to be effective in preventing spina bifida, it needs to be taken when the individual is planning her pregnancy - which very few people do. In the UK, where folate supplementation is voluntary, very little reduction in spina bifida frequency has been noted. However in countries such as the US and Canada, where folate fortification of bread flour is mandatory, the number of cases has lessened.

The initial study that demonstrated the effectiveness of folic acid was a clinical trial closely monitored by doctors. There is a large step between undertaking such a trial in a controlled environment and rolling it out within a large population, which is why education and voluntary supplementation were first trialled. However, the key finding from this was that the effectiveness of folic acid will only work on a population basis if it is made mandatory, so this is the logical next step.”

Dr Murray Skeaff is Professor of Human Nutrition at the University of Otago, New Zealand

“Earlier this year I attended a conference in Prague at which the results of an as-yet unpublished pooled analysis of all the randomised control trials of folic acid to date were revealed. This analysis, conducted by the Clinical Trials Service Unit at Oxford in the UK, combines the results from around 35,000 individuals who participated in studies of high dosage folic acid supplementation in countries around the world. Most of these trials looked at folic acid and B vitamins and the prevention of cardiovascular disease.

“The results showed that the risk of cancer in those taking B-vitamins was not different from those who were not taking the vitamins. In other words, folic acid did not change cancer risk.”

“They looked at whether men and women in the trials had different risks of cancer from folic acid. They looked at whether people who had low or high folate status at the beginning of the trials had different risks of cancer from folic acid. In each case, they found that folic acid and B vitamins had no effect on cancer risk.

“The results showed no evidence of increased risk for prostate cancer, and they showed no evidence of increased risk for colorectal cancer, which are the two forms of cancer for which some much smaller studies had previously suggested an increased risk.

“These trials included in the pooled analysis used high dosage folic acid, ranging from 800 micrograms to about 5000 micrograms a day. To put this in context, the fortification of bread in Australia will provide women, who are the target group, an extra 120 micrograms per day.

“The pooled analysis involves studies mainly done in Europe and North America, from the mid 1990s to the present, and they’ve looked at the results and specifically at whether the results differed among countries with folic acid fortification schemes in place, and there was no difference.

“This pooled analysis looks at the totality of the scientific evidence from clinical trials. It’s state of the art - the highest quality of analysis that there is. It is the best evidence we have so far, and it shows that there is no increase in cancer risk with high dose folic acid.

“We can be confident on the basis of these trials that concern about cancer risk with mandatory folic acid fortification is unwarranted and unsubstantiated.”