Spina Bifida affects 250,000 children every year. Iron deficiency impairs the development of 50% of the world’s children. Yet simply putting folic acid or iron in flour can slash the incidence of both problems. While some governments have acted, others hesitate. Chris Lyddon reports.
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“As a society we have a duty to do something,” Andrew Russell, executive director of the Association for Spina Bifida and Hydrocephalus (ASBAH), told just-food.com. Few other problems presented such simple answers. “There is a proven preventative effect for Spina Bifida and other neural tube defects which folic acid provides,” he said. “That is a very rare phenomenon. It’s not very often we find an almost universal vitamin deficiency which is leading to a disease.
ASBAH believes that governments should step in and insist that folic acid be added to flour, although there should be the chance to buy non-fortified if you insist. “The standard flour should be fortified,” he said.
Many women who are planning a pregnancy already take folic acid supplements, but it is not enough, he said. “Voluntary supplementation does not work. Half of all pregnancies are not planned.”
There were no valid safety reasons for stopping the fortification of flour with folic acid. “It is a completely safe substance,” he said. “There is no evidence anywhere in the world that you can overdose on folic acid.”
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By GlobalDataNot just for women
Folic acid is not just of interest to women of childbearing age. “It’s also important for heart and general cardiovascular health,” he said. “Especially for middle aged men.” Folic acid prevented the build up of homosysteine, raised levels of which clog arteries.
The arguments against were too weak to be taken seriously. A raised level of folic acid suppresses the symptoms of pernicious anaemia, but that was no excuse for the UK government’s failure to insist on flour fortification. “To our mind it is a complete cop-out to say you shouldn’t prevent 1,000 to 1,200 cases of spina bifida a year because there is an outside chance of a problem with pernicious anaemia,” he said. Folic acid did not create any extra problem with pernicious anaemia. “It just makes diagnosis a bit harder. To us it’s a complete reversal of sensible priorities.”
But while the British government refuses to make flour fortification compulsory, over 40 countries have brought it in, including the United States. “If people are looking for bad effects, at some point we’ve got to turn round and say we haven’t had any. The US has had a very big reduction in heart failures and strokes.”
Combating iron deficiency
Fortification with folic acid had been a big success in the US, William Dietz, director of the Centre for Disease Control’s Nutrition and Physical Activity Division, told a meeting in London in June called by the Flour Fortification Initiative.
“There’s no more important step in national development than addressing micronutrient deficiency and the critical factor there is flour fortification,” he said.
Pellagra or niacin deficiency had been widespread in the southwestern United States before World War Two. The introduction of flour fortification had triggered a sharp fall in cases. “This is a disease in the US that we rarely see today,” he said.
Flour fortification with folic acid had been made optional in the US in 1997 and mandatory in 1999, resulting in achieving a 30% fall in the incidence of neural tube defects.
Iron deficiency had a major impact on the IQ of children. It affected 50% of children worldwide and around 10% in the US. To fortify flour with iron meant adding 60 grammes of premix for a tonne. He put the cost of premix at US$8.75 a kilogramme or not much more than 50 cents a tonne.
UNICEF support; Turkey leading the way
Flour fortification has the support of UN children’s agency UNICEF. “There has been some remarkable and encouraging progress,” said UNICEF director of programmes Joe Judd. “We see fortification as one of the most important tools possible for the achievement of the UN’s development goals.”
One flour miller which has introduced fortification on its own initiative is Turkey’s Doruk (Doruk Una Deger Katma Gida San. Ve Tic A.S.). Board member Hakan Esen said Doruk had communicated directly with consumers, in cooperation with the bakeries, to make sure they understood what was going on. “We had to differentiate the product,” he said.
Doruk’s moves have attracted the attention of the Turkish government. Now the company is represented on a Turkish government committee on flour fortification. “We are hoping that fortification will become mandatory within a couple of months,” he said. Doruk has financed some of the government’s own research and development programme on fortification.
Australian, Indian industries keen to fortify
Andrew Lindberg, managing director of the Australian Wheat Board, said the deficiency problem had been recognised for over 60 years and flour fortification was a simple answer. “It’s safe, effective and cheap,” he said.
There were ways for the industry to resolve the cost issue. “The cost is significant,” he said. To make sure it did not create problems in the market, the supply chain had to work together to work out how it was to be carried. “We have found commercially sensible ways of sharing the cost,” he said.
Vinod Kapoor, chief executive of Kapoor Brothers Roller Flour Mills in India, felt that cost would make little real difference. “Cost is not a factor that will determine the industry not to fortify,” he said. “It is the mindset that needs to change.”
Jose Luis Fuente, president of the South American millers’ organisation ALIM, warned against expecting governments to pay for fortification. “If we think that the government is going to pay it’s a fallacy,” he said. “At the end it’s the consumer who will bear the cost.” To make fortification work consumers had to be persuaded that flour fortification was worth the expense for health reasons.
AWB’s Andrew Lindberg warned the industry to take the issue of flour fortification seriously. The risk was that governments would impose rules which were hard to apply and did not do the job. “Sometimes the legislation you get is not the legislation you want,” he said. The answer was to make sure the industry made the running. “We need to lead it, not lag it,” he said.
