By Dan Satherley
The debate over whether the Government should force bakers to supplement bread with folic acid is set to reignite.
New research out this week suggests the benefits for newborns extend beyond reducing neural tube defects like spina bifida.
On Tuesday, scientists in the US released the findings of a study which show since the introduction of mandatory fortification in the late 1990s, there has been a significant decline in childhood brain and kidney tumours.
They found the effect was even stronger in infants, increasing the likelihood that would-be mothers' increased consumption of folic acid is the cause.
The results of the study, which looked at rates of cancer in children over the last 25 years, were published in the journal Pediatrics.
Also this week, our Ministry for Primary Industries began taking submissions on the issue. One of the options it is considering is introducing mandatory folic acid fortification here at the end of September.
In 2007 the Labour government approved measures to introduce mandatory fortification in 2009, but the change of Government at the 2008 election saw the plan put on hold.
Then Food Safety Minister Kate Wilkinson said mandatory fortification was a "standard that was put upon us by the last government", and Prime Minister John Key said he was "not convinced" that adding folic acid to bread would bring any health benefits.
And if the Baking Industry Association of NZ (BIANZ) has its way, the status quo will remain.
BIANZ is one of several organisations that make up the Folic Acid Working Group, established in 2009 to come up with options on the future of fortification.
Vice-president of BIANZ, Michael Gray, told 3 News they're no longer against fortification, they just want consumers to have a choice.
"At the moment we're under a voluntary regime where there are people are offering ranges of products," says Mr Gray. "We want to continue doing that."
Many bakers offer fortified products already, and Mr Gray doesn't believe making it mandatory would make much difference.
"A lot of people these days avoid eating bread – on gluten-free diets, and so on – so therefore that whole group is being missed."
Folic acid is an artificial form of the naturally-occurring folate. Mr Gray says if people want extra folate, there are other ways to get it – eating leafy vegetables such as spinach, lettuce and asparagus, for example.
"It comes back to the old fluoride in the water situation… it comes down to that people don't want to be force-medicated."
Dr Andrew Marshall, clinical leader of paediatrics at Wellington Hospital and spokesperson for the Paediatric Society of NZ (PSNZ) rejects that mandatory fortification of bread would be forced medication.
"This is a natural vitamin," says Dr Marshall. "It's not a medication."
The PSNZ is strongly in favour of fortification. Dr Marshall says a study undertaken by Food Standards Australia New Zealand last year showed a doubling of blood folate levels in women of child-bearing age under the voluntary regime, but improvements were focused on the most educated and aware sectors of society.
"The only way that we'll reach the whole population is to do a public health initiative that is mandatory, therefore will reach all of the population," he says.
"Any targeted approach will only reach a percentage of the population, and often targeted approaches reach the most-educated, the most aware – but miss out on disadvantaged groups."
BENEFITS FOR UNPLANNED PREGNANCIES
One of the strongest arguments in favour of mandatory fortification is that would-be mothers often don't plan to get pregnant – or can't afford supplements.
In February New Zealand Doctor quoted Otago University micronutrients researcher, Dr Lisa Houghton, as saying mandatory fortification of bread would be an effective way to reduce inequality as low-income families tend to eat a lot of bread, because it is so cheap.
In the same article, New Zealand Doctor reported that half of all women in New Zealand don't plan their pregnancies, and only a third make an effort to up their folate intake.
Liz Tay, announcer for radio station Times FM, is almost four months pregnant. Three months before conceiving, she began taking folic acid supplements on the recommendation of her doctor, as she wasn't sure if she was getting enough in her regular diet.
"It was all Government subsidised," she says. "It was, you know, $4. When I ran out, I went to the chemist and got some more. When I got pregnant, I just got another prescription."
Ms Tay thinks mandatory fortification of bread is a good idea, as it's "probably better to have it than not to have it".
"If people aren't able to go to the chemist and get it or for whatever reason, then buying a $3 loaf of bread, if that can help, then why not? It's all for the benefit of babies at the end of the day, and it doesn't affect the mother in any way."
TOO MUCH FOLATE A BAD THING?
There have been concerns raised about potential side-effects of having too much folate, such as increased rates of prostate cancer in men, but Dr Marshall says they're overblown. He says studies on thousands of people in countries with mandatory fortification have shown no adverse health reactions.
"It's certainly at worst neutral, and at best it may actually be beneficial for the population."
In fact, Dr Marshall says that mandatory fortification would not be adding extra folate to our diet – it would just be replacing folate missing due to modern food manufacturing techniques.
"The folate that we're proposing to put into bread is actually folate that should be in our diet, and if our diets were more natural and less processed it would be there," he says.
"It's been stripped out through the manufacturing process of various foods, and so it's not right that we're medicating the population – we're just ensuring that a natural and normally occurring vitamin is present in our diets to the same degree it was present in our diets 50 or 60 years ago."
In 2009, the baking lobby argued would-be mothers would need to eat 11 pieces of fortified bread a day in order to get their recommended daily amount of folate. The PSNZ calls this "a distortion of the facts", saying this would be the case if women ate only bread, and nothing else.
BAKERS' CONCERNED OVER LOST SALES
It's been estimated in the US that the cost to the consumer of folic acid fortification is around 25 cents a year. BIANZ vice-president Mr Gray agrees that the added cost per loaf would be "negligible".
"The biggest cost is going to be the rollover and changeover – lots of people are going to have to dump lots of packaging because labelling would be incorrect, and it's also staff education, redeveloping your recipes, and those sorts of things."
He doesn't believe the cost will be what puts people off – it's the impression they're being medicated against their will.
"Like any change there's always going to be a cost, but at the end of the day our main standpoint is that we don't want to lose future bread sales because people are forgoing bread because they want to avoid eating folic acid."
RECENT EVIDENCE LACKING
Unfortunately, there is no hard evidence whether the increased folate levels recorded over the last three years in New Zealand has resulted in lowered rates of neural tube defects.
Dr Marshall says that due to change in the way data was collected, there is a gap in the records between 2008 and now.
"The Ministry of Health doesn't collect that data in a way that can be analysed," he says, "so we do have real issues in New Zealand in many areas of health where the data that's collected and captured isn't useful and isn't analysed."
Another roadblock Dr Marshall points to is that the data is collected by "the statutory body that supervises terminations of pregnancy, and as such it's very politically sensitive".
As a result, most of the research comes from places like Western Australia and Scandinavia.
FURTHER INFORMATION
Information on how to make a submission to the Ministry of Primary Industries is available on the Food Safety Authority website. Submissions are due by July 16.
A list of what breads are currently fortified with folic acid is available on the BIANZ website.
3 News
source: newshub archive
