Folate is an essential natural B vitamin found in green leafy vegetables, citrus fruits, wholemeal bread, liver, and legumes. Folic acid is the synthetic form which is taken as a supplement usually in the form of a pill.
Many countries, including the New Zealand Ministry of Health, recommend that women take the recommended dose of folic acid supplements before and during early pregnancy. This has proven to reduce the risk of babies developing birth defects such as neural tube defects like Spina Bifida.
To increase folate intake among women, many countries have made it mandatory to fortify staple foods with folic acid. This has been shown to reduce the rates of neural tube defects, in some cases substantially.
New Zealand currently relies on industry-led voluntary fortification of bread.
In April 2017, the Ministry of Health commissioned Sir Peter Gluckman, at that time the prime minister’s chief science advisor (PMCSA) and the Royal Society Te Apārangi to review the health benefits and risks of folic acid fortification of food. The report written is over 140 pages and reviews the scientific evidence from New Zealand and internationally on the health benefits and risks of folic acid fortification, particularly in relation to food fortification and consumption of higher-dose supplements.
The report concludes that:
- Mandatory fortification of folic acid is unequivocally associated with lower rates of neural tube defects.
- Taking folic acid supplements at the recommended doses in pregnancy has no adverse effects on pregnancy outcome or the child’s health.
- There is no evidence that folic acid supplements increase the risk of neurological/cognitive decline, diabetes, or cardiovascular disease, or that unmetabolized folic acid that remains within the body’s circulation is harmful.
- There is no strong evidence of adverse effects on risks of some common cancers, or total cancers. This is an ongoing area of research which should be monitored.
Based on an overall assessment of the evidence, and considering the need to ensure health equity including Māori receive benefit, the Expert Panel concludes that the benefits of mandatory fortification of packaged bread with folic acid outweigh any potential adverse effects.
In addition, the Panel strongly encourages the continued use of folic acid supplements by pregnant women as recommended by their healthcare professionals, and encourages all women of childbearing age to ensure that their folate intakes are adequate.
The full report is available on the Office of the Prime Minister’s Chief Science Advisor website:
Summary written by Alison Pask, ANA, August 2018