Monday, 13 July 2009

Quick hit: Folic acid in bread - maybe not?

From the Herald this morning:
Food Safety Minister Kate Wilkinson says she will seek a review of the use of folic acid in bread - but not until a month after bakers have started adding it.

Folic acid prevents some birth defects, and the idea of putting it in bread is so women who do not know they are pregnant get the protection. Ms Wilkinson has criticised the decision to use the additive from September, which was part of a joint New Zealand-Australia food standard. However, she says that since the Labour Government signed up to it she has no option but to let the implementation go ahead.

Click through for the rest of the article.

I have to say I'm personally a bit concerned about this idea of putting folic acid in bread, as it seems a lot like mass medication of pretty much everyone to get to a tiny portion of the population in what may be an ineffective manner. What do you think?


Trouble said...

So is fluoridation of water. So is iodine in salt. Both have contributed heavily to improved health of people who would otherwise have problems accessing vital nutrients - that means people who don't know they need them, or people who can't afford to provide them.

I know these days it's fashionable to worry about additives and the like, but I can't reconcile that position with any sort of genuinely left-wing feminism. This benefits poor women - those who don't know they can get a cheap folate supplement from the chemist and can't face shelling out $80 for a course of Elevit, and those who get unexpectedly pregnant - about 50% of pregnancies, I think I heard. And it doesn't cost anyone anything else, except the bakers, who have access to the kind of PR that can whip up alarmism, unlike the people this policy will benefit.

moz said...

I'm with Trouble above.

Part of the price of living in a safer society is putting up with this sort of "nanny-state nonsense"<tm>. Wear your seatbelt, stop hitting your kids, get immunised, license your gun, tie up your dog... it's all part of living in a country where you don't get polio, shot, crippled, whatever. And it's a price I'm happy to pay.

Now, if folate was as toxic as the alarmists try to imply I'd be a little concerned. Instead I worry about the mental state of the alarmists...

Anonymous said...

I'm not thrilled about it, particularly because from what I understand the actual dosage in the bread is so low that a pregnant woman would have to eat around 11 slices to get any benefit (I need to check that). So it's mass medication for very little benefit - what's the point?

A Nonny Moose said...

Moz: One of the guys in my office said "What about the guys who have healthy levels of folic acid in their bodies? It's going to KILL THEM!" I know he was half joking, but it's alarmist BS like that from men that just don't/won't understand that grates.

I'm undecided - if it was healthy levels, then good oh. But if you have to get 10+ slices a day (greater than the average RDI) it sounds like an imbalance in diet.

Is there a generic alternative to Elevit? ie: behind the counter non-brand name folic supplement.

Why not create a line of folic supplemented bread? Or is that getting into the haves/have nots argument again (because of price)? Well hey, there's lite/calcium enriched/kids/boy milk - what's the difference?

Alison said...

@ A Nonny Moose

Yes, there is a generic version. A doctor or midwife can prescribe it for close to nothing.

I'm not sure where the 400 microgram recommendation they quote in the article comes from. The amount commonly prescribed here is, I believe, 800mcg daily. It's 400mcg in the US because they already have folate-fortified bread. Supplementation is by no means sufficient to achieve the RDI, but it's better than nothing; it's worth considering that Neural Tube Defects have a range of severity, so a little folic acid may lesson the severity if not completely solve the problem.

Trouble said...

Nonny - the RDI for pregnancy is lots higher than the RDI for everyone - 800mcg rather than 400 mcg. And if you're "at risk" of neural tube defects, they'll put you on a much higher dose of folate - over 1000mcg. The levels of folate at which studies thought there may be an increased cancer risk is higher again. The tolerable upper limit of supplemental folate consumption is 1000mcg for adults, so that's way more than 11 pieces of bread a day.

It's hard to get enough folate in your average diet - they don't say eat lots of leafy veges if you want to get pregnant, because it won't be enough. They say to supplement. Fortified bread won't get you into supplementing territories, but it will get you closer to them, which is better than nothing. And there is plenty of evidence to say that there are benefits for the rest of the population in higher folate consumption - lower levels of some kinds of cancer, stroke, mental agility, maybe heart disease. Unfortunately for Paul Holmes, the cite for the prostate cancer claim on Wikipedia doesn't work.

Yep, APO-Folate is a cheaper equivalent to Elevit - under $15 for a three month supply. But it's not marketed as "the only proven way to prevent neural tube defects". You have to know to ask for it. The difference between that and Elevit is that Elevit also has iron and a few other minerals in it, and charges $70 or so more for the privilege.

M-H said...

I'm with Trouble and moz. It won't harm anyone, and it will help some women.

A Nonny moose said...

I meant the RDI of slices of bread :) the food pyramid sez 6 per day.

Interesting to know there is a generic. $15 for 3 months - that's 3-4 loaves of bread.

I've become a big fan of asking for generic medication instead of branded, since we discovered generic branded anti-histamine. Thanks Fair Go :)

Julie said...

Thanks for all the feedback, very helpful!

I think one of the key points about putting folic acid into bread is that the time when the increased folic acid intake is most beneficial is often before a woman even knows she is pregnant (and indeed increased intake is recommended prior to conception, when you are planning to get pregnant). So my reading was that this measure is not so much about getting to the women who decide not to take folic acid (for whatever reason, and I acknowledge that prohibitive price and not knowing about it are not "choices"). It's more aimed at the unexpected/unknown pregnancies at that crucial early stage when the neural tubes are forming, right? Which makes me more kindly disposed to it.

I guess I just feel quite uneasy that giving everyone more folate might cause unforeseen negative stuff down the track. Maybe I just need to get over that and see the greater good ;-) Thanks Trouble for sharing some of the possible wider benefits of increased folate intake, I didn't know about that!

Trouble said...

Crikey, if anyone needed any extra persuasion, I've just seen a photo of a meningomyelocele. Not something anyone would want to risk, for their child or anyone else's.

What winds me up about this is the way it's been framed. The evidence of harm is scant to non-existent, and what there is, relates to very high doses ( Yet the bakers argue that it's not justified because it's not enough to make a difference. They've tapped into the ZOMG nanny state is making us eat our greens vibe (see the outright misogyny in the Kiwiblog thread on the issue) at the same time as the greeny keep medicine out of our foods one. Sue Kedgely is saying 1: we need our food sovereignty and 2: we should consider what countries like Ireland are doing. Consistency?

It's a complete public relations fail on the part of common sense and evidence, just because bakers don't want the extra expense of adding folate.

Anita said...

I'm less positive about adding folic acide to bread (or fluoride to water) because it's being done in a way which makes it extremely difficult to avoid. This isn't folic-acid-by-default-but-opt-out-if-you-like, this is folic-acid-for-all (yes, I know organic bread won't be fortified, but organic bread is hard to access and expensive).

Part of my discomfort is that, as some with somewhat fragile health, being able to control my medications, supplements etc is important to me – both as a part of keeping me well, and as a sign of my self-determination rather than being controlled by the medical establishment.

Secondly, nutritionism bothers me. If a lack of leafy green vegetables in many NZers diets is leading to birth defects and other ill health then we should encourage people to eat more leafy green vegetables, not break a whole food down into technocrat controlled chemical components completely disconnected from food.

I write this, of course, as someone with entirely adequate dietary folate levels and no likelihood of pregnancy.

AWicken said...

folic acid apparently has cardiovascular health benefits, at least according to a quick internet search. And the cancer issue seems to be pretty weak both ways at this stage.

Personally, I think it's nice that someone has to add a vitamin to the food they mass-produce, rather than just suger or corn/palm oil.

And it's no surprise to me that the National Party is siding with industry against the health of the citizenry, but that's just a general sideswipe from a socialist.

Trouble said...

Here's a thought - given that there are 14 babies born with neural tube defects every year, and that the Coalition of Parents of Children with Spina Bifida thinks that number represents about half of pregnancies where NTDs are diagnosed, why aren't the the so-called pro-lifers on the case? With those numbers it would have to be a pretty common reason for post 20 week terminations.

In fact, it's one of the few areas in which I'd have common ground with a pro-life stance, and where they could make a useful contribution to reducing suffering in the world. Unless of course the whole shtick is about punishing people for having sex...

pleitch said...

I disagree with adding these things for a number of reasons.

Firstly, if they are doing it for health reasons then they should make other things that harm people illegal first. How our society puts up with the burden on smokers is beyond me. There is no benefit to smoking, not to the smoker and definitely not to everyone else.

Actually... I'm against the government outlawing things that harm us too - because if that is taken to it's logical conclusion the "big killers" such as cars, fast food and workplaces would be made illegal.

But my point is that their premise is flawed.

Secondly any medical treatment must pass a double blind trial to determine efficacy (does it work) and side-effects (does it harm). No prescribed drug can be sold without one of these tests. But these tests have not been done on the items we are mass-medicating with. That leaves people arguing over how harmful or helpful they are because nobody has "double blind" rigorous information.

I don't think that these additives are harmful, but that's just what I think, there is no double-blind test to determine that beyond reasonable doubt.

Finally I simply don't believe it is the role of a government to mass-medicate their citizens in a way that they have very little real choice to avoid the medication. This is an ideological position.