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Failure to put folic acid in flour is a public health 'tragedy', say experts

Experts have said failure to fortify flour with folic acid to prevent neural tube defects (NTDs) in babies is 'more than a missed opportunity; it is a tragedy'. 

Experts have said failure to fortify flour with folic acid to prevent neural tube defects (NTDs) in babies is 'more than a missed opportunity; it is a tragedy'. 


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It was revealed that consuming 4mg of folic acid daily, immediately before and during the first trimester of pregnancy, prevented about 80% of NTD cases.

A call to discard the upper limit has come after a new study finds that the upper limit once set for intake of folate is invalid. The study revealed that the Institute of Medicine (IOM) based its upper limit of 1mg a day on studies carried out over a century ago.

The studies were carried out on individuals with B12 deficiency who had been wrongly treated with folic acid and claimed that neurological damage tended to occur more frequently in patients treated with higher doses of folic acid. The IOM concluded that treating individuals with vitamin B12 deficiency with higher doses of folic acid might lead to a greater risk of neurological damage. 

But a re-analysis of the data shows that there is no link between the dose of folic acid and the appearance of neurological symptoms, as claimed by the IOM. The nerve damage arose simply by not treating B12 deficiency with vitamin B12. 

Commenting on the paper, Professor Neena Modi, president of the Royal College of Paediatrics and Child Health, said: 'In the early stages of pregnancy when neural tube defects arise, many women do not know they are pregnant, others may be unaware of the importance of taking folic acid, or may forget, so fortification of flour, which is harmless if consumed by children and adults, is a logical answer to a problem which can have catastrophic consequences.'


Wald N, Morris JK, Blakemore C (2018) Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate. Public Health Reviews. doi: 10.1186/s40985-018-0079-6

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