Katherine Rich gives her considered opinion in the Herald today on the subject of the supplementation of folate in bread. Ms. Rich at least addresses other issues than “Nanny state” concerns, citing the possible link between folate and prostate cancer and the unknowns involved in over-supplementing children.
Folate fortification has been going on for a decade in the US and Canada. They not only fortify bread, but pasta, cereals and rice as well. A recent study in the New England Journal of Medicine shows that supplementation in Canada has significantly reduced the incidence of devastating neural defects like spina bifida. Clearly supplementation works.
The Journal Of the American Medical association published a study in 2007 that indicated that folate did not reduce the number of pre-cancerous polyps formed in the colon. There was a significant increase in the incidence of prostate cancer noted in the study. But the study was not designed for prostate cancer and the increase has not bee demonstrated elsewhere. Certainly, the US and Canada has not reported an increase in Prostate cancers.
An epidemiological (raw data from the population and hospital statistics, rather than a clinical trial) study in Chile showed an increase in the incidence of colon cancer since the fortification of flour with folate, but this was a poor study and it would be unwise to take alarm at this. The US reports a decline in colon cancer over the past decade (actually over the past 40 years, with no change in the rate of decline since supplementation). The weight of evidence makes colon cancer a very unlikely consequence of folate supplements. Apparently, the Irish government is conducting a more definitive study, but these results will not be available until the end of the year.
Besides the colon cancer pseudo-scare, the New Zealand Food Safety Authority makes this peculiar observation:
“In rather alarming advice, the minister at the time was told by NZFSA: “There are unknown risks that may not become apparent for one or two generations. Children will be exposed to much higher levels of folic acid than in previous generations. It may not be until this generation of children have their own children that adverse effects become apparent.””
Now there is absolutely no evidence that this may be the case. There is no rational basis for supposing that even an overdosage of folate would cause such intergenerational harm. This is pure scaremongering. Folate supplementation has been used for decades in children with sickle cell anaemia with no significant problems and no strange intergenerational effects.
I consider both of these medical objections to be unconvincing, to say the least. I am left with the impression that the real reason for wanting to delay the fortification of flour is this:
“Practical problems have also arisen since New Zealand committed to the food standard two years ago. Bread companies have conducted clinical dosage trials and concluded that dosing the bread accurately every time within the tolerance levels will be impossible.”
The word impossible here means impossible without new, expensive equipment, of course. The US and Canada have been managing reasonably standardised levels for years. Clearly it is possible to achieve this, but the bread companies are reluctant to part with the capital investment. I have some sympathy for this problem, but let us debate the merits of folate fortification without the spurious resorting to medical scare tactics.