Folate Friction
Ah yes, these would be the cancer concerns that every doctor and scientist (as opposed to journalist, baker and blogger) said were blown out of all proportion and were a major over-interpretation of some epidemiological data. But apparently, the government preferred to listen to the bakers, journalists and bloggers and folded their plans to add folate to bread. A classic case of political expediency overcoming common sense.
Folate has been added to bread in the US and Canada for more than a decade. Recent research has shown that there is good evidence that it does, indeed prevent neural tube defects (spina bifida and the like), virtually halving the rate. It is true that colorectal cancers suddenly climbed in the US and Canada at around the time folate was added to bread and then leveled off about two years later. As the addition of folate to bread in both countries coincided with a increase rate of colonoscopy due to a change in medical practice, not much inference can be drawn from this.
The study from Chile which caused all the excitement showed a 162% increase in the incidence of cancer of the colon (190% over the age of 65). Unfortunately, it used hospital discharge diagnoses, rather than direct cancer incidence statistics. Hospital discharge diagnoses are often dependent on funding (saying a colorectal adenoma – a common benign tumour – was a cancer would get them considerably more funding). Also increased discharge diagnoses may reflect differing treatment protocols. Patients with colon cancer may have been more regularly admitted for chemotherapy, or pain control in the later group.
All in all, the results from this study have not been borne out in other studies and interpretation of these results is problematic. Interestingly, Rats may get an increase in prostate cancer if treated with folate, But this has not been demonstrated to be statistically significant in humans. However, there is evidence that humans may actually prevent colon cancer with high doses of folate. Confused yet? I know I am.
The point is that the link between folate supplementation and any sort of cancer is dubious at best but the link between fortification and reduced neural tube defects is pretty solid. There is therefore no point in waiting for some politically arbitrary date to decide whether folate fortification of bread is worthwhile. It should be done as soon as possible.
And the bleating of bakers should be ignored…
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Oct 23 09 9:37 pm
And the bleating of bakers should be ignored…
As will be the bleating of statisticians who point out the way
politically motivated epidemiologists distort data in order to force people to be vitamized whether they want to be or not.
The most robust study of this shows benefits where the rate of neural tube defects is high to begin with and only small effects, probably statistically insignificant, where it is low already. The regional variation in the incidence of neural tube defects, which is quite large, is the real question and I suggest answering this would be the key to managing this problem on a population basis rather than the hail mary solution of more government interference in peoples lives whether they want it or not.
Confused yet? I know I am.
Why – it is obvious that a great many things may be beneficial for one aspect of human health and detrimental to another – our biochemistry is a compromise, is it not? And many dietary essentials are toxic in large doses e.g. selenium springs to mind immediately.
To throw another curveball each individuals biochemistry is unique so what may benefit individual a may be harmful to individual b. I am of the opinion that for the most part we tend to choose foods which suit our personal biochemistry by instinct and for the vast majority this works out ok, well at least until advanced age when the depredations of life catch up with you.
I am surprised that the mass medication of entire populations isn’t an anathema to you MacD, its using a sledgehammer to crack a walnut with unknown consequences.
At the end of the day plumbers have done more for human health and welfare than any doctors with their faddish dietary ideas or “public health” nannies and busybodies.
Oct 23 09 10:46 pm
Andrei: I am surprised that the mass medication of entire populations isn’t an anathema to you MacD
Mass medication I have no time for. As you correctly point out, everyone is unique and responds to medication differently.
However, what is proposed is merely the reintroduction of a small amount of a vitamin into a product (bread) that has been deliberately denuded of all nutritional value. I cannot see how this can be anything other than good.
Of course, if the Bakers had been really clever, as opposed to merely cunning, they would already be marketing a fortified bread line especially aimed at women of childbearing age…
Oct 24 09 7:43 am
“what is proposed is merely the reintroduction of a small amount of a vitamin into a product (bread) that has been deliberately denuded of all nutritional value.”
Does that mean that there’s naturally folate in bread but the bakers take it out?
There are foods that naturally have good concentrations of folate in them, so I don’t see that the issue of whether we use the states power to change peoples diet in this instance is different to using it to change peoples diet in other instances.
Oct 24 09 9:55 am
Indeed yes – some bright spark might get the idea of fortifying bread with Tryptophan which if the epidemiological research is to be believed might lead to a more contented a relaxed population with a reduction in depression and better sleep patterns for all.
And as a gedankenexperiment imagine some epidemiological research shows feeding adolescent boys high dosages of some vitamin or other reduced the likelihood of them developing prostate cancer in later life. D’ya reckon the concept of fortifying bread with said vitamin would fly? As for me – I doubt very strongly that it would.
Oct 24 09 12:47 pm
Andrei: some bright spark might get the idea of fortifying bread with Tryptophan
Either you are a bit paranoid, or I’m not paranoid enough!
I point out that folate is vitamin that is deficient in most people diets – Tryptophan most certainly is not. Proper wholemeal bread (not the weird stuff that they throw some seeds into) is rich in folate. All that is being done here is a partial reversal of a manufacturing process (removing the wheatgerm from flour)