Fortified Flour

Steve Brine Excerpts

Wednesday 16th May 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Thank you, Mr Hanson. Should that be the miller, Steve Brine? I like the notion from the shadow Minister that the European Union is waiting for us to lead. That is a new concept.

It is a pleasure to serve under your chairmanship for the first time, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing the debate and I thank him for devoting it to an issue that I know he cares about. He works closely with Shine, which he mentioned and which was mentioned by others, and is based in his constituency. It does some fantastic work supporting people with spina bifida and anencephaly and their families. I have asked my officials to see if Shine will come in and see me as soon as possible. It is not a charity that I know, so I want to speak to and get to know its staff.

I hope I can reassure hon. Members a little bit—I suspect it will not be a lot—that the Government and those who provide us with expert independent advice are looking incredibly closely at all of this, as I will set out. I will say at the outset that I am sorry to disappoint the shadow Minister, but I cannot give the House an exclusive announcement today, I am afraid. However, I may be able to give some encouragement.

Part of the pregnancy advice currently provided to women is of course to take folic acid supplements. The consequences of folate deficiency in the general population are that pregnant women are at greater risk of giving birth to low birth-weight, premature babies with neural tube defects. Unless someone is pregnant or is thinking of having a baby, they should be able to get all the folate they need by eating a generally varied and balanced diet. Women who are trying to conceive, or who are likely to become pregnant, are advised to take a daily supplement of, we say, 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods such as spinach and broccoli, which sounds lovely, and foods that are voluntarily fortified with folic acid such as, as has been said, a wide range of breakfast cereals.

As has been said by pretty much every Member who has spoken, around half of pregnancies are unplanned. Of those that are planned, it has been estimated that only half of all mothers take folic acid supplements or modify their diet to increase their folate intake. That is one of the main reasons behind the calls for mandatory fortification and is one of the reasons why the debate was called.

UK wheat flour is currently fortified with calcium, iron, niacin and thiamine in accordance with the Bread and Flour Regulations 1998—introduced under the last Labour Government—which apply in England, Scotland and Wales, with parallel regulations in Northern Ireland. This mandatory fortification is a domestic, not an EU, requirement and is done for public health reasons. It has the primary objective of restoring those nutrients lost during the milling process, with the exception of calcium, which is added in larger amounts than that lost.

To date, successive Governments have not considered that the mandatory fortification of flour with folic acid is the best way of protecting public health and have instead promoted the use of supplements as part of a wide range of pre and post-conception advice to women of childbearing age. That may be merely stating the obvious of where we have come from, but it does not necessarily need to mean where we are headed.

While it may appear straightforward to just add folic acid to the existing mandatory flour fortification measures, a problem that arises with the proposal to move from the current advice of taking a measured supplement is of how to ensure that women are able to assess their folate intake if getting it from foods made from flour instead. Women in the targeted age group may not eat the relevant products in sufficient quantities.

We also want to consider the population’s wider dietary advice, and to educate women to encourage them to achieve a greater folate intake by way of eating those folate-rich vegetables that I mentioned earlier, rather than relying on flour-containing foods, which may not be the best contributor to a balanced diet. It will be necessary to consider properly women’s consumption of all wheat flour-containing products to fully understand the impact of any mandatory fortification on diet and folate intake levels. Additionally, we are aware that the universal fortification of flour with folic acid may not be readily accepted by the general public, especially when the measure is intended to benefit only a specific section of the population.

The aforementioned Scientific Advisory Committee on Nutrition—SACN; it was indeed called COMA—is a committee of independent experts on nutrition that provides advice to Public Health England, for which I have ministerial responsibility, and other Government agencies and Departments across the UK. It has recently updated the evidence on folic acid in response to a request from Food Standards Scotland, which was prompted by Scottish Ministers expressing a desire to proceed unilaterally with the mandatory folic acid fortification of flour north of the border.

In its most recent July 2017 report, SACN saw no reason to change its previous recommendations, made in 2006 and 2009, for mandatory folic acid fortification, to improve the folate status of women most at risk of NTD-affected pregnancies, provided that this is accompanied by restrictions on voluntary dietary fortification with folic acid. Again, this emphasises the need to fully understand all the sources of folate intake by women, to ensure that their health is protected as well as to protect their unborn children. The Wald paper, which is a new scientific paper published on 31 January this year in Public Health Reviews, has again raised this issue. However, the paper suggests that there should be no upper limit on folate intake, which would remove some of SACN’s concerns.

The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—COT—is another independent scientific committee that provides advice to the Government on, among other things, the safe upper levels for vitamins and minerals. The Wald paper was brought to the attention of COT by its chairman, and COT agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT discussed a scoping paper in March this year and will have its first detailed discussion in July to see whether Wald’s analysis of the data is correct and whether the original tolerable upper level recommendation is not appropriate. COT will then receive a second paper in September considering all of that and is hoping to be able to report its findings towards the end of this year.

I wanted to put that on the record because it is the advice I have been given, but I have to say that, frankly, I am the Minister, and that is not good enough for me. I want it sooner than that, so I have asked COT to come and see me by the end of this month to explain itself and to see whether we can move forward more quickly.

To conclude, I am moved by the testimonies given today. The right hon. Member for Belfast North (Nigel Dodds) is a gentleman and an excellent parliamentarian, and his speech about his son, Andrew, cannot have been an easy one to make. I thank him for putting those personal things on the record in the way he did. There are many issues to consider, but I wholeheartedly agree with the sentiment of the debate. I will do my utmost as the public health Minister, working with other colleagues across Government—this impacts on other Departments as well—to work through the issues to give the best effect to the aim of the debate as soon as we possibly can.