Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the remarks by Baroness Merron on 11 September (HL Deb col 1562) that they propose that 250 micrograms of folic acid per 100 grams should be added to non-wholemeal wheat flour, what scientific advice they have received on the maximum volume of folic acid per 100 grams that could be added to non-wholemeal wheat flour without damaging the health of patients who are advised not to take folic acid.

Pregnant women with folate deficiency are at greater risk of neural tube defects (NTDs). Currently government advice recommends that women who could become pregnant take a daily supplement of folic acid before conception and up until the 12th week of pregnancy. However, we know that around 50% of pregnancies in the UK are unplanned. Government is therefore looking at this UK-wide measure to mandate the fortification of flour with folic acid to reduce the number of NTDs in pregnancies as a priority.

The Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) have considered the proposed level of fortification in depth.

The proposed policy is to fortify non-wholemeal wheat flour at 250 micrograms per 100 grams. Fortification above this level would allow for greater reductions in NTD risk but would increase the risk of people exceeding the recommended upper level of folic acid intake.

An upper limit of 1 milligram per day was set in the UK by the UK Expert Group on Vitamins and Minerals in 2003, which was later reviewed and agreed by COT in 2018. In 2006 and 2009, SACN concluded that it was also necessary to minimise exposure to high intakes of folic acid because there was still uncertainties regarding folic acid and cancer risk at high intakes.

The UK Government and devolved governments addressed concerns on the interaction of folic acid with treatments and medications for different conditions, such as cancer and epilepsy, in the consultation on the policy proposal in 2021. In addition, information on the presence of folic acid will be included on the ingredients list on product labels to inform consumers. In 2023, COT published a risk assessment of the potential risks of allergic reaction (hypersensitivity) to folic acid if flour is fortified with folic acid at 250 micrograms per 100 grams.

There is agreement from both SACN and COT that the proposed levels of fortification are appropriate and provide a balanced approach to fortification.

The level of folic acid fortification will be kept under review as part of the monitoring and evaluation of the policy, which would assess both positive and postulated negative impacts.