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5 April, 2006

Big Mother says...

Folic acid apparently reduces the risk of birth defects if pregnant women take it as a dietary supplement.  Hence, the Food Standards Agency (FSA) proposes making it a compulsory ingredient of all white bread flour used in the UK.

It may mask cobalamin (vitamin B12) deficiency, and hence put the elderly at risk, but that doesn't seem to be considered so important. Likewise, there's an (unsubstantiated) possibility that folic acid may be carcinogenic, but that doesn't appear to matter either, as the FSA has come up with a high-profile way of being seen to be Doing Something about foetal neural tube defects. And that's what matters - being seen to be acting.

Apparently, 500-600 babies are born with neural tube defects each year in the UK, and it's almost certain that if pregnant women (or those planning to become pregnant) were to take 400 µg of folic acid per day, there would be a positive effect; perhaps a halving of the statistics.
However, up to 10% of the over-65 population have borderline B12 levels, which could become deficiency, and anaemia. I don't know the absolute numbers, but it's safe to assume that'd affect more than 600 people. In extreme cases, it could cause permanent nerve damage to the spine – mirroring precisely the problem that it's supposed to prevent in babies. Personally, I don't regard babies as so overwhelmingly important as to make the elderly expendable.
That's not counting the vast majority of people who are simply unaffected by the core purpose: the non-pregnant, including the male near-50% of us who, by definition, can't give birth.

All this seems to be an excellent reason to publicise and promote the use of folic acid supplements, in the form of tablets/capsules, for those who need them, and, as importantly, consciously choose to take them, but it's a ludicrous justification for medicating the entire population.

The article does mention that folic acid may also be advantageous to those at risk of cardiovascular disease, so there may be a wider benefit, but again, that's a reason to promote use of supplements by individuals, not to engage in compulsory mass-medication.

I don't like the cliché 'nanny state', but for once I do think it's applicable.

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