An example of a fortification debate - folic acid fortification in the UK

Although the fortification of foods can be a very effective way to help a population to achieve optimum nutrient intakes, this must be balanced with concerns about excessive intakes of the nutrient in question and any safety issues this may raise. In addition, some consumers may feel that fortifying foods equates to ‘mass medication’, as they are not given a choice as to whether the additional nutrients are consumed or not. The debate around mandatory fortification of flour with folic acid in the UK, which is currently still ongoing, is outlined below as an example.

In 2000, the UK’s Advisory Committee on Medical Aspects of Food and Nutrition Policy, COMA, recommended mandatory folic acid fortification of flour at the concentration of 240micrograms per 100g flour to prevent neural-tube defects (NTD) in babies. However in 2002, the Board of the UK’s Food Standards Agency decided against such action. A primary concern was the possibility of masking vitamin B12 deficiency anaemia in older people, a condition known to increase in prevalence with age, and to affect about 127 per 1000,000 people in the general UK population. Folic acid prevents megalobastic anaemia, an early symptom of vitamin B12 deficiency, and hence potentially delays diagnosis of the neurological complications that can arise in B12 deficiency.

The Food Standards Agency Scientific Advisory Committee on Nutrition (SACN, COMA’s successor) published a report on folate and disease prevention in December 2006, and the FSA launched a consultation on options for improving the folate intake in the population. These were:

Option 1 – Continue with the current policy of advice to women (folic acid supplementation in pregnancy)
Option 2 – Increase the effort to encourage young women to take folic acid supplements (folic acid a synthetic form of the vitamin folate, used in supplements and as a food fortificant) and changes to diet to increase the consumption of folate-rich foods
Option 3 – Encourage industry to fortify more foods with folic acid on a voluntary basis
Option 4 – Recommend the mandatory fortification of bread or flour with folic acid

Following the consultation in May 2007, the FSA board recommended the mandatory fortification of bread and flour with folic acid. However, new research published at about that time raised concerns that folic acid might affect the risk of some kinds of cancer. As a result, SACN was asked to consider this new evidence and to advise whether their original recommendation was still appropriate. The outcome of this process is expected shortly.


Last reviewed July 2009. Modified February 2016. Next review due June 2013.