LONDON (Reuters Health) – Before Britain begins fortifying foods with folic acid as a way to prevent birth defects, the possible harmful effects of the scheme need to be carefully assessed, two physicians contend in the November 24th issue of the British Medical Journal.
The Department of Health recommended last year that flour be supplemented with folic acid as a means of reducing the incidence of neural tube defects. The move follows a similar programme implemented by the US in 1998.
But Dr. Brian Wharton from the Institute of Child Health at University College London and Dr. Ian Booth from the Institute of Child Health at University of Birmingham argue that the potential negative effects have not been properly assessed.
"We must consider the implications of exposing the general population to folic acid supplementation in the absence of a controlled trial," Dr. Booth told Reuters Health. "Although folic acid supplementation has been shown to be beneficial in the US, there have been no controlled trials of its effects in the general population there or in the UK."
In older people, taking folic acid can hide the symptoms of anaemia caused by vitamin B12 deficiency, Dr. Booth said. "If this anaemia is masked, the physician may not be alerted to the potentially irreversible neurological damage that may also result from B12 deficiency."
"Folic acid supplementation can also block the effects of antiepileptic drugs and the antifolate class of cancer drugs," he added.
The researcher also pointed out that England and Wales saw a 52% decline in birth defects affecting the nervous system during the 1990s, without any folic acid fortification. This is significantly higher than the 19% reduction in neural tube defects seen in the US following fortification.
Nearly 400 pregnancies were affected by central nervous system malformations in 1998, according to the authors. "Is it acceptable to increase folic acid intake of 50 million people to prevent a third to two-thirds of these affected pregnancies before there is firm evidence of efficacy and safety in people who are not pregnant?" they ask.
A spokesperson for the Department of Health noted that the folic acid project is handled jointly by the Department of Health and the Food Standards Agency (FSA), and that both departments are currently finishing extra work "particularly on the potential adverse effects of high folic acid intakes."
The results of that analysis, and the FSA's advice, will be considered before any action is taken, the spokesperson said.
BMJ 2001:323;1198-1199.
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