SCOTLAND could “go it alone” and legislate to put folic acid in flour to reduce birth defects even if the rest of the UK decided against the move, experts have said.
The Food Standard Agency (FSA) board meeting in London heard that Scotland had the legal powers to enforce the mandatory fortification of food with folic acid.
The supplement is recommended for women before and during pregnancy to reduce the risk of problems such as spina bifida.
But because many do not take it, either because their pregnancy is unplanned or they do not know about it, many experts have called for folic acid to be included in foods such as bread and flour. This has already happened in countries including Australia and South Africa.
In 2007 the FSA recommended the mandatory fortification of bread or flour with folic acid to reduce neural tube defects (NTDs) which affect around 700 births a year in the UK.
Last year the Scottish Government asked the FSA to provide further advice on the action needed in relation to fortification in Scotland.
As a result the meeting heard that ministers should be advised that the previous recommendation about the benefits of mandatory fortification remained valid in Scotland.
Their report also said that if agreement could not be reached with other parts of the UK, Scotland had the legal competence to require fortification of flour made in the UK and sold in Scotland.
‘Strong evidence of benefits’
Elspeth MacDonald, head of policy and operations at FSA, said: “There is strong evidence that consuming higher intakes of folic acid before becoming pregnant and in the first 12 weeks of pregnancy reduces the risk of neural tube defects.
“But targeted health messages to this effect have been unsuccessful in raising folic acid intakes and reducing NTDs.
“Fortifying bread or flour increases folic acid intake in women who might otherwise have low intakes.”
Some have raised concerns about the impact of folic acid fortification on other parts of the population, including the possibility it may mask vitamin B12 deficiency in some patients.
But board members said the evidence was still weighed in favour of the benefits of reducing NTDs as opposed to the possible risks.
Board member Etta Campbell said the best way forward would be for a UK-wide approach on fortification. Other parts of the UK are currently considering their position and awaiting more research on folate levels in the population.
But Ms Campbell urged ministers in Scotland and Northern Ireland not to hesitate too long.
“if there is no willingness for a UK-wide approach then we should head forward together to tackle this issue,” she said.
A Scottish Government spokesman said: “The convincing evidence of the benefits of adding folic acid to flour to help reduce causes of spina bifida and other neural tube defects means this is an issue needing careful consideration.
“The Minister for Public Health has requested further advice from Food Standards Agency in Scotland (FSAS) on this issue. We will look closely at this advice before making any decisions on how to progress.”