Q: Why do we need to artificially add folate to bread or flour?
A: Folate is an important dietary vitamin that is esential for healthy growth and development and for normal metabolism. Increased folate intake is especially important for women at least one month before and during the first three months of pregnancy to help prevent birth serious defects like spina bifida.
A baby's growth is most rapid in the first weeks of life - often before you even know you are pregnant, so increasing your intake of folate before you become pregnant is especially important for the health of your baby.
Folate is found naturally in green leafy vegetables, oranges, baked beans and cooked lentils. Experts recommend that women who are planning pregnancies or could possibly fall pregnant, should consume extra folic acid in the form of supplements or fortified food at a level of 400 micrograms (µg) of folate each day.
Most people eat bread and this is the best way to ensure that women who may become pregnant consume a little more folate to reduce their risk of having a baby affected by a neural tube defect such as spina bifida.
Q: Wouldn't it be easier to encourage women to take folate once they know they're pregnant?
A: No. It is important to take folate for at least a month before a baby is conceived to have the best chance of having a healthy baby. Around half of all pregnancies are unplanned and by the time women know they are pregnant it is too late to receive the benefit of folate. Mandatory fortification is a very simple way of helping women increase their folate intake, even before they plan to become pregnant -- although they will still be encouraged to take supplements.
Q: Why do we need mandatory rather than voluntary fortification with folate?
A: Voluntary fortification has been tried, but wasn't as effective as hoped. Scientific studies show that increased folate should reduce neural tube defects (NTDs) by around 70%. Unfortunately, education programs and voluntary fortification have resulted in only a 30% reduction.
Mandatory fortification will mean better protection for everyone, particularly vulnerable groups including the young, people in remote communities with less access to fresh fruit and vegetables, and those with unplanned pregnancies (that's about 40% of all pregnancies).
When mandatory fortification is combined with voluntary fortified products and supplement use, we expect that the reduction in the number of babies conceived with NTDs will be 49 per year in Australia and could be up to 84.
And it's important to remember that folate has been scientifically proven to bring other health benefits including a reduction in the risk of certain cancers and improved cardiovascular health.
Q: What's the point of fortification if women still need to take supplements?
A: Mandatory fortification will help ensure access and equity to folate fortified products for all women, especially those who are less well off, unaware of the benefits of folate or have an unplanned pregnancy.
An example of the need for greater equity is in our indigenous communities where the rate of NTDs in Aboriginal babies is twice as high as in non-indigenous babies, and the gap is widening.
Q: Wouldn't it be better if the fortification levels were higher?
A: Yes, however this is a great start and higher levels would be beneficial but it is important to be careful to evaluate compliance and effectiveness before moving to higher levels.
Q: Why should everyone get extra folate if this measure is aimed at women of child-bearing age?
A: The most obvious benefit is the decreased cost to the health system of having fewer babies born with NTDs. The cost saving is estimated at $120-150 million each year, ongoing. Evidence from many studies also demonstrates a lower risk of stroke, cardiovascular disease and colorectal cancers associated with higher folate consumption.
Q: Can you overdose on folate?
A: Folate is very safe and we are talking about fortification with very small amounts of the vitamin. There are no known toxic effects of eating too much folate. However, The National Health and Medical Research Council has recommended an upper limit of 1mg/day. This is much more than anyone will get from eating fortified bread.
Q: What risks are there from fortification with folate?
A: The evidence has been reviewed by FSANZ's scientific advisory board which found there is minimal or no risk.
Q: Does mandatory fortification with folate happen anywhere else?
A: Mandatory fortification has already been introduced in over forty countries, including Canada, the United States, Indonesia, and a number of African and South American countries including Chile. In these countries, the most common food fortified with folic acid is wheat flour.
A number of other countries are currently considering mandating folic acid fortification of flour, and include the United Kingdom and Ireland. Studies in the US have shown significant health and economic benefits, and no adverse consequences.
Q: Is there mandatory fortification of any other element into Australia's food?
A: Yes. Bread is already fortified with thiamine in Australia and Vitamin D is also added to margarine and oil spreads in Australia. FSANZ is also evaluating the option of mandating fortification of food with iodine at this time.
Q: How many birth defects could be prevented by mandatory fortification?
A: Food Standards Australia New Zealand has suggested that 49 and as many as 84 neural tube birth defects will be prevented in Australia from the introduction of mandatory fortification at the current level.
Q: Will this make basic food like bread more expensive to buy?
A: After initial set up costs for producers, ongoing folic acid fortification will cost just a fraction of a cent for each loaf. In contrast, the cost savings to the health system is estimated at $120-150 million each year, not to mention a reduction in the heartache and challenges that accompanies babies born with such serious disabilities.