Consumer NZ supports putting folic acid in non-organic bread-making flour - saying it "balances consumer choice" with reducing devastating birth defects.

The non-profit also wants an education campaign to make sure women know they must also take folic acid supplements before conception and in early pregnancy.

• Read the full investigation into New Zealand's folic acid debate and legacy by clicking here

The Government is again considering making it mandatory for non-organic bread or bread-making flour to be fortified with folic acid, after plans for the public health initiative were dropped in 2009 following opposition, including from the food industry.

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New modelling has estimated up to 171 pregnancies affected by a neural tube defect could have been prevented in the past 10 years had mandatory fortification of bread went ahead.

Consumer NZ has opposed mandatory fortification in the past, and is still wary of adding folic acid at the breadmaking process, including because of the costs put on thousands of bakers.

However, the organisation has now submitted in favour of fortifying all non-organic wheat flour for bread-making - an option favoured by Food Safety Minister Damien O'Connor, and a less complicated step because of the small number of millers.

"We believe this option balances consumer choice (organic wheat bread and non-wheat varieties will be available) with reducing neural tube defects [NTDs]," Consumer NZ's submission explained.

"We consider products using fortified flour should include this information in the ingredients list. We would also support small 'boutique' manufacturers being able to apply for an exemption.

"If mandatory fortification proceeds, we are concerned that women in the target group will think that fortification will provide enough folate to prevent NTDs. Education campaigns must be clear that supplementation will still be needed to reach recommended levels."

A Herald investigation has confirmed other groups concerned about mandatory fortification in the past now support it, including the Green Party and Dieticians NZ.

Food Safety Minister Damien O'Connor wants mandatory fortification progressed. Bay of Plenty Times Photograph by John Borren
Food Safety Minister Damien O'Connor wants mandatory fortification progressed. Bay of Plenty Times Photograph by John Borren

The neural tube is the part of an embryo that becomes the brain and spinal cord. Defects including spina bifida happen when a portion doesn't close properly, which affects about 64 pregnancies in New Zealand every year. Such pregnancies are often terminated, and children born can face severe disability.

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Adequate folate, a natural B vitamin found in foods such as leafy green vegetables, can considerably reduce, although not eliminate, the risk of neural tube defects, but it's very difficult to get enough from diet alone.

Women should therefore take tablets of folic acid - a synthetic form of folate - at least four weeks before conception and for the first 12 weeks of pregnancy. However, more than half of pregnancies aren't planned, and the neural tube closes 15-28 days after conception.

Countries that have made it compulsory for folic acid to be added to staple foods include the United States (in cereal grains since 1998), Canada (in flour and bread since 1998) and Australia (bread-making flour from 2009). Defect rates have fallen in those countries.

The Ministry for Primary Industries (MPI) last year called for feedback on options including mandatory fortification. The work has been paused because of the Covid-19 whole-of-government response, but O'Connor has said he remains committed to progressing it.

Under the current voluntary system about 38 per cent of packaged bread has folic acid.

The Food & Grocery Council, which represents food manufacturers, wants that system to continue in the interim, while more consideration is given to emerging evidence of possible health risks.

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It says those risks include over-consumption of folic acid including by children, whether an elderly person with high folate but low vitamin B12 levels could have faster cognitive decline and what unmetabolised folic acid might do to the nervous system.

Mandatory fortification is backed by groups including Spina Bifida NZ. Families spoken to by the Herald on Sunday were also supportive, including Davina Maddox, whose son David had anencephaly, a fatal neural tube defect.

"Babies aren't always planned," she said. "If it can prevent one family from experiencing [anencephaly], why not? No one deserves to go through that."

The Perinatal and Maternal Mortality Review Committee, experts tasked by the government with monitoring deaths of babies and mothers, again called for mandatory fortification in its latest annual report, noting the leading cause of baby death is congenital abnormalities.

"Until bread and flour fortification is implemented, and as an interim measure, folic acid should be provided free. This is not a suitable long-term measure. Fifty per cent of pregnancies are unplanned; therefore, this method is less effective than fortification of bread and flour," the committee recommended.

Overall, MPI has estimated that mandatory fortification of bread or bread-making flour could reduce neural tube defects by 10-20 per cent, compared to current voluntary fortification.

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