The end of the COVID-19 pandemic left a hole in the lives of two groups of people. The first are those who loved the pandemic because it allowed them to flaunt their hypochondria. They have largely disappeared but they can occasionally be spotted, fully masked up, sounding the alarm about things like monkeypox. The second are those who loved the pandemic because it allowed imbeciles to masquerade as contrarians. They graduated to taking photographs of contrails in the sky, but nothing could quite recapture the thrill of talking with ill-deserved confidence about Gompertz curves, spike proteins and false positives.
But now they’ve found a new target for their rage: vitamin B9, otherwise known as folic acid. It has been known for decades that consumption of folic acid at the start of a pregnancy prevents spina bifida, a neural tube defect that often condemns children to a life in a wheelchair. From December, most of the flour sold in Britain will be fortified with folic acid by law at a level of 250ug (micrograms) per 100g.
Around sixty countries already do this. The USA and Canada have been doing it for nearly thirty years. And it works. Chile saw rates of neural tube defects fall by 47 per cent after it added folic acid to flour. In Newfoundland, Canada, where rates were unusually high before fortification, the rate fell by 78 per cent. Nothing else produces this kind of result. Advising women to take folic acid if they are planning to get pregnant has not reduced rates in Britain (or Europe), partly because half of pregnancies are unplanned and many women are not aware that they are pregnant for the first 28 days when folic acid is needed for the spinal cord to close properly.
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In 2006, the Scientific Advisory Committee on Nutrition (SACN) found that working age women had an average daily intake of folic acid of 292ug, which was above the recommended minimum of 200ug but not enough to prevent neural tube defects. The idea of fortification is to lift the average by around 200ug which would not only reduce the prevalence of spina bifida but practically eradicate folic acid deficiencies which are no fun either. Consuming too little folic acid prevents you from making red blood cells and repairing DNA, leading to fatigue, shortness of breath, diarrhoea and ulcers. SACN found that 23 per cent of Britons were not consuming enough folic acid and the problem seems to have got worse since. By contrast, the USA has seen its rate of folic acid deficiency fall from 16 per cent to 0.5 per cent since flour fortification began.
Copying a policy that has been introduced safely and successfully in dozens of the other countries and which is backed by a huge amount of scientific evidence shouldn’t be too controversial and yet an increasingly deranged campaign against it has been bubbling away on the fringes of the internet since the summer. A petition calling on the government to “stop the fortification of flour with synthetic folic acid” has now attracted over 100,000 signatures, meaning that it can be considered for a parliamentary debate. The petition was set up by Clare Craig, a pathologist who rose to social media prominence during the pandemic, notably for her claim that there were “no excess deaths” at the peak of the second wave in 2020/21 and her later insistence that the Covid vaccines, which she says didn’t work, were responsible for a great many deaths. Last year she co-authored a study — currently unpublished — which strongly implies that folic acid causes autism. She knows her audience, I’ll give her that.
Restore leader Rupert Lowe, who is more intelligent than his supporters but can’t afford to let them know that, has twice tweeted his support for the petition, saying: “Food should be as natural as possible… People should be able to buy ordinary bread without having unnecessary products forced in by the state.” He seems unaware that Britain has been fortifying bread since 1941 when a law to add calcium carbonate to flour took effect, followed in 1956 by iron, thiamin and niacin. The last two are better known as vitamin B1 and vitamin B2 respectively, and are both “synthetic”. It is not obvious why the addition of “synthetic” vitamin B9 to this little list should cause such outrage, nor why the inclusion of the other “chemicals” attracts so little. According to the petition, it is because it is “unethical to mass medicate the entire population without their knowledge or consent in the hope that a minority group of people might see a benefit.”
It is tempting to observe that those who are most concerned about “mass medication” would most benefit from some actual medication. Vitamin B9 occurs naturally in wheatgerm. There would be more of it in refined flour if the milling process didn’t inadvertently remove so much. Vitamins, synthetic or otherwise, are not drugs and putting a vitamin back into a product is not medication. It is perfectly natural to consume folic acid. Indeed, the continued existence of neural tube defects suggests that many people are consuming less of it than nature intended.
We should, of course, demand a very high threshold of proof before we use the law to add or remove anything from the food supply. Government failure is more dangerous than market failure because the government holds a monopoly on force. But far from taking a reckless step into the unknown, the British government has been extraordinarily cautious on folic acid fortification. It is twenty years since SACN recommended it and thirty years since the first country introduced it. Although SACN found no convincing evidence that folic acid causes cancer, heart disease or any other disease, one potential unintended consequence led the government to wait for further research.
The issue was this. People who have a vitamin B12 deficiency can have their anaemia corrected by taking high doses of folic acid, but this only masks a symptom and risks delaying treatment of a potentially serious and debilitating disease. This is the only proven risk from high consumption of folic acid and it is the sole reason why, in 2000, the European Scientific Committee on Food set a “Tolerable Upper Limit” of 1,000ug a day. The limit is extremely conservative. Most of the evidence that folic acid masks anaemia comes from case-reports of people who were taking at least 5,000ug a day in the late 1940s and early 1950s. Below this level, only a handful of cases have ever been documented. Erring heavily on the side of caution, the agency used an “uncertainty factor of 5”, taking the observed adverse effect level of 5,000ug and dividing it by five to create a Tolerable Upper Limit of 1,000ug.
Having accepted this as the safe upper limit, the question turned on whether fortification would push people who have a vitamin B12 deficiency over it. SACN found that 55,000 adults consumed more than 1,000ug of folic acid a day, including 900 pensioners who had low levels of vitamin B12. SACN estimated that fortifying flour at its preferred level of 300ug of folic acid per 100g would increase average daily folic acid intake from 302ug to 474ug, reduce the number of people with vitamin B9 deficiency from 13.2 million to 1.5 million and reduce the number of neural tube defect pregnancies by between 126 and 285 per year, but also lead to 220,000 people exceeding the 1,000ug threshold, of whom 3,300 would be pensioners with low vitamin B12 levels. However, SACN claimed that the latter figure would be reduced to zero if the mandatory fortification system replaced voluntary efforts by the food industry to fortify breakfast cereals, butter and margarine.
Twenty years later, the British government has decided to proceed on the basis that voluntary fortification will continue, but its chosen level of 250ug per 100g is lower than that recommended by SACN and wholemeal flour will be exempt. It may have been reassured by evidence from the USA showing no increase in cases of vitamin B12 deficiency in the absence of anaemia after folic acid fortification took place. Reasonable people can disagree about whether the government’s policy will have a negative impact on elderly people who are at risk of vitamin B12 deficiency, but that is the only question about folic acid fortification that remains remotely open. Since the SACN report was published, a comprehensive meta-analysis of randomised controlled trials has found no evidence of folic acid supplements causing any form of cancer. A similar meta-analysis found no evidence of increased risk of cardiovascular disease although it did find a slight reduction in risk for stroke.
None of this counts for anything in Clown World where the “free thinkers” have not only been fantasying about how many flour-based products they would have to eat for them to “overdose” on folic acid, but have decided that folic acid is dangerous in any quantity. To this end, they have latched on to an NHS webpage which lists a few groups of people for whom folic acid tablets “may not be suitable” (my emphasis), including people who have cancer and people who have coronary stents. The specific concerns of the NHS are about the ways in which folic acid affects certain forms of chemotherapy, which can be positive or negative, and the possibility that folate therapy narrows the stented artery, the evidence for which is equivocal. Although the NHS explicitly states that its webpage is “about folic acid taken as a medicine or supplement and does not cover folic acid that has been added to food”, the thickest people on the internet have interpreted it as meaning that a slice of bread will soon be a mortal threat to cancer patients.
If the “nanny state” was always as benign as this, no one would have a problem with it
Social contagions tend to snowball and so it is no surprise that, after layering ignorance upon ignorance, the most gullible of the hypochondriacs now seek to kick folic acid out of their lives entirely. The kind of people who are soiling themselves about this “medication” are exactly the kind of people who buy health supplements, especially if they are advertised by Alex Jones on InfoWars. One of the most amusing aspects of the current panic has been watching them howl about “synthetic” vitamin B9 being in their multi-vitamin pills. Others have been sending indignant messages to Waitrose and Marks & Spencers demanding to know how folic acid got into their wholemeal bread and green beans. Vitamin B9 is naturally abundant in many foods, including sprouts, broccoli, parsnips, spinach and liver. Although the crazies insist that “synthetic” folic acid is fundamentally different from — and, in some unexplained way, much more dangerous than — natural folates, scientists often used the terms “vitamin B9”, “folic acid” and “folates” interchangeably. The term “folic acid” is generally used by the food industry on packaging, much to the anger of people who had never heard of it until last week but who are now convinced that it is killing them.
Some people say that we should be opposed to the government interfering in the food supply on principle. Perhaps, but what exactly is the principle and how far are you prepared to take it? If there were any downside to topping up vitamin B9 in flour, we would be entitled to revolt, but regardless of what the nutters claim, it is only a vitamin. It isn’t toxic. If you consume too much of it, which you could only do by taking supplements, you will pee it out. It doesn’t taste of anything. If the government hadn’t told you it was happening, you never would have noticed. The cost to industry is negligible and the health benefits are real. If the “nanny state” was always as benign as this, no one would have a problem with it.