Home Health Folic acid in the flour: that’s what Britain decided. Against spina bifida

Folic acid in the flour: that’s what Britain decided. Against spina bifida

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The British government has given the green light to flours fortified with folic acid to reduce the cases of children with congenital defects of the neural tube, spina bifida the first of all. The English one will be a so-called mandatory fortification, in practice folic acid or vitamin B9 will be added by law to non-whole grain flours, and not on a voluntary basis by the manufacturers.

It is not the first country in the world, Great Britain, to make this decision. Just under 90 nations – ours, as well as the others in the EU, is not among them – already add folic acid to flours by default, so to speak. And with obvious results, it seems: when for example Canada introduced mandatory fortification in the late 1990s, neural tube defects, or dtn, in children halved. And when the same choice was made in Australia, they fell by 14%.

Pregnant and a little unprepared

fabio di todaro


What we are talking about: the numbers of spina bifida and Dtn

In Italy the dtn concern 6 births per 10 thousand, in 50% of cases it is spina bifida which consists in the failure to close the spinal column: the spinal canal remains open, it does not close as it should, causing a more or less chronic condition disabling depending on the severity.

In addition to spina bifida, other neural tube defects “are anencephaly, that is the total or partial lack of the skull and brain, and encephalocele, that is the leakage of part of the brain and meninges due to incomplete welding of the bones. The risk factors are different: they range from the state of health of the mother (for example malabsorption, uncontrolled diabetes), to genetic predisposition, to the continuous intake of certain drugs (some antiepileptics), to exposure to environmental contaminants .

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The Italian Spina Bifida Registry, which gathers 9 clinical centers for a total of 170 patients, is to date unique in Europe, operating thanks to RegistRARE, the national web platform developed by the National Center for Rare Diseases “, he explains. Sunday Taruscio, director of the National Center for Rare Diseases of the Higher Institute of Health.

Now, there is no doubt about the importance of taking folic acid in pregnancy, starting one month before conception and for the following 12 weeks, and there has not been for several decades: supplement the diet with 400 micrograms (or 0.4 milligrams) of folic acid per day is very important since in doing so the risk of giving birth to a child with a neural tube defect is reduced by up to 70%. But for the general population, might there not be a risk of overdosing associated with mandatory fortification policies? Because folic acid is useful for everyone, of course: it is essential for the synthesis of proteins and DNA, as well as for the formation of hemoglobin, in the right quantities it also helps to prevent cardiovascular risks. However, it was also feared that over-intake of B9 could mask vitamin B12 deficiencies or even increase the risk of colon cancer.

No cancer risk …

“The first to introduce mandatory fortification was the United States in 1998 as a real public health strategy of primary prevention and today there are just under 90 countries around the world that have adopted the same policy. Now, it is Great Britain to having given the green light in our continent to the obligation to add folic acid to non-whole wheat flour on the basis of studies that have shown too little folic acid intake before and during pregnancy “, Taruscio continues.

Here, but how are things with us, and why did we make a different choice? “In fact, even on the Italian market you can already find fortified foods to which folic acid has been added during the production process: breakfast cereals, biscuits, rusks, fruit juices, yogurt, products for early childhood. various countries of the European Union, including Italy, the intake of folic acid is recommended and therefore we are talking about supplementation and not fortification, accompanied by a correct lifestyle (weight control, blood sugar and other risk factors) and by a balanced diet, rich in fruit and vegetables “.

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… but caution

So we supplement but do not necessarily strengthen. “Exactly – resumes Taruscio – Sticking to the indicated quantities is important, because an excess of vitamins, which can occur for example if you consume fortified foods together with the intake of multivitamin complexes, could mask a vitamin B12 deficiency, as has been seen. in the USA. While regarding the hypothesis of an increased risk of developing malignant tumors in people with high levels of folate in the blood, it must be said that a meta-analysis conducted on 50,000 people did not show any increase (or decrease) in these Therefore, in the face of still limited data and still conflicting evidence in the literature regarding the risk of over-intake, especially in some population groups, in particular the elderly and children, the Italian Network for the Promotion of Folic Acid for the Primary Prevention of Congenital Defects, coordinated from the National Center for Rare Diseases of the Higher Institute of Health, he always kept a profile prudential on fortification, sharing the principle of caution expressed by the working group of the European Food Safety Agency (EFSA) “.

Supplements for males and females: are they really useful?

by Elisa Manacorda


How to take B9 during pregnancy and why

The percentage of women who take folic acid correctly is still quite low in Italy, we are talking about one in 4 and this despite most of the pregnancies today are planned. “For this reason, the Italian Network Promotion of Folic Acid for the Primary Prevention of Congenital Defects recommends that all women of childbearing age, who plan or do not actively exclude pregnancy, regularly take at least 0.4 milligrams per day of acid by mouth. folic, one month before conception. This is because the neural tube normally closes between the 17th and 29th day of conception, when often the woman has not yet ascertained her pregnancy – and then throughout the first trimester of gestation. it is good to remember that in Italy folic acid at this dosage is on the list of class A drugs, therefore totally reimbursable “, remembers the expert.

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There are women who may need a higher dosage of 0.4 milligrams per day. In fact, for those who have risk factors for spina bifida and other malformations, for those who have previous pregnancies with spina bifida, or family history of malformations, in case of insulin-dependent diabetes, epilepsy 4.0 – 5.0 milligrams per day are recommended. folic acid day.

“Supplementation – Taruscio recalls and concludes – must always be accompanied by a healthy lifestyle and a balanced diet, rich in fruit and vegetables”.

Leaf folic: eat vegetables and more

Folic acid is a vitamin that belongs to group B and is present in a wide variety of foods: from liver to vegetables (hence the name folic, from leaf) such as spinach, artichokes, lettuce, broccoli. It is in beans and fruit such as oranges or tangerines. However, most of the folate present in food is unstable, with cooking some of it is lost, but despite this our diet, if balanced and rich and varied, generally manages to cover the need we have for B9. It is during pregnancy that this need increases, and this is the meaning of integration.

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