Essentially, folate food fortification involves the enrichment of denatured, highly refined, frequently poor quality and high risk (triggering allergies and sensitivities) grains. These flours are dangerous enough and should be completely avoided. This is an extremely unpopular position to take because grains marketing through Departments of Agriculture and 'scientific' associations has assumed a health-righteousness that supports an erroneous orthodox view that grains are essential sources of nutrient needs. Unpopular to be sure, but a position I stand by nevertheless.

This situation is compounded by the addition of folate. As further studies come to light we are highly likely to discover various unwanted effects of supplementing folate indiscriminantly, which is what food fortification programs effectively deliver. We saw in the Swedish study linked to above that low folate levels may guard against colorectal cancer. Indiscriminant supplementation may therefore raise the incidence of this cancer.

Indeed, a new study has found further problems on a wider scale. Morris, Jacques, Rosenberg and Selhub published the results of their research in the American Journal of Clinical Nutrition (January 2007, Volume 85, Number 1, Pages 193-200) in a paper titled "Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification." It raises some serious questions about the effects and ethics of folate fortification programs.

The effects of increased folic acid intake amongst the elderly may be a two-edged sword, with benefits and harm dependent on the person’s vitamin B12 levels. “In this study of older Americans in the age of folic acid fortification, we found direct associations between high serum folate and both anaemia and cognitive impairment in subjects with low vitamin B12 status,” wrote lead author Martha Morris from Tufts University's Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging.

Morris and her co-workers found that low vitamin B12 status was significantly associated with an increase in anaemia (170%) and cognitive impairment (150%). The four per cent of subjects with the low B12 and high serum folate levels (greater than 59 nanomoles per litre) had even higher associations with anaemia (210%) and cognitive impairment (160%) compared to those with normal B12 levels. In people with normal B12 levels, high serum folate levels were associated with a 60% decrease in cognitive impairment, compared to those with normal folate levels.

In an editorial accompanying Morris et al's paper, Dr David Smith from the University of Oxford asked:

"Should the issue of fortifying food with vitamin B-12 be reopened in those countries that have already fortified certain foods with folic acid? An expert group has already recommended vitamin B-12 fortification in the Americas

Should countries considering folic acid fortification defer a decision until more is known about the interaction between folate and vitamin B-12 status? This question is particularly pertinent for the many countries that have a high prevalence of poor vitamin B-12 status

Should supplements containing folic acid be combined with high doses of vitamin B-12 to ensure an optimal balance of the 2 vitamins?"

They seem like entirely reasonable questions. Let's hope they are addressed by decision makers.

There is little doubt that ensuring safe folate levels during early pregnancy is beneficial in reducing the incidence of neural tube defects (NTD). However, I regard flour fortification to be an unacceptable way of ensuring this outcome. It by no means guarantees a benefit to the individuals who consume fortified foods, including the target group of early pregnant women. It actively and incorrectly promotes refined flours as 'healthy foods'. It increases population level risks in increasingly known and probably several unknown ways.