The Case for Folic Acid Fortification Finally, a benefit of Brexit?

A plate of spinach salad because spinach leaves are high in folate

Cover artwork

Spina bifida is a neural tube defect that is one of the most common severe birth defects in the world. The main cause is a lack of folate vitamin in the diet, and in 1991, the UK’s Medical Research Council halted a trial of folic acid supplementation early because it was obvious that the supplement was preventing a large number of cases. At the time, the trial’s authors concluded: “public health measures should be taken to ensure that the diet of all women who may bear children contains an adequate amount of folic acid.”

The United States was relatively quick to act, mandating flour be fortified with folic acid in 1998, followed by around 80 countries worldwide. Countries with mandatory fortification have seen a drop in neural tube defects of between one third and one half. But not the European Union nor, until recently, the United Kingdom.

The European Union concedes: “There has been no real progress in preventing NTDs in Europe since folic acid supplementation was shown to be an effective preventive measure.”

Finally, the UK has put forward proposals to fortify white flour, but many doctors say they could do much more. Europe is still to act.


  1. The US Centers for Disease Control has an excellent series of pages on neural tube defects with links to a lot more research.
  2. The European Union also has a page on Folic Acid and Neural Tube Defects.
  3. Helena Bottemiller Evich recently did a great and personal write-up of prenatal vitamins in her newsletter, Food Fix.
  4. Mun-Keat Looi’s article Folic acid: The case to rethink the UK’s food fortification plans is behind a paywall.
  5. Here is the transcript.
  6. Spinach salad by Lucy Clink, photographed by me. Folic acid molecular model by Ben Mills.

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