Food for Fortification

The UK government, as with any government, receives a lot of negative attention about trivial laws and illogical budget cuts, but perhaps the most worrying issues that makes the headlines are those concerning health care. Recently, the suggestion that a national programme for meningitis B vaccines was turned down due to poor “cost-effectiveness”, but this is not the only decision concerning health that has caused some controversy. In the past year alone two vitamin deficiencies have been discussed by medical authorities and government health departments alike, and each time no positive action has been taken to resolve the issues associated with the vitamin deficiencies. These vitamins are vitamin B9 (a.k.a. folate, folic acid), and vitamin D, and they are causing severe health problems in the UK.

Vitamin B9 deficiency causes many issues for adult sufferers, including the extreme fatigue and weakness associated with fully developed pernicious anaemia. However, the main concerns surrounding vitamin B9 focus on the first few weeks of pregnancy, when the brain and spine of the foetus start to form, becoming distinct organs. A lack of vitamin B9 during this time period prevents this development from occurring normally, leading to anencephaly, as pictured above, spina bifida, spontaneous termination of pregnancies, stillbirths, and infant deaths (2). All of these conditions are highly distressing, especially as anencephaly is almost invariably fatal, and spina bifida leads to lifelong disability. It is therefore recommended that women planning pregnancies should take folate supplements from three months prior to conception, to 12 weeks into the pregnancy, the only issue of course, being that many pregnancies are unplanned, and so supplementation cannot be relied upon to prevent anencephaly and spina bifida (3). Many studies have shown that the most effective way of preventing these diseases is to fortify flour with vitamin B9, meaning that enough B9 may be available to all women at the start of any pregnancy, planned or otherwise, promoting healthy brain and spine development for the foetus. However, despite the fact that this type of fortification has been successfully undertaken in 77 different countries, that the Scientific Advisory Committee on Nutrition (SACN) supports fortification (4), and that there has been a 35% reduction in the number of cases of anencephaly and spina bifida since the USA began fortifying flour (5), the British government seems reluctant to take any action at all. Many people, myself among them, finds this decision baffling, and others simply find this infuriating.

Unfortunately, vitamin B9 is not the only vitamin deficiency to be causing problems in the UK; there is also a profound issue with vitamin D. This vitamin is often referred to as the “sunshine vitamin”, due to the fact that upon direct exposure to sunlight, the skin is able to create vitamin D. However, the low levels of sunlight during winter put the UK population at risk of vitamin D deficiency, and since there are few foods rich in vitamin D (oily fish and egg yolk contains the most), the vitamin D intake of anyone living here is often low. This issue is increased when sunscreen is used heavily, or when skin is covered due to the cold, or religious requirements, restricting vitamin D synthesis and thus further limiting intake (6). Deficiency in vitamin D most famously leads to rickets in children, and a similar disease in adults called osteomalacia. There is also a positive association of deficiency with fracture risk, and other possible benefits include a reduction in the risk of cancer, infections, autoimmune diseases, dementia, and even autism (6). The efficacy of supplements concerning this deficiency is disputed, although supplementation is recommended for pregnant or breast-feeding women, and those who have little exposure to direct sunlight (i.e. night-shift workers, office workers) (7). It has therefore been suggested that fortifying particular foods with vitamin D would benefit this widespread issue, especially foods rich in calcium, which would improve both vitamin D and calcium absorption from food, as done in the USA. Milk is mandatorily fortified, and breakfast cereals, yogurts and orange juice may be fortified if the manufacturer wishes to in America. In comparison, the UK fortifies some breakfast cereals and margarines with vitamin D, yet none is added to milk (8). Once again, many well-respected authorities such as SACN have suggested that the fortification of foods with vitamin D would be extremely beneficial, but the government has still chosen to ignore this advice.

Why fortification programmes have not been undertaken by the UK government is beyond comprehension to those who understand the positive impact it would have on anyone living in the UK. Disease is an issue that everyone has come into contact with in their lifetime, and many know of the devastation that it leaves behind. Why then, when lives could be saved, the quality of those lives could be improved, and the NHS would save money on treating these conditions, is this issue so blatantly disregarded by those who have the power to make changes?

By Emma Steer, 2nd year BSc Nutrition.


  1. Novielli C, 2014, Remembering Grayson: Anencephalic Baby Facebook Banned Whose Life Impacted so Many [online], date accessed [13/03/2016], URL []
  2. Morris J.K, Rankin J, Kurinczuk J.J, Springett A, Tucker D, Wellesley D, Wreyford B, Wald N.J, 2015, Prevention of neural tube defects in the UK: a missed opportunity, Archives of Disease in Childhood [online], date accessed [13/03/2016], URL []
  3. Food Standards Agency, 2016, Folic acid fortification [online], date accessed [13/03/2016], URL []
  4. BBC News, 2015, Folic acid to fortify flour ‘would cut birth defects’ [online], date accessed [13/03/2016], URL []
  5. Centers for Disease Control and Prevention (USA), 2015, Folic acid fortification continues to prevent neural tube defect [online], date accessed [13/03/2016], URL []
  6. Buttriss J.L, 2015, Vitamin D: Sunshine vs. diet vs. pills, Nutrition Bulletin (British Nutrition Foundation) [online], volume 40, issue 4, pages 279 – 285, date accessed [13/03/2016], URL []
  7. NHS Choices, 2015, Vitamin D [online], date accessed [13/03/2016], URL []
  8. United States Department of Health and Human Servics, 2014, Vitamin D [online], date accessed [13/03/2016], URL []

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