Flour fortification with folic acid

A major step forward for UK public health

In November 2024, the UK government announced legislation mandating folic acid fortification of non-wholemeal wheat flour, effective by the end of 2026. This landmark policy will reduce neural tube defects (NTDs), serious birth defects affecting brain and spinal cord development that can cause miscarriage, stillbirth, or lifelong disability.

Despite longstanding recommendations by public health authorities such as the UK National Health Service (NHS) and the World Health Organization (WHO) for women to take folic acid (vitamin B9) supplements before conception, many start too late or not at all.

Professor Sir Nicholas Wald carried out the research, published in The Lancet in 1991, that showed that NTD’s are folate deficient disorders. He has been a leading advocate for a mandatory folic acid fortification policy. His June 2024 BMJ Opinion piece, Folic acid fortification: will the new UK government pass the ‘acid test’? makes the case for fully effective fortification by extending fortification to all flour and rice and raising the fortification level. This would be better; it could prevent up to 80% of NTDs instead of only 20% with the current mandated policy.

Although Hansard does not cite Professor Wald’s 2024 BMJ article by name, his influence is unmistakable. The House of Lords debate from November to December 2024 references the scientific foundation behind the new folic acid legislation, built on decades of Professor Wald’s research and public advocacy.

Notably, Lord Rooker asked whether the Secretary of State had contacted Professor Wald directly, recognising him as a key scientific authority. This public acknowledgement suggests that Professor Wald’s research did help to inform the evidence base that the government drew upon.