The issues raised by the Hon. Member for Surrey Heath have been dealt with in answers to previous written questions. Most recently, I refer him to the answers provided on 10 July in response to Question 15320 and on 15 July in response to Question 16699.

The mandatory addition of nutrients to flour is not a new concept, as non-wholemeal wheat flour is already required to be fortified with calcium, iron, niacin, and thiamin. Responsibility for enforcing the updated Bread and Flour Regulations remains with local authorities. UK-wide guidance for food businesses and enforcement authorities on compliance with the current requirements, including the mandatory fortification of non-wholemeal flour with folic acid, was published in April 2025, and is available at the following link:

https://www.gov.uk/guidance/bread-and-flour-labelling-and-composition

The issues raised by the Hon. Member for Surrey Heath have been dealt with in answers to previous written questions. Most recently, I refer him to the answers provided on 10 July in response to Question 15320 and on 15 July in response to Question 16699.

The mandatory addition of nutrients to flour is not a new concept, as non-wholemeal wheat flour is already required to be fortified with calcium, iron, niacin, and thiamin. Responsibility for enforcing the updated Bread and Flour Regulations remains with local authorities. UK-wide guidance for food businesses and enforcement authorities on compliance with the current requirements, including the mandatory fortification of non-wholemeal flour with folic acid, was published in April 2025, and is available at the following link:

https://www.gov.uk/guidance/bread-and-flour-labelling-and-composition

The issues raised by the Hon. Member for Surrey Heath have been dealt with in answers to previous written questions. Most recently, I refer him to the answers provided on 10 July in response to Question 15320 and on 15 July in response to Question 16699.

The mandatory addition of nutrients to flour is not a new concept, as non-wholemeal wheat flour is already required to be fortified with calcium, iron, niacin, and thiamin. Responsibility for enforcing the updated Bread and Flour Regulations remains with local authorities. UK-wide guidance for food businesses and enforcement authorities on compliance with the current requirements, including the mandatory fortification of non-wholemeal flour with folic acid, was published in April 2025, and is available at the following link:

https://www.gov.uk/guidance/bread-and-flour-labelling-and-composition

The issues raised by the Hon. Member for Surrey Heath have been dealt with in answers to previous written questions. Most recently, I refer him to the answers provided on 10 July in response to Question 15320 and on 15 July in response to Question 16699.

The mandatory addition of nutrients to flour is not a new concept, as non-wholemeal wheat flour is already required to be fortified with calcium, iron, niacin, and thiamin. Responsibility for enforcing the updated Bread and Flour Regulations remains with local authorities. UK-wide guidance for food businesses and enforcement authorities on compliance with the current requirements, including the mandatory fortification of non-wholemeal flour with folic acid, was published in April 2025, and is available at the following link:

https://www.gov.uk/guidance/bread-and-flour-labelling-and-composition

The issues raised by the Hon. Member for Surrey Heath have been dealt with in answers to previous written questions. Most recently, I refer him to the answers provided on 10 July in response to Question 15320 and on 15 July in response to Question 16699.

The mandatory addition of nutrients to flour is not a new concept, as non-wholemeal wheat flour is already required to be fortified with calcium, iron, niacin, and thiamin. Responsibility for enforcing the updated Bread and Flour Regulations remains with local authorities. UK-wide guidance for food businesses and enforcement authorities on compliance with the current requirements, including the mandatory fortification of non-wholemeal flour with folic acid, was published in April 2025, and is available at the following link:

https://www.gov.uk/guidance/bread-and-flour-labelling-and-composition

The Bread and Flour (Amendment) (England) Regulations 2024 made provisions for the mandatory fortification of non-wholemeal wheat flour with folic acid, following a final decision to proceed with this long-standing proposal taken by the previous government in January 2024, when the Rt Hon Member was the Minister for Common Sense.

These provisions were made using powers in sections 6(4), 16(1)(a) and (e), 18(1)(c), 26(1)(a) and (3) and 48(1) of the Food Safety Act 1990. In particular, section 16(1)(a) includes provisions for “requiring, prohibiting or regulating the presence in food or food sources of any specified substance, or any substance of any specified class, and generally for regulating the composition of food.”

The Food Standards Agency’s (FSA) website moved over to the GOV.UK platform on 25 June 2026. The FSA’s information page on the fortification of flour with folic acid is available at the following link:

https://www.gov.uk/government/publications/folic-acid/folic-acid

Folic acid fortification was recommended by the Committee on Medical Aspects of Food and Nutrition Policy in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid. The tolerable upper limit was also re-considered by the Committee on Toxicity (COT) in 2018.

In its 2006 report on folate and disease prevention, the SACN considered data from hospital discharge surveys in the United States of America, where mandatory fortification of enriched cereal grain products with folic acid was authorised in 1996 and fully implemented in 1998. The data suggested that the number of cases of pernicious anaemia or subacute combined degeneration of the spinal cord had not increased post-fortification. This suggests that mandatory fortification had not led to a delay in the detection of vitamin B12 deficiency by masking the diagnosis of pernicious anaemia.

In the SACN’s extensive review of the evidence on folate and health it considered other medical conditions for whom folic acid supplementation may not be appropriate including epileptic patients on phenytoin, an epileptic drug, pregnant women in the context of multiple births and embryo selection and anti-folate chemotherapy. For each, the SACN noted that there is no evidence or no substantive evidence to suggest that folic acid fortification would cause adverse health outcomes.

The policy was developed with Government’s public consultations on both the impact assessment and legislation. This issue was considered as part of the consultation and impact assessment process.

The level of folic acid chosen for fortification, 250 micro grams per 100 grams of flour, was based on modelling carried out by Food Standards Scotland. The level of fortification has been chosen in order to minimise the risk of the population exceeding the tolerable upper intake level and therefore the risk of masking the diagnosis of pernicious anaemia. COT concluded in 2018 that “Further work is needed to identify the maximum level of folic acid intake at which masking would not occur. However, it is very unlikely that this would be such that the [upper limit] for intake would be less than 1 mg/day, as at present.”

The Government is planning an evaluation on the impact of the policy to assess the effectiveness of the level of mandatory folic acid fortification for both the prevention of neural tube defect affected pregnancies but also to check that the population are not routinely exceeding a tolerable intake and identify any further unintended consequences.

In the United Kingdom, folic acid fortification was first considered by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000.

In its report on Folic Acid and the Prevention of Disease, COMA considered the 1997 paper by Hook and Czeizelb, Can terathanasia explain the protective effect of folic-acid supplementation on birth defects?.

COMA noted that “It has been suggested that some agents that reduce the incidence of birth defects might do so by increasing the rate of death or abortion of affected fetuses ("terathanasia") and that the effect of folic acid on [neural tube defects] NTDs could be mediated by this means. For this reason, there has been some concern over an increased rate of spontaneous abortions among women taking folic acid supplements.”

COMA further noted that it “is most likely due, however, to an increase in fertility and multiple pregnancies among women taking supplements and to an effect of folate in allowing the survival of non-viable conceptuses to a stage where their loss is recognised as abortions. The generally accepted view is that folic acid supplements prevent NTDs simply by allowing the normal development of the fetal neural tube.”

Folic acid fortification was recommended by COMA in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid and did not identify any further concerns on the issue.

Folic acid fortification was recommended by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 2000 and by its successor the Scientific Advisory Committee on Nutrition (SACN) in 2006, after an extensive review of the evidence on folate and health. The SACN has further considered the evidence in its 2009 report to the Chief Medical Officer on folic acid and colorectal cancer risk and its 2017 update on folic acid.

In SACN’s 2017 update on folic acid, the evidence on high folic acid intakes on cancer risk specifically in relation to prostate, breast, colorectal, and overall cancer risk was reviewed. The report concluded that the findings from the different types of studies were inconsistent but overall, the evidence was inconclusive in relation to prostate and colorectal cancer risk and did not suggest an adverse association with breast cancer or overall cancer risk.

The SACN’s risk assessments concluded that ‘conclusive evidence from randomised controlled trials (RCTs) has shown that folic acid supplementation during the early stages of pregnancy can reduce the risk of the fetus developing neural tube defects (NTDs)’.

Foetal death rates was not a health outcome specifically considered by the SACN.

The level of folic acid chosen for fortification was 250 micrograms per 100 grams flour, with a view to minimising the risk of the population exceeding the tolerable upper intake level, which was considered in the Governments impact assessment.

The Government is planning an evaluation on the impact of the policy.

The Government introduced mandatory fortification of non-wholemeal wheat flour with folic acid as a preventative public health measure to help reduce the risk of neural tube defects (NTDs) during pregnancy. Increasing folic acid intake through fortification will help prevent approximately 200 NTDs, including spina bifida each year, which is about 20% of the annual United Kingdom total. The policy will have the wider benefit of increasing the intake of folic acid and improving folate status across the whole population. Folate, including folic acid, plays an important role in forming healthy red blood cells and maintaining brain health.

This policy has been developed over many years, with advice from UK scientific committees, with two public consultations, and clear public communications, including a Government announcement. Further information is available at the following link:

https://www.gov.uk/government/news/birth-defects-prevented-by-fortifying-flour-with-folic-acid

The four chief medical officers of the UK wrote to healthcare professionals about the policy in relation to pregnancy advice for women who are trying to conceive or likely to become pregnant, with further information available at the following link:

https://www.gov.uk/government/publications/folic-acid-supplementation-advice-to-health-professionals/folic-acid-supplementation-advice-to-health-professionals-from-the-uk-chief-medical-officers-chief-nursing-officers-and-chief-midwifery-officers

A consumer facing information page has also been published by the Food Standards Agency.

All non-wholemeal wheat flour is already fortified with four nutrients: iron; thiamine; niacin; and calcium.

In developing the policy, it was agreed that fortification should be limited to non-wholemeal wheat flour, helping to ensure that alternative flour choices remain available for those who choose or need to avoid fortified products. This includes wholemeal flour and other flour types such as soya or spelt flour. This was set out in the consultation document.

To help consumers identify suitable products, added vitamins and minerals, including folic acid, must be declared in the ingredients list on flour and on foods made using fortified flour. Individuals with specific dietary requirements should seek advice from an appropriate healthcare professional.

The Government’s impact assessment, called De Minimus Assessment, was published at the following link in November 2024:

https://www.legislation.gov.uk/uksi/2024/1162/resources

The Government introduced mandatory fortification of non-wholemeal wheat flour with folic acid as a preventative public health measure to help reduce the risk of neural tube defects (NTDs) during pregnancy. Increasing folic acid intake through fortification will help prevent approximately 200 NTDs, including spina bifida each year, which is about 20% of the annual United Kingdom total. The policy will have the wider benefit of increasing the intake of folic acid and improving folate status across the whole population. Folate, including folic acid, plays an important role in forming healthy red blood cells and maintaining brain health.

This policy has been developed over many years, with advice from UK scientific committees, with two public consultations, and clear public communications, including a Government announcement. Further information is available at the following link:

https://www.gov.uk/government/news/birth-defects-prevented-by-fortifying-flour-with-folic-acid

The four chief medical officers of the UK wrote to healthcare professionals about the policy in relation to pregnancy advice for women who are trying to conceive or likely to become pregnant, with further information available at the following link:

https://www.gov.uk/government/publications/folic-acid-supplementation-advice-to-health-professionals/folic-acid-supplementation-advice-to-health-professionals-from-the-uk-chief-medical-officers-chief-nursing-officers-and-chief-midwifery-officers

A consumer facing information page has also been published by the Food Standards Agency.

All non-wholemeal wheat flour is already fortified with four nutrients: iron; thiamine; niacin; and calcium.

In developing the policy, it was agreed that fortification should be limited to non-wholemeal wheat flour, helping to ensure that alternative flour choices remain available for those who choose or need to avoid fortified products. This includes wholemeal flour and other flour types such as soya or spelt flour. This was set out in the consultation document.

To help consumers identify suitable products, added vitamins and minerals, including folic acid, must be declared in the ingredients list on flour and on foods made using fortified flour. Individuals with specific dietary requirements should seek advice from an appropriate healthcare professional.

The Government’s impact assessment, called De Minimus Assessment, was published at the following link in November 2024:

https://www.legislation.gov.uk/uksi/2024/1162/resources

The Government introduced mandatory fortification of non-wholemeal wheat flour with folic acid as a preventative public health measure to help reduce the risk of neural tube defects (NTDs) during pregnancy. Increasing folic acid intake through fortification will help prevent approximately 200 NTDs, including spina bifida each year, which is about 20% of the annual United Kingdom total. The policy will have the wider benefit of increasing the intake of folic acid and improving folate status across the whole population. Folate, including folic acid, plays an important role in forming healthy red blood cells and maintaining brain health.

This policy has been developed over many years, with advice from UK scientific committees, with two public consultations, and clear public communications, including a Government announcement. Further information is available at the following link:

https://www.gov.uk/government/news/birth-defects-prevented-by-fortifying-flour-with-folic-acid

The four chief medical officers of the UK wrote to healthcare professionals about the policy in relation to pregnancy advice for women who are trying to conceive or likely to become pregnant, with further information available at the following link:

https://www.gov.uk/government/publications/folic-acid-supplementation-advice-to-health-professionals/folic-acid-supplementation-advice-to-health-professionals-from-the-uk-chief-medical-officers-chief-nursing-officers-and-chief-midwifery-officers

A consumer facing information page has also been published by the Food Standards Agency.

All non-wholemeal wheat flour is already fortified with four nutrients: iron; thiamine; niacin; and calcium.

In developing the policy, it was agreed that fortification should be limited to non-wholemeal wheat flour, helping to ensure that alternative flour choices remain available for those who choose or need to avoid fortified products. This includes wholemeal flour and other flour types such as soya or spelt flour. This was set out in the consultation document.

To help consumers identify suitable products, added vitamins and minerals, including folic acid, must be declared in the ingredients list on flour and on foods made using fortified flour. Individuals with specific dietary requirements should seek advice from an appropriate healthcare professional.

The Government’s impact assessment, called De Minimus Assessment, was published at the following link in November 2024:

https://www.legislation.gov.uk/uksi/2024/1162/resources

The National Health Service website section on medicines is in the process of being transformed. NHS England undertook in-depth research to understand what the user needs are for medicine information on the NHS.UK website and then designed, tested, and iterated a new medicines page format, which is now rolling out across the medicines content, rather than being specific to folic acid.

This new format is shorter and simpler than the legacy medicines topic pages, making them more accessible and easier to maintain, decreasing risk. As NHS England cannot provide definitive advice for all patients in all situations, instead patients are encouraged to read the relevant Patient Information Leaflet and to consult a physician if they have any existing medical condition.

The National Health Service website section on medicines is in the process of being transformed. NHS England undertook in-depth research to understand what the user needs are for medicine information on the NHS.UK website and then designed, tested, and iterated a new medicines page format, which is now rolling out across the medicines content, rather than being specific to folic acid.

This new format is shorter and simpler than the legacy medicines topic pages, making them more accessible and easier to maintain, decreasing risk. As NHS England cannot provide definitive advice for all patients in all situations, instead patients are encouraged to read the relevant Patient Information Leaflet and to consult a physician if they have any existing medical condition.

Government laid legislation in England on 14 November 2024 to introduce the mandatory fortification of non-wholemeal wheat flour with folic acid. The policy is estimated to prevent approximately 200 babies being born with neural tube defects each year. Legislation will come into force in December 2026. An assessment of the impact of the policy was published alongside the legislation, and is available at the following link:

https://www.legislation.gov.uk/uksi/2024/1162/pdfs/uksiod_20241162_en_001.pdf

This public health policy has a long history and was recommended in 2006 by the Scientific Advisory Committee on Nutrition, which advises the four United Kingdom governments on nutrition-related matters, after an extensive review of the evidence on folate and health. Further information is available at the following link:

https://www.gov.uk/government/publications/sacn-folate-and-disease-prevention-report

Since then, there have been several further evidence reviews and modelling work to establish the level of folic acid added to flour as well as addressing concerns about potential adverse effects.

The policy was subject to extensive consultation. The evidence supporting the policies was included in the 2019 Department of Health and Social Care and devolved governments consultation on the proposal to add folic acid to flour and in a consultation by the Department for Environment, Food and Rural Affairs and the devolved governments on the Bread and Flour review in 2022. The two consultations are available, respectively, at the following two links:

https://www.gov.uk/government/consultations/adding-folic-acid-to-flour/proposal-to-add-folic-acid-to-flour-consultation-document

https://consult.defra.gov.uk/food-compositional-standards/bread-and-flour-consultation-2022/

The Government is exploring how to evaluate the impact of the policy.

Mandatory fortification of non-wholemeal flour with folic acid is a preventative population-wide public health measure. Increasing folic acid intake through fortification will help prevent approximately 200 neural tube defects, including spina bifida each year, about 20% of the annual United Kingdom total.

This measure has been implemented via amendments to the Bread and Flour Regulations. These regulations already require non‑wholemeal flour in Great Britain to be fortified with calcium, iron, thiamine, and niacin for public health purposes, and the addition of folic acid builds on this established policy.

This public health measure has a long history and was recommended by the Scientific Advisory Committee on Nutrition, which advised the four UK governments on nutrition-related matters in 2006 after an extensive review of the evidence on folate and health, with further information available at the following link:

https://www.gov.uk/government/publications/sacn-folate-and-disease-prevention-report

Since then, there have been several further evidence reviews and modelling work to establish the level of folic acid added to flour as well as addressing concerns about potential adverse effects.  The policy was subject to extensive consultation.

The information on folic acid was shortened and simplified as part of the process of redesigning medicines information on the NHS website. The NHS website sets out that before taking folic acid, patients, which includes those with stents or receiving kidney dialysis, should tell their doctor if they have any medical conditions. It also advises patients to check the information provided in the leaflet that comes with their medicine or contact a health professional to ensure that the medicine is suitable for them.