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.

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

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 Government values the contribution of the flour milling sector, with around 85 percent of wheat coming from home grown production, providing a stable, reliable market for British farmers. Domestic production supports arable farm viability and reduces exposure to international shocks. Government has made a firm commitment to the farming and food security.

Defra invests to support farmers and in turn strengthen the raw material base on which flour millers depend, including through Environmental Land Management schemes which reward sustainable practices and improve soil health and long-term productivity. These are designed to enhance the resilience and profitability of arable farmers, including in the cereals sector.

Defra invests in innovation and research to help farmers adopt more efficient and sustainable practices, such as precision agriculture and crop breeding.

Defra engages regularly with industry stakeholders, including the Milling sector. The UK Agricultural Market Monitoring Group provides early warning of atypical market movements by tracking trends in prices, inputs, and trade.

The Government introduced legislation in England on 14 November 2024 to mandate the fortification of non-wholemeal wheat flour with folic acid based on strong scientific assessment and modelling. The policy is estimated to prevent approximately 200 babies being born with neural tube defects each year.

Voluntary fortification of other foods with folic acid has existed for many years, mainly in products such as breakfast cereals and the Government has no plans to restrict it.

The fortification level for non-wholemeal flour was set using extensive modelling that accounted for existing voluntary fortification. This work showed that voluntary fortification makes only a small contribution to the number of people exceeding the recommended upper level for folic acid intake. On this basis, introducing limits on voluntary fortification was not considered necessary and would add regulatory complexity for businesses.

The level of folic acid fortification will be kept under review as part of the evaluation of this policy.

The Government laid legislation in England on 14 November 2024 to introduce the mandatory fortification of non-wholemeal wheat flour with folic acid. Similar legislation in Scotland, Wales, and Northern Ireland has also been laid. The provisions will become mandatory in December 2026.

Non-wholemeal wheat flour is already the established vehicle for mandatory fortification, as it is currently fortified with calcium, iron, niacin, and thiamine. There was a United Kingdom-wide agreement to limit folic acid fortification to flour that is already fortified, so that individuals are able to avoid fortified flour if they choose to or need to. These individuals will continue to be able to consume wholemeal flour and other non-wheat products, including gluten-free products and soy and spelt flours.

To ensure people can easily identify products that are suitable for them, added vitamins and minerals, including folic acid, must be labelled in the flour’s ingredients list. This must also be declared when fortified flour is used as an ingredient. For individuals with specific dietary needs, personalised advice from a registered dietitian or healthcare professional is recommended to help manage intakes as part of a healthy, balanced diet. An impact assessment has been published alongside the legislation, and is available at the following link:

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

The Government’s policy to mandate the fortification of non-wholemeal wheat flour with folic acid is aimed at reducing the incidence of neural tube defects (NTDs) in pregnancy. This policy is based on robust assessment of the evidence by the UK Scientific Advisory Committee on Nutrition (SACN) and has included two public consultations.

The SACN’s assessment included consideration of individuals with a specific MTHFR gene variant that reduces their ability to process folate from their diet resulting in lower levels of folate in their blood. The two public consultations invited feedback from a wide range of stakeholders, which included individuals concerned about MTHFR gene variants.

An increased intake of folic acid will raise blood folate levels, which reduces the risk of an NTD-affected pregnancy. Therefore, mandatory folic acid fortification is likely to be beneficial to individuals with the specific MTHFR gene variant.

The Government is exploring options to evaluate the policy, which will assess health impacts across different population groups.

The Government is committed to harnessing the purchasing power of the procurement food supply chain to set the tone in delivering our wider ambitions on net zero, sustainability, animal welfare, economic growth and nutrition and health. Over the next year, for the first time ever, the government will review food currently bought in the public sector and where it is bought from. This work will be a significant first step to inform any future changes to public sector food procurement policies.

The Government is committed to harnessing the purchasing power of the procurement food supply chain to set the tone in delivering our wider ambitions on net zero, sustainability, animal welfare, economic growth and nutrition and health. Over the next year, for the first time ever, the government will review food currently bought in the public sector and where it is bought from. This work will be a significant first step to inform any future changes to public sector food procurement policies.