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 congenital anomalies 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) 15 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 1991 , 16 which showed that NTDs 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’?, 17 makes the case for extending fortification to all flour and rice. Although Hansard does not cite Professor Wald’s 2024 article by name, his influence is unmistakable. The House of Lords debate, recorded at the end of 2024 18 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. 19
“The UK’s decision to mandate folic acid fortification of non-wholemeal wheat flour marks a long overdue but hugely important advance in public health. I commend The BMJ for continuing to publish evidence based arguments that influence and inform public debate.” Professor Sir Nicholas Wald , professor of preventive medicine, University College London, UK
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