Mandatory fortification of flour with folic acid
All non-organic wheat flour suitable for breadmaking produced or sold in New Zealand must be fortified with folic acid.
What is folate?
Folate is a B vitamin found naturally in food, especially:
- green vegetables like broccoli, spinach, and salad greens
- citrus fruit
- wholegrain bread and breakfast cereals
- chickpeas, nuts, dried beans, and peas (although cooking reduces the folate level).
What is folic acid?
Folic acid is the synthetic form of folate and can be added to food to restore what is lost during processing, such as flour milling. Folate is an essential B vitamin needed for healthy growth and development, particularly for babies during the very early stages of pregnancy. Folic acid is added to some manufactured foods and drinks. It may also be taken as a vitamin supplement.
In more than 80 countries, including Australia and the United States, fortification of flour with folic acid has been proven to reduce the prevalence of neural tube defects. Neural tube defrects can be life-threatening for babies or cause life-long disabilities.
Why folate is important
Folate is vital for everyone for healthy cells and tissues.
If you don't get enough folate, your body may not be able to produce healthy red blood cells. Red blood cells may be larger than normal. This is a disorder called megaloblastic anaemia.
Folic acid and pregnancy
Folic acid is important for the healthy development of babies in the womb. Especially at the very early stages of pregnancy, when babies grow most rapidly.
Some people don't get enough folic acid before and during early pregnancy. They have a higher risk of giving birth to babies with conditions known as neural tube defects. Neural tube defects are serious birth defects where the brain and spinal cord have not developed properly. Neural tube defects can be life-threatening for babies during pregnancy. People who live with a neural tube defect can have severe disabilities. Spina bifida and anencephaly are the most common types of neural tube defect.
To reduce the risk of a neural tube defect, the Ministry of Health recommends that people who plan to become pregnant take a folic acid tablet for:
- at least 4 weeks prior to conception
- 12 weeks after conceiving.
The commonly recommended supplement is an 800 microgram folic acid tablet. Folic acid tablets can be bought at pharmacies. They are free with a prescription from your doctor or midwife.
This recommendation still applies even though bread flour in New Zealand is fortified with folic acid.
Because not all pregnancies are planned, some people do not take the recommended folic acid supplement during the critical period (one month before and the first 3 months following conception). Fortifying foods with folic acid is a way to ensure that people of child-bearing age are getting more folic acid. This improves health outcomes and health equity.
Further information about folic acid
Folic acid fortification
Fortification is when nutrients are added to food and drinks during manufacturing.
Voluntary fortification of bread started in New Zealand in 1996. Fortification of non-organic wheat flour for breadmaking was made mandatory in August 2023. This was done to increase folic acid uptake and ensure better health outcomes for New Zealanders.
Current scientific evidence shows that adding folic acid to bread is safe. There are more than 80 countries that have mandatory fortification of foods with folic acid. The countries include Australia, the United States, and Canada.
Mandatory fortification has been shown to reduce neural tube defects
The rate of neural tube defects in New Zealand is higher than in countries with mandatory folic acid fortification. Māori and Pasifika babies are disproportionately affected.
Australia introduced mandatory folic acid fortification in 2009. This led to reductions of neural tube defects for:
- 14% of the general population
- 55% of teenage pregnancies
- 74% of indigenous people.
We have taken the same fortification approach as Australia.
Types of flour that do not need to be fortified
Some types of flour do not need to be fortified. They are:
- wheat flour for organic bread
- flour made from other grains
- wheat flour not specifically intended for breadmaking (such as for biscuits, cakes, pastry and pizzas).
This provides a choice for consumers who don't want to consume foods fortified with folic acid.
Folic acid in other foods
Food manufacturers can choose to add folic acid to other foods. This includes:
- breakfast cereals
- fruit and vegetable juices
- milk alternatives, like soy milk
- food drinks (such as liquid meal supplements)
- gluten-free breads (for example, non wheat-flour bread)
Foods fortified with folic acid must be labelled
If folic acid has been added, it will be on the product's ingredients list. Food makers can list this as folate or folic acid.
It will sometimes be on the nutrition information panel.
Adding folic acid is safe
In April 2017, the Ministry of Health commissioned a review of the health benefits and risks of folic acid fortification of food. The review was done by Sir Peter Gluckman, at that time the Prime Minister’s chief science advisor (PMCSA), and the Royal Society Te Apārangi.
It involved a literature review and analysis of the available scientific evidence from New Zealand and internationally.
The report found that there is compelling evidence that mandatory folic acid fortification is associated with lower rates of neural tube defects. It also found that taking folic acid supplements at the recommended doses in pregnancy has no adverse effects on pregnancy outcomes or the child's health.
No evidence was found to link the use of folic acid supplements or fortification to increased risks of neurological/cognitive decline, diabetes, or cardiovascular disease. Nor was there evidence that unmetabolised folic acid is harmful.
There was no consistent evidence that folic acid, when fortified in food at the recommended level, had any harmful health effects.
Information for food businesses
Who to contact
If you have questions about folate and folic acid added to food, email email@example.com