Mandatory Folic Acid for every man, woman & child

Clare Craig, Ros Jones & Mark Stronge 

The change in the law to enable this came as an amendment, SI2024/1162, to the Bread and Flour Regulations 1998. As a Statutory Instrument, there was no parliamentary debate.  There was no full scientific Impact Assessment; just a de minimis financial assessment by DEFRA and limited DHSC input. The stated aim is to increase blood folate levels in pregnant women in order to reduce the risk of neural tube defects (NTDs).  The Government estimates a reduction of about 200 Neural Tube Defect (NTD)-affected pregnancies annually, approximately 20% of UK cases.  Most of these would have ended in a termination of pregnancy or a neonatal death but a small number of births of children with spina bifida may be avoided.

No proper assessment of the harms of folic acid has been carried out, yet it is proposed to give it to every man, woman and child in this country indefinitely, rather than just giving supplements for a few months to those women wishing to take them. Most notably there are several groups of people whom the NHS currently advises to avoid folic acid medication. This includes patients with cancer, Vitamin B12 deficiency and cardiac stent procedures (patients on haemodialysis were also included in the list until recently). Analysis of long term outcomes from 10 randomised trials has shown a worrying 23% increase in cancers, 24% for prostate cancer. 

What is not at all clear, is how people will avoid folic acid once it is in virtually all flour. 

The UK Government presents folic acid fortification as a settled, cost-free public health win. 

Every one of its load-bearing claims collapses under examination. 

First, “folic acid is a B vitamin.” This is the foundational deception. Folic acid is not a vitamin at all. It is a synthetic, oxidized compound that does not occur in nature. The actual vitamin is folate, found in leafy greens and liver. Folic acid must be converted in the body, and a large share of the population converts it poorly due to common MTHFR gene variants. The result is unmetabolized folic acid circulating in the blood, which has been linked to masking vitamin B12 deficiency and to accelerated growth of existing pre-cancerous lesions. Calling it “a B vitamin” is the rhetorical move that makes the whole policy sound harmless.

Second, “it helps prevent neural tube defects.” The honest version is that high-dose supplementation in women with a previous affected pregnancy showed benefit in a 1991 trial. What the government has done is extrapolate that clinical result to low-dose, population-wide dosing through bread. Those are not the same intervention, and the “200 cases prevented” figure is a model output, not a measurement.

Third, and this is the killing blow, the only large randomised trial in otherwise healthy women, the Hungarian trial by Czeizel and Dudás, found that every category of fetal death was higher in the folic acid group. Total fetal deaths were 374 (13.4%) against 304 (11.4%) in the control arm, an excess of 70 deaths that was statistically significant. In that same trial, the number of neural tube defects prevented was six. That is roughly nine to twelve dead babies for every defect apparently prevented. The mechanism was named by the trial’s own principal investigator in a 1997 Lancet paper: terathanasia, the death of the malformed. Folic acid may reduce the count of babies born with neural tube defects not by curing them, but by killing the affected embryos before birth.

Fourth, the government knows this and has chosen to redefine the dead babies as a benefit. When asked directly in Parliament, the Department of Health answered that folic acid extended the viability of early conceptuses, so the excess miscarriages were really evidence of extra life-creation. No evidence was supplied for this. The data refute it, because if early losses were merely being promoted upward, chemical pregnancies should have fallen. They rose alongside every other category.

Fifth, the surveillance data cannot detect the harm. The US monitoring system only records fetal deaths at 20 weeks or later, while the excess deaths in the trial were overwhelmingly first-trimester miscarriages and chemical pregnancies. The harm signal is structurally invisible to the system used to claim success.

Sixth, the “200 babies” figure is inflated. Even on the government’s own final assessment, the operative effect is around 31 fewer live births a year, of which about 28 would be children living with disability. The rest of the “200” is mostly terminations avoided and a notional quality-of-life valuation. The economic case values a life-year at £70,000, more than double what the NHS uses for medicines.

Seventh, the decline in neural tube defects happened before folic acid existed. Spina bifida fell 82 percent between 1972 and 1991 in England and Wales. The recommendation to take folic acid arrived in 1992, after almost all of that decline had already occurred. Folic acid is being credited with a fall it could not have caused, and after 1992 the rate of decline actually slowed.

Eighth, the safety question for everyone else, which the campaign suppresses entirely. The NHS itself lists categories of people told to avoid folic acid, and most of them have no idea that mandatory fortification means avoiding flour entirely. These include people with cancer, people with B12 deficiency, people with stents, and people with kidney disease.

Ninth, take cancer. Lifetime cancer risk in the UK is around one in two, so you are mandating a synthetic compound linked to driving pre-cancerous growth for a population, half of whom will at some point be cancer patients or survivors. Unmetabolized folic acid has been associated with accelerated growth of existing pre-cancerous lesions, particularly in the colon. For anyone with active cancer or a history of colorectal adenomas, folic acid is not benign. It is fuel.

Tenth, then B12. Folic acid masks vitamin B12 deficiency, allowing neurological damage to progress invisibly while blood markers look normal. The elderly are the classic at-risk group, and they are also heavy bread consumers. The policy doses the exact population most vulnerable to hidden B12 deficiency.

Eleventh, stents and cardiovascular disease. People with coronary stents and certain vascular conditions are among those advised against folic acid, with some trials showing worse cardiovascular outcomes, including restenosis concerns, in people with existing heart disease. Those patients cannot avoid the exposure without abandoning a staple food.

Twelfth, then kidney disease. Folic acid metabolism and accumulation are altered in renal impairment, and patients with kidney disease are routinely told to be cautious. Again, no exemption, no alternative, no consent.

Thirteenth, beyond the NHS list, there is the prostate cancer signal, with some research suggesting a doubling of prostate cancer risk in men, and concerns about immune response in women. None of this was given a value in the government’s assessment. The final assessment named potential harms to others but then did not quantify them.

Fourteenth, like men, infants and children are a group that cannot benefit. For children, the duration of mandatory folic acid ingestion will effectively last a lifetime. Yet the dosage per kilogram is far higher for children, when existing fortification of breakfast cereals is added to the new mandatory fortification of flour and hence bread.

Finally, the “nearly half of pregnancies are unplanned” argument is a confession disguised as a justification. Because some women do not know they are pregnant early on, the answer is to medicate every man, woman, child, and elderly person in the country through the bread supply. The number needed to treat is roughly 440 women to prevent one neural tube defect. The number needed to harm is one in 50 women suffering a lost pregnancy. The harm is about nine times more likely than the benefit. Where are the safety studies for a whole population?

The structure of the policy is the scandal. Tens of millions of people will be exposed every year with zero possibility of benefit. Only a small subgroup, women in early pregnancy, is the nominal target. For everyone else, the benefit is exactly nothing, and any risk at all is pure downside. The people this is unsafe for are not a rare corner case. They are half the population over a lifetime, concentrated precisely in the groups that eat the most bread.  

This UK government policy is built on a misrepresented trial, an inflated model, the reclassification of fetal deaths as a public health victory, and the forced medication of the entire population, including the very groups for whom folic acid is contraindicated, with no risk-benefit assessment and no consent. From December 2026 it becomes compulsory.

A letter has been sent to the minister last month and a very inadequate response received, here. Letters have also been sent to all medically qualified MPs and peers, with as yet one reply. 

Sign the parliamentary petition to stop folic acid being added to flour. We need a complete stop to all fortification. https://petition.parliament.uk/petitions/769589 

Also, if any readers do have one of the NHS listed medical contradictions, do write to your MP and get them to ask questions.

To find all the recent HART articles on Folic acid go to https://www.hartgroup.org/category/folic-acid/

Or click on any of the links below:

Six Saved Babies. What About the Seventy Who Died? In the only trial in healthy women, for every neural tube defect prevented, NINE babies were lost ~ 23/03/26

What you need to know about Folic Acid Part One: The Deficiency That Wasn’t: No one needs folic acid fortification ~ 11/06/2026

What you need to know about Folic Acid Part Two: How 100 microgram Became 400: The dose that was doubled, and then doubled again ~11/06/2026

What you need to know about Folic Acid Part Three: Folic Acid Is Not Folate: Vitamin B9 is benign, folic acid is not ~ 11/06/2026

Support debate on folic acid in flour: Please help force a parliamentary debate on folic acid ~ 18/06/2026

Why can’t Public Health U-turn? When experts recommended removal of fortifications from flour – nothing happened ~ 29/06/2026

Some people should avoid folic acid but how? Government response to folic acid petition ~ 30/06/2026

The NHS’s folic acid rewrite What an FOI revealed ~ 02/07/2026

Reality behind the claim folic acid could “save 200 babies”: Modelling and false assumptions have led to an inflated number ~ 05/07/2026

Australia added folic acid to flour in 2009 then went silent about the results: The country most often cited as proof that mandatory folic acid fortification works quietly stopped collecting the data needed to prove it ~ 19/07/26

Folic acid and Cancer: the safety studies do not show what is claimed: Analysis based on dosage and long follow up all points one way ~ 19/07/26

Government reimagines dead babies as a benefit of folic acid exposure When a claim becomes unfalsifiable it is no longer scientific ~ 22/07/26

Finding the missing flour: The government’s modelling of what flour we eat has a massive error ~ 27/07/26

Hunting for evidence of folate deficiency as a cause of neural tube defects: The folate-deficient women nobody could find ~ 28/07/26

How does folate fare during a famine? What is the science behind the government plans? ~ 28/07/26

Letter re Folic acid to Secretary of State & a woeful reply from DHSC’s Communications Officer ~ 28/07/26

The children who pay the price: Children are the ones most likely to overdose on folic acid  05/08/26

Dosage is key to efficacy, so why is it ignored for safety? Smaller doses act differently to larger ones  05/08/26

Chapatti flour and the highest-risk women: Reaching the women most at risk  06/08/26

Ireland Is Importing Britain’s Folic Acid Law: Ireland is being forced to copy undemocratic UK decision ~ 06/08/26

What really causes neural tube defects? The certainty with which neural tube defects are blamed on folate deficiency is misplaced ~ 15/08/26

Diabetes in pregnancy tripled after Australia added folic acid to flour: Researchers asked for an urgent safety assessment 15/08/26

The dose in the bottle: Does folic acid cause as well as complicate formula feeding? ~ 15/08/26

Half of just one measured harm would cancel any claimed benefit from folic acid: The government has costed the benefit of fortification but ignored the harm ~ 19/08/26

The fall before folic acid Neural tube defects in England and Wales fell dramatically from the 1960s to around 1990 then plateaued. Why? 21/08/26 

Why did Britain choose 250 micrograms of folic acid?  The model behind the mandate ~ 21/08/26

Canada’s 46 percent: What does the study with the most ambitious claim show? ~ 23/08/26

Folic acid and heart stents: What is the evidence? ~ 23/08/26

Why does bowel screening almost always expand when folic acid is rolled out? Multiple countries increased bowel screening at a time when measuring any change from folic acid is really important ~ 23/08/26

The statistical mistake that made it look like folic acid worked: The Canadian result survives even when every province is given the wrong outcome ~ 23/08/26

Where is the safety trial on folic acid? Eighty thousand people have been included in trials for benefit but none in a trial designed to question safety ~ 23/08/26  

The impossible shop Try buying a week’s food without folic acid ~ 03/09/26 

The plateau in four countries Why is the decline that stopped in four countries cited as proof that folic acid worked? ~ 05/09/26

The enzyme bottlenecks MTHFR gets the attention but DHFR is slow in everybody ~ 05/09/26

Three things high folic acid does to animals Animal models provide evidence of harm ~ 06/09/26

What caused Britain and Ireland’s neural tube defect epidemics? The search for the reason was abandoned halfway through ~ 08/09/26

Case studies in neural tube defect causation Neural tube defects occur in epidemic waves. Why? ~ 08/09/26

What can we learn from neural tube defects in migrants? Why do Bangladeshi and Pakistani mothers in England have such different rates of NTDs? ~ 14/09/26

How folic acid works – HART A mechanism was traced for the first time in July 2026 ~ 14/09/26

A country wide experiment with no way to collect the results A fall, a plateau or a rise in neural tube defects could all be presented as success ~ 14/09/26

Starvation in the midst of plenty Usable folate can run short in the embryo while the mother’s blood folate reads entirely normal ~ 14/09/26