No compulsory medicating of bread

September 3rd, 2012 at 1:00 pm by David Farrar

Kate Wilkinson announced last week:

The fortification of with will remain voluntary, Food Safety Minister Kate Wilkinson announced today.

A thorough eight-week public consultation process by the Ministry for Primary Industries (MPI) resulted in 134 submissions, of which 88 supported voluntary instead of mandatory fortification.

“In making my decision in favour of voluntary fortification, I read all the submissions and the clear message is that people want choice,” Ms Wilkinson says.

I am pleased with this decision. Personally I hope bakers decide to include folic acid in the bread they sell, but it has to be a choice. Any other decision could have been a slippery slope.

Women’s red blood folate levels have increased in the past few years under the existing voluntary fortification. Between 2008 and 2011 the level of women with blood folate levels that put them at risk of having a neural tube defect (NTD) affected pregnancy has nearly halved.

“Folic acid plays an important role in reducing NTDs in babies, but fortification of bread is only one part of a wider package of initiatives.”

We encourage parents in New Zealand to vaccinate their children, but we don’t make it compulsory.  This is in keeping with that tradition.

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51 Responses to “No compulsory medicating of bread”

  1. Redbaiter (6,465 comments) says:

    How come we have flouridation of public water supplies?

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  2. Pete George (21,804 comments) says:

    Personally I hope bakers decide to include folic acid in the bread they sell

    Personally I hope it is added to some bread and excluded from some bread so we can choose if we increase our folic acid intake or not.

    I’m never going to become pregnant so don’t see a need for it myself.

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  3. James Stephenson (1,885 comments) says:

    I’m never going to become pregnant so don’t see a need for it myself

    You may like to consider that it’s reasonably strongly linked to decreasing the risk of heart disease and Alzheimers though.

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  4. anonymouse (651 comments) says:

    So how does the mandatory use of iodized salt in bread fit with this voluntary tradition????

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  5. rouppe (852 comments) says:

    How come we have flouridation of public water supplies?

    Because everyone has teeth.

    Folic acid is recommended for women trying to get pregnant and in the early stages of pregnancy. That is a minority of the population at any given time. They can take folic acid supplements when they are trying to conceive.

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  6. rouppe (852 comments) says:

    So how does the mandatory use of iodized salt in bread fit with this voluntary tradition????

    Because iodine is not present in NZ-grown foodstuffs, and is required for the good health of everyone.

    In addition to that you can choose to not use iodized salt as there are non-iodized alternatives such as rock salt.

    Virtually everyone eats bread, and for those that would rather not be or do not need to be dosed with folic acid (more than half the population) there would be no reasonable opt-out choice.

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  7. Redbaiter (6,465 comments) says:

    I want pure water.

    If I want medication, I’ll buy it.

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  8. tamati (58 comments) says:

    As much as I am against mandatory medication, their still will be a significant number of NTD’s (Neural Tube Defects) that could have been prevented by mandatory fortification. The simple fact of the matter is that folate is required before conception and very early in development, simply taking supplements at ten weeks onwards isn’t good enough. The problem is that around half of all pregnancies are not planned, so the mother is unlikely to me taking folate supplements.

    (Perhaps fortified bread should be introduced at high school canteens across the country!)

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  9. hmmokrightitis (1,458 comments) says:

    James S,

    There is also some concern about the role additional supplements of folate has in upping the rates of some male cancers, particularly testicular. Apparently this was a consideration as well.

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  10. georgebolwing (493 comments) says:

    As Tamati notes, using bread is an effective delivery mechanism given unplanned pregnancies.

    The down side is that folic acid can also mask symptoms of vitamin B12 deficiency.

    So the question is one of balance: compulsory medicating of bread would have reduced the harm of NTD, but increased harm from masked B12 deficiency. The voluntary approach means that those with a risk of B12 deficiency (mainly older people) can eat bread without folic acid, while those who might become pregnant can eat the medicated variety.

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  11. Pete George (21,804 comments) says:

    I want pure water.

    It falls out of the sky (as pure as you’re likely to get).

    I’m fine with some salt being iodised, I have both types at home.

    There are than many additives (for example to bread and milk), supplements, pills and potions there’s more chance of getting too much of many things rather than too little.

    If they just dosed up fast foods they would probably cover most people who aren’t aware of balanced diets and adequate special purpose nutrients.

    Megadose burger?

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  12. georgebolwing (493 comments) says:

    Redbaiter: I want to buy my reticulated water fluirdated? Who wins?

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  13. Ryan Sproull (6,661 comments) says:

    Eat vegetables.

    http://www.globalhealingcenter.com/natural-health/folic-acid-foods/

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  14. tamati (58 comments) says:

    I really don’t buy the argument that the decision was made out of public health concern. It was an ideological/populist decision plain and simple.

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  15. Redbaiter (6,465 comments) says:

    “Who wins?”

    I win-

    1) Because the idea that government is responsible for personal well being is one that is behind so many evils within this country

    2) Councils are not responsible for public health

    3) What say I wanted Whiskey put in the water? Would you approve?

    4) I should not be forced to pay for a service I do not want.

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  16. Elaycee (4,066 comments) says:

    I want pure water.
    If I want medication, I’ll buy it.

    Fair enough.

    Rainwater it is, then. But make sure you don’t use toothpaste either because they contain ‘medication’ to protect your teeth and gums. And also remember to include all dental work in your Southern Cross policy because you’ll need it….

    That is, if you still have your own teeth! :D

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  17. Pete George (21,804 comments) says:

    3) What say I wanted Whiskey put in the water? Would you approve?

    No, that would contaminate the whiskey.

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  18. tvb (3,938 comments) says:

    There about 20 babies involved and we medicate 4 million for no benefit. Seriously. No no no

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  19. georgebolwing (493 comments) says:

    Redbaiter:

    I’m not talking about governments, I’m talking about my preferences as a consumer of reticulated water services, and I have decided, for purely selfish personal reasons, that I want to purchase treated water.

    You have a different view. But even if the water system had been privatised (which I think it should be), we still have a conflict of preferences, since there is only one reticulated system.

    So none of your arguments seem to apply to the question I am posing.

    Who wins?

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  20. barry (1,317 comments) says:

    Another missed opportunity by National, another example of a ‘Do Nothing’ government.

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  21. bhudson (4,720 comments) says:

    PG,

    Well said!

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  22. joe bloggs (126 comments) says:

    So Bazza @2:47pm, you’d rather the government forced medications on 4.4 million New Zealanders to address an issue affecting 24 births in the past year. So much for the right to choose what we eat.

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  23. hmmokrightitis (1,458 comments) says:

    barry, there are almost annually reported cases of spontaneous human combustion or SHC. Should we therefore legislate to all carry fire extinguishers as well?

    No, thought not. Do gain some grip.

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  24. thedavincimode (6,105 comments) says:

    georgebolwing

    Isn’t the zero-base position that we get water and bread without any crap put in it. We then have the freedom to mix up a folic acid and fluoride cocktail with it if that’s what we actually want.

    This mass “medication” of the populace is not on. For example, you wouldn’t suggest that the populace of Tauranga should be forced to consume lithium carbonate, Ridal or Clopine just to ensure that the fuckwit m’bator gets his daily meds would you?

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  25. PaulL (5,774 comments) says:

    Adding fluoride to water is a little different. There is no opportunity for some to have it and others not. As with most other decisions, it should be taken at the lowest level possible. As I understand it fluoridation is voted for and agreed at the local council level – i.e. a reticulated supply does or does not have fluoridation. If your neighbours all vote to have fluoridation in that supply, then you need to buy bottled water if you don’t like it.

    With bread it is quite feasible that some people have bread with folic acid, and others have bread without. The lowest level the bread decision can be made is at the household – so if your wife goes to the supermarket and brings home bread with folic acid, then your choice is to eat it or to go and buy your own bread.

    Frankly, I’m not sure that fluoridation is a useful comparison point, it’s not really similar. Iodine might be a more useful comparison, as some have suggested. The difference being that you can buy non-iodised salt. So quite similar to the decision that has been taken on folic acid.

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  26. Camryn (549 comments) says:

    Got to second hmmokrightitis on the male cancer issue. Males should probably avoid excessive folic acid, which will be easier if it’s not in all bread.

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  27. PaulL (5,774 comments) says:

    Especially since a lot of men eat lots of bread. A lot of women eat little or no bread. Sort of seems like a funny place to put the supplement. Can’t they put it in quiche or some other foodstuff that’s only eaten by women?

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  28. hmmokrightitis (1,458 comments) says:

    “Can’t they put it in quiche or some other foodstuff that’s only eaten by women?”

    Line of the day, thank you for the laugh :)

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  29. Monique Watson (1,062 comments) says:

    Quiche is awesome. Ticks all the boxes nutritionally apart from for 100 yr old male smokers. Why won’t you males eat it?

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  30. Monique Watson (1,062 comments) says:

    Ha ha PG. I use to live across the road from Wilson’s distillery; would go and steal daffodils in spring.

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  31. Griff (6,263 comments) says:

    quiche-eater, meaning a man who is a dilettante, a trend-chaser, an over-anxious conformist to fashionable forms of ‘lifestyle’, and socially correct behaviors and opinions, one who eschews (or merely lacks) the traditional masculine virtue of tough self-assurance. A ‘traditional’ male might enjoy egg-and-bacon pie if his wife served it to him; a quiche-eater, or Sensitive New Age Guy would make the dish himself, call it by its French name quiche, and serve it to his female life partner to demonstrate his empathy with the Women’s Movement. He would also wash up afterwards.

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  32. thedavincimode (6,105 comments) says:

    These quiche-eaters sound a bit gay to me Griff.

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  33. GrahamR (1 comment) says:

    One of the reasons so many countries have decided to opt for folic acid supplementation is the significant reduction in the rate of strokes in adult populations. See:
    http://www.thelancet.com/journals/lancet/article/PIIS014067360760854X/abstract

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  34. Viking2 (10,704 comments) says:

    Redbaiter (609) Says:
    September 3rd, 2012 at 1:44 pm

    I want pure water.

    If I want medication, I’ll buy it.

    chemist just down the road. Do you need us to call the taxi for you?
    Medication indicated.

    :lol:

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  35. Lucy (32 comments) says:

    Sorry David – how exactly is it a ‘slippery slope’? We already treat our water and our salt. This decision is disgusting. More than half of pregnancies are unplanned and folic acid needs to be taken before conception. This will not do anyone any harm and could benefit several families each year. It is not a ‘medication’ – it is a vitamin – much like lots of other things that go into commercial bread already. Believe me, you’re eating a lot worse things every day than this.
    The Minister went on Q&A to say that consumers wanted choice. ‘Consumers’ are lay people that don’t know about the benefits of this vitamin. Why on earth should they be making a decision. A brave, courageous decision was needed and she completely wimped out.

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  36. wat dabney (3,438 comments) says:

    I think they should be made to sprinkle some of those toasted seeds on top.

    I quite like that.

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  37. redeye (626 comments) says:

    ‘Consumers’ are lay people that don’t know about the benefits of this vitamin. Why on earth should they be making a decision.

    Are you serious?

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  38. OneTrack (1,958 comments) says:

    redeye – yes she is. You dont want people to have choice do you? Some people ( usually with a BA ) are better than us and they can tell us what to do.

    Back to the bread. A better idea would be to just put Boron in the bread. That way you wouldnt even need the folic acid to start with and things would be a lot quieter and “nicer” – no uppity males causing trouble. I am sure we can find an educated person in some fine academic establishment who can confirm it is a wonderful idea and, of course, that the science is settled.

    Time for a final judgement from the Maori Council don’t you think.

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  39. PaulL (5,774 comments) says:

    Lucy: you’re missing the point of the thread. We treat our water because it comes in bulk – there cannot easily be choice at lower than the community level. However, we do let communities choose. Even then a lot of people bitch about it. Salt has been treated for years, good luck getting that added if you tried it today. And again is something that everyone needs due to deficiency in NZ soils.

    Folic acid, however, is something that has some negative indications, that only a small proportion of the population need (women of child bearing years), and that many of those people already get sufficient of from their diet. It’s not hard to add folic acid to bread and market as “healthy women’s bread”. If it’s as great as you think, everyone will buy it. If it’s as cheap as you think, it won’t cost any extra. So why wouldn’t that work just as well?

    One of the key beliefs of the right is that people should be entitled to make choices. Disagreeing with people’s choices, and therefore deciding to compel them to do something, is not generally considered a liberal stance.

    I do like your use of the words brave and courageous in the context of Ministerial decisions. Too young to have watched “Yes Minister”?

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  40. mavxp (490 comments) says:

    this is a minor issue.

    The bigger fish to fry are obesity, diabetes, and heart disease. Focus people, focus.

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  41. tristanb (1,133 comments) says:

    Although I don’t have strong views regarding mandatory folic acid in bread (maybe Tip Top or Freyas could add folate and market it towards women planning pregnancy) I absolutely HATE the slippery slope argument!

    It doesn’t stack up. If Policy A is a good policy, why not do it? If someone says we should do Policy B (an arguably bad idea), because of Policy A, they should be told where to stick it. Just because we agree with policy A doesn’t mean we give carte blanche to every future idea proposed. Each idea can still be looked at independently.

    Maybe folate could be put into all cheap white bread. This is the bread likely purchased by young potential mothers who haven’t thought about preconception vitamins. It’s also the bread of choice of alkies and old people who don’t eat their vegetables – both groups could do with more folic acid.

    Folic acid is just a B vitamin. You get it from leafy greens. It’s not going to give you cancer – you sound like Green voters when you say stuff like that!

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  42. hmmokrightitis (1,458 comments) says:

    This is easy. Every time a woman and a man have unprotected sex, she should eat a bread roll with folic acid spread on it, available from 24 hour convenience stores set up around the country. Whilst she is chewing, her randy partner is getting a cup of tea with bromide, a lecture and a 12 pack of Durex’s finest.

    labour party policy, right there.

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  43. gump (1,228 comments) says:

    I’m profoundly disappointed that DPF has chosen to use the word “medicating” in this blog post.

    Folate is a naturally occurring nutrient.

    http://en.wikipedia.org/wiki/Folic_acid

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  44. Pundit (8 comments) says:

    DPF- “A slippery slope” to what exactly – an informed policy? God forbid that any decisions should be based on solid evidence and not some ideological mysticism. The scientific case for folate is overwhelming, and the nonsense about folate and cancer rates has been proven to be utter nonsense. The baking industry has totally failed to live up to its promises under a voluntary regime in NZ to introduce a greater range of fortified breads at cheaper price points and it has also failed to institute an awareness campaign that it earlier promised. The only thing the industry has done is put its hand in its pocket to continue to pay ex Nat lobbyists to spread scientifically doubtful information to lobby decision makers with. The consequence is that individual families and communities bear an immediate and significant consequence and cost of a greater number of neural tube defects in the general population than would be the case with fortification, and certainly already a greater number than Australia has with its compulsory fortification. Against all scientific evidence New Zealand has gone to great lengths to opt out from trans-Tasman standards on this matter. It makes no rational sense. If the anti-folate folks really have the courage of your convictions then you should volunteer to provide relief care to kids – or adults still in the care of hard pressed older parent – with NTDs. The Minister lacks the courage to do anything about it. She would be due much more respect if she sought to deliver some practical improvements when in power than to subscribe and perpetuate empty ideological cant.

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  45. annie (533 comments) says:

    It’s a sound decision, I think.

    Unlike the issues of flouridated water or iodized salt, there isn’t enough information on the effects of folate supplementation for the entire population to be certain that it would be safe. There is still an incompletely resolved suggestion that folate may have the potential to cause harm in the geriatric population, typically more enthusiastic supermarket bread-eaters than young women, the target population for the supplementation. A Cochrane meta-analysis doesn’t equal evidence, in my opinion, except to those who want to believe the results.

    Also, there is increasing evidence that supplementation of other vitamins, particularly the popular ‘anti-oxidants’ is harmful, after a long period of having thought they were benign.

    Perhaps in 10 or 20 years the evidence can be considered to be settled. In the meantime, I think it’s prudent to hold off.

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  46. annie (533 comments) says:

    Should have said, above: conflicting evidence around the effect of folate on bowel cancer/adenomatous polyps should be fully resolved before we consider population-wide folate supplementation.

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  47. Griff (6,263 comments) says:

    A Cochrane meta-analysis doesn’t equal evidence,
    A Cchane meta analysis gives a result taking into account all known work on a subject It does seem to me that you are seeking the one piece of evidence that up holds your view and ignoring any that don’t
    If you follow science you know that there are few absolutes however it does seem that the benefit cost analysis supports adding folic acid

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  48. annie (533 comments) says:

    Sorry Griff, don’t agree.

    1. A Cochrane meta-analysis is just that, a collection of studies analysed as a group. If you read many medical meta-analysis reports, you will have noticed that they are often based on what a careful researcher might consider incomplete information regarding the source papers. I don’t consider them to be more than an averaging of a group of papers of often unknown research quality. Anyone who has done biological research will know how easy it is to bias your results either intentionally or not; and conversely, how difficult it is to eliminate all sources of bias.

    2. “..it does seem that the benefit cost analysis supports adding folic acid”. Yes, this is true. But if you’re adding a biologically active substance to the diet of the entire population, “it does seem that the cost-benefit analysis supports” the addition just isn’t safe enough. You need absolute certainty to be able to make a defensible decision to supplement. Anything else would be irresponsible.

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  49. Griff (6,263 comments) says:

    I get the feeling that you are somewhat alt med in your personal life would I be correct in assuming that are you a member of the non scientific nutritionist profession by any chance? Do you do detox and other slightly weird non science supported things?

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  50. annie (533 comments) says:

    I get the feeling that you are somewhat alt med in your personal life would I be correct in assuming that are you a member of the non scientific nutritionist profession by any chance? Do you do detox and other slightly weird non science supported things?

    Couldn’t be more incorrect.

    I get the feeling that you have a mediochre set of qualifications and an attitude to evidence analysis and patient care that lacks rigour. Primum non nocere.

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  51. Griff (6,263 comments) says:

    To be honest annie I have no qualifications of any sort so they can not be called mediocre a cochrane library report does evaluate papers considered for research bais and quality and is the best tool available to answer such questions as is this the present scientific knowledge on a subject.
    Your attitude is in till its proven 100% safe and as such I will give you a little website to pursue in the interest of rounding your scientific medical knowledge in reference to best practise research interpretation
    http://www.badscience.net/
    Water is not 100% safe it does stop dehydration and the risks are far outweighed by the benefits
    “First do no harm” rules out most of most medical intervention even aspirin or antibiotics do harm just that the harm done is far out weighed by the benefit achieved It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit. from that it is reasonable to project that you have it reversed somewhat to don’t do something that carriers a known benefit because of a less certain chance of harm

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