The Food Standards Agency (FSA) has reaffirmed its recommendation that bread or flour should be fortified with folic acid after considering updated information on folic acid and cancer from the Scientific Advisory Committee on Nutrition (SACN).

The recommendation to the chief medical officer (CMO) Sir Liam Donaldson means mandatory fortification is increasingly likely, but raises unanswered questions about how the proposal would be implemented, who would foot the costs and what effect it would have on sales.

Alex Waugh, director of the National Association of Irish and British Millers, told British Baker that, if the recommendation is adopted, the practicalities would have to be addressed by government. "It could be done if folic acid was added at the same time as other fortificants, but there would be a cost involved and that is an issue we would raise," he said. "There is also a worry that the length of time discussions have taken has polarised views. The column inches dedicated to folic acid have not been helpful in developing consumer understanding. Some consumers could be turned off bread."

Gordon Polson, director of the Federation of Bakers (FoB), said: "Whatever decision is reached, the FoB will fully support [it]," and added it continued to strongly advise that fortification of flour at the milling stage was the most viable solution.

Chris Young, project officer at the Real Bread Campaign, said that if the recommendations go ahead, it would be "more undeclared mass medication", that would only benefit a very small percentage of the population. He added that traditional wind and water millers would also struggle to foot the costs. "An estimate from the secretary of the Traditional Cornmillers Guild, said it would involve spending around £20k on new equipment," said Young. The Soil Association would request an exemption for organic products if the recommendation is accepted.

The FSA first recommended mandatory fortification of bread or flour with folic acid in June 2007, following advice from the SACN. However, the CMO asked the SACN to consider two new studies on folic acid and colo-rectal cancer risk before advice was given to health ministers. After analysing the new evidence, the SACN concluded that its previous recommendation that flour should be fortified with folic acid was still valid.

Folic acid fortification would prevent dozens of babies develo-ping spina bifida each year, as it plays a key role in foetal growth.

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