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TO FORTIFY or not to fortify? That is the question being debated in Britain as the Food Standards Agency examines whether folic acid should be routinely added to wheat flour.

In 1998, the US began adding folic acid to all grain products, cutting birth defects such as spina bifida by 19 per cent. In 2000, Britain鈥檚 Committee on Medical Aspects of Food and Nutrition Policy suggested Britain follow suit, but no decision has yet been made.

The benefits during pregnancy are clear. According to Andrew Russell, executive director of the Association for Spina Bifida and Hydrocephalus, 鈥渉undreds of terminations and the birth of more than 100 severely disabled babies could be avoided each year鈥� in Britain if pregnant women got enough folic acid鈥攁bout 40 micrograms per day.

The advantage of fortifying food, rather than popping pills, is that it ensures women get folic acid at the crucial period at the beginning of a pregnancy. But there are also risks. For example, it would be harder to spot people with a vitamin B₁₂ deficiency, which can cause severe neurological problems. This is because folic acid alleviates anaemia, the hallmark of the illness. About 5 per cent of people over the age of 65 have B₁₂ deficiency, according to John Grimley Evans, a gerontologist at the University of Oxford.

But Grimley Evans thinks that the deficiency could be picked up by GPs if they began routine tests for raised homocysteine levels (see story Feed your sperm)in the over-75s and spot checks from age 65. By introducing the tests, he says, not only B₁₂ deficiency, but also folic acid deficiency and renal failure would come to light.