Enriching Flour, Enriching Lives: The Flour Fortification Initiative

3. Folic Acid
The vitamin folate enables cell division and tissue growth. Folate is found only in small amounts in wheat, higher levels being contained in a variety of fruits, vegetables, and legumes (Gibbson, 1990). Folic acid is a synthetic form of folate which is used in food fortification and is more easily absorbed by the body than natural folates (Anon., 2000). Since 1991, scientists have discovered that folic acid consumed at high levels is important for preventing disabling neural tube birth defects and has a significant potential for preventing heart attacks and strokes as well as colon cancer. The protective levels of folic acid described in these studies were primarily consumed through the use of multivitamins, not through consumption of normal, non-fortified diets (Anon., 1991a and 1991b; Giovannucci et al., 1998; Rimm et al. 1998).

Globally, 300,000 children are born each year with neural tube defects (Oakley, 2002). This is equivalent to the number of global polio cases which sparked the well-publicized polio eradication campaign in 1988 (Oakley, 2003). Neural tube birth defects occur when skin and bone do not form correctly around the brains and spinal cords of foetuses at about 20 days post conception. These defects lead to brain and spinal cord damage which leaves children paralyzed, incontinent, or without parts of their brains (Behrman, 2000). Of the 300,000 children born with these debilitating defects, 200,000 defects each year could be prevented through mothers consuming higher levels of folic acid (Oakley, 2002). Folic acid fortification of flour increases maternal consumption of folic acid and has been shown to decrease the number of children born with birth defects in the USA and Canada by 19% and 48% respectively (Anon., 2003b, Honein et al., 2001 and Persad et al., 2001).

4. Nutrient Loss in Flour Processing
Iron and folic acid are among the vitamins and minerals lost when bran and germ are separated from endosperm. Flour extraction therefore determines the levels of iron and folic acid in the flour. The higher the flour extraction, the greater are the remaining levels of iron and folic acid. The nutritional content of high-extraction flour is complicated by the presence of natural phytates in the flour which also exist in higher levels in high-extraction flour. These phytates prevent the body from absorbing most of the wheat's iron and folic acid (Ge et al., 2001 and Hurrell, 1997). Thus, the unique health benefits of high extraction or "whole wheat" flour do not extend to increased iron and folic acid available to the consumer.

Like iron and folic acid, many vitamins and minerals contained in flour are diminished during the flour refinement process. As discussed above, the vitamins and minerals found in flour are not naturally highly bioavailable, meaning that they are not usually available for absorption by humans (Hurrell, 1997). The vitamin and mineral content of whole wheat and refined flour is illustrated in Tab. 82 for the quantities of iron, folic acid and several B vitamins found in 170 g of flour.
Tab. 82: Vitamin and mineral daily intake from wheat and white flour a,b

This table demonstrates the effect processing to make white flour has on the nutritional content of the flour. Flour processing decreases the levels of naturally occurring, non-bioavailable nutrients in flour. As an example, this table shows that the average American man can consume a large amount of non-bioavailable iron through whole-wheat flour without meeting his daily needs. The folate naturally contained in flour is also less available for absorption than the type of folate, folic acid, which is added during fortification (Anon., 2000). So enrichment and fortification replace iron and folic acid in the flour in a form that the body can absorb and use.

Bulk production of flour in industrialized countries as well as in many economically less developed countries entails the production of white refined flour. The processing and end product quality of a vast majority of the products made from wheat flour requires the use of this white refined flour. There are various levels of refinement of white flour that may be specific to a company, country or region; however, an extraction rate of 75% for white flour is generally considered an average figure for most of these situations. This means that approximately 25% ends up in animal feed.

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