Dr. Bob McDonnell:

Reference was made to voluntary fortification decreasing over a few years. Professor Turner cited the recent study which showed it decreased from 2009 to 2013. The recommendation in 2006 from the Department of Health was that there should be mandatory fortification of staple foods in Ireland. As a work up to this, the Food Safety Authority of Ireland did a baseline study of the incidences of neural tube defects, between 2005 and 2007, which was fairly low. The food industry anticipated there would be fortification, and there was a lot of voluntary fortification of their breads, cereals, milks, etc., in advance of this because they knew it was coming down the line. The effect was that it seemed to increase the levels of folic acid in women's blood. When the FSAI actually looked at the amount of voluntary fortification occurring during that period it found that the food producers were over-estimating the amounts required and putting a lot more folic acid into the products that they should have been. In 2008, when the incidences of NTDs had decreased, when women's folic acid levels were quite high and when there was already voluntary fortification happening, it was decided not to fortify. The world food producers were advised that they had a lot of folic acid in their products and they then decreased the amount in their products. That will have decreased the amount of folic acid that women were getting. We did our own survey for the period 2009-11 and we saw that the incidence of neural tube defects had crept back up again.