Armenian Healthcare Ministry insists on benefits of mandatory  enrichment of wheat flour with folic acid and iron 

ArmInfo. The Ministry of Healthcare of Armenia believes that the enrichment of flour with micro-elements and vitamins is one of the most important measures to protect public health. Thus, the Ministry of Healthcare of Armenia did not abandon  the resonant project on the enrichment of flour with folic acid and iron.

"Legislation on mandatory enrichment of wheat flour was adopted in 82  countries," the Ministry of Healthcare said in response to a request  from ArmInfo. The goal is to compensate for the shortage of vitamins  and micro-elements in a number of countries, to improve the health  status of the population by correcting the deficiency of  micro-elements in the diet, in particular, iron and folic acid in the  quantities required in a full-fledged diet. The Ministry of  Healthcare proceeds from the fact that micronutrients, including iron  and folates, are not synthesized by the human body, and the only  source for their production is human nutrition.  In this regard, the  Ministry of Health of Armenia notes the importance of raising the  awareness of the Armenian population in this issue, holding public  and expert discussions, and if funding is available, the need for  additional laboratory research.  As stated in the response to the  request of Amrinfo, taking into account that the technical  regulations of the EAEU do not envisage mandatory flour fortification  as imperative,  and according to the results of study of anemia in  Armenia for 2015-2016 positive dynamics was observed, the Ministry of  Health of Armenia, "will return to the revision of the legislation on  overcoming the shortage in microelements after additional laboratory  research and work on public awareness".

Enrichment as a panacea Hrayr Aslanyan, senior researcher at the  National Institute of Health (NIH) of the Ministry of Health care of  the Republic of Armenia, told ArmInfo that the recommended daily  intake of folic acid is 400 ?g for an adult. Meanwhile, a person a  day gets one tenth of the required minimum or a little more - up to  one-fifth.  As a result, according to statistics, in Armenia, neural  tube defects (Spina bifida - hydrocephalus), which cause permanent  disability among children, are 4 times higher than the number of such  cases in countries where the legislative imperative for flour  fortification is in force. At the same time, as Aslanayan pointed  out, today there is no register of children with congenital defects   in Armenia.  According to Aslanyan, the problem of hidden hunger is  often not related to the financial capabilities of citizens, and even  well-to-do families have problems with malnutrition due to unhealthy  diet. This is caused by both the specifics of the national cuisine,  and the way of life of the Armenian population, which prefer not to  visit doctor until the last fateful zero hour.

Does Healthcare Ministry guard interests or just want to follow the  global trend?  Artificial flour fortification with folic acid is the  trend of the latest decades. The initiative belongs to the Food  Fortification Initiative (FFI USA), consisting of 89 organizations,  including WB, WHO, UNICEF and other major global institutions.  Approximately 80 countries have legislation on wheat flour  fortification, 12- corn flour, and 5 countries- rice. Flour  enrichment is mandatory in 7 countries in Europe and Asia.  Almost  the entire Americas and Australia are involved in this program, in  most countries of Eurasia (including China and India) flour is not  enriched. The main additives are iron compounds and folic acid.   Zinc, vitamins A, D and other B vitamins: nicotinic acid, thiamine,  riboflavin, and cyanocobalamin can also be added According to FFI,  each country decides for itself how much and which additives should  be used by local mills.  In 2014, Armenia also decided to follow the  trend - the Government of Armenia approved the draft laws on Making  Amendments to the RA Law on Enrichment of Wheat Flour and the Code on  Administrative Offenses. According to the first draft, in flour mills  of Armenia with a capacity of 30 tons and more high and first grade  wheat flour should be enriched with premixes, that is, mineral and  vitamin supplements.  There are seven such mills in the republic (as  of 2014). The flour they produce accounts for 80-85% of the total  flour sold on the market.  The initiator of the program is the United  Nations Children's Fund- UNICEF. The Fund will provide free equipment  and methodological knowledge. In the first year, the government will  receive supplements for free, after which premixes, again with the  assistance of UNICEF, will be purchased at market prices. According  to the government, in terms of improving public health indicators,  the effects of fortified wheat flour will manifest themselves in the  next 3-5 years after the introduction of the program. Cardiovascular  diseases are expected to be reduced by almost 10%, birth defects by  30-35%, and anemia in children and women by 25-30%. The second bill  establishes penalties in the event of unenrichment or violation of  requirements for the enrichment of high and first grade flour.

First off, do no harm

Local experts were anxious of the initiative. According to experts,  Armenians are a people who consume bread in large quantities, and  after products made of fortified flour are put into circulation, it  will be difficult to control the amount of iron and folic acid  consumed by humans, as well as how well these microelements are  assimilated. Referring to international experience, they also stated  that in a number of countries where the flour fortification process  was launched, cases of oncological diseases of the large gut became  three times more frequent. Many countries, including Russia, Austria,  Germany, Israel, and Japan, abandoned the idea of enriching flour.

Calling to adhere to the principle of bioethics "Do no harm!", the  expert community, and the majority of Armenian citizens said their  decisive "no" to the project. However, as it turned out, the staff of  the Ministry of Healthcare of Armenia did not abandon the intention  to "enrich" wheat flour with iron microelements, as well as folic  acid. As part of the initiative, in August 2017, the Government of  Armenia approved a program of activities, the main purpose of which  is to "raise the awareness of the Armenian population about the  benefits of flour fortification". As it turned out, the new  government did not abandon the mandatory enrichment initiative,  waiting for zero hour.