The Food Journal and Food, Nutrition & Science

An alliance between The Lempert Report and The Center for Food Integrity

Food Fortification

Food Fortification

Health and Wellness

July 30, 2014

From iodizing our salt to adding vitamin D to our milk, the practice of fortifying our foods in the developed world has been around for more than a century. Food fortification is deliberately increasing the content of an essential micronutrient in a food to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health, according to the World Health Organization and the Food and Agriculture Organization of the United Nations. 

In the early 20th century, diseases like goiter and rickets were common health problems in the U.S. as a result of diet deficiencies (goiter is caused by a lack of iodine; rickets by a lack of vitamin D), but thanks to a series of food fortification programs that are now ubiquitous to our food system, these diseases are rarely seen in developed countries. In developing countries, however, daily dietary deficiencies continue to affect consumer health, with more than two billion people worldwide suffering from micronutrient deficiencies because they are simply not meeting their daily dietary requirements for essential vitamins and minerals.

Even domestically, deficiencies persist. The majority of the U.S. population does not ingest the daily requirements of fiber, vitamin D, and vitamin E, and more than one-third of Americans do not meet the requirements for vitamin A, calcium, and magnesium. The inadequate intake of these nutrients has led them to be listed by the 2005 and 2010 Dietary Guidelines Advisory Committee as nutrients of concern. The outcomes of low intakes are well documented and many of them carry long-term consequences. For example, low intakes or vitamin A and zinc impair the immune system and make children more susceptible to infection. Additionally, these nutrients have been shown to impact learning and behavior.

The 2013 International Food Information Council Functional Foods Consumer Survey reveals that despite consumers’ reported knowledge about nutrition, the majority (67%) believe they fall short of meeting “all or nearly all” of their nutrient needs. And a comparison of the survey’s findings about perceptions of diet adequacy (by specific nutrient) and National Health and Nutrition Examination Survey (NHANES) data shows a huge gap between how many believe their intakes are adequate versus the actual Dietary Reference Intakes (DRIs) recommended by experts (vitamin D reaches 68% perception, yet only achieves 32% in consumption). Meanwhile, half of consumers (53%) do believe that it is worthwhile to eat fortified foods compared to foods that are not fortified.

With straightforward evidence that food fortification is an important part of our food system, it is hard to believe that there is so much debate surrounding such a simple and successful solution to eradicating dietary deficiencies. Yet, controversies here abound. In fact, the Environmental Working Group (EWG) recently released a report titled “How Much Is Too Much? Excess Vitamins and Minerals in Food Can Harm Kids’ Health.” The report suggests that young children are at risk of consuming too much vitamin A, zinc, and niacin, and that the FDA should set Daily Value levels that reflect current science. 

Dr. Julie Jones, PhD, CNS, ISN, Professor Emeritus, College of St. Catherine, says that the messages put forward by the EWG are unnecessarily alarming and not in the scope of a group with environmental expertise. She also points out that there isn’t a complete understanding of the setting and meaning of the “Upper Level” (UL) set by the National Academy of Sciences. The Upper Level is the maximum level of total chronic daily intake of a nutrient from all sources judged to be unlikely to pose a risk of adverse health effects on humans. The UL, says Jones, is an estimate of the level of intake that carries no risk of adverse health effects. It also suggests that it would be better to not exceed the UL regularly. However, in developing countries supplementation of nutrients like vitamin A and zinc at levels greater than the UL to address malaria or childhood blindness is associated with improved, not worsened, public health.

“In EWG’s paper the examples showed products in a single serve package where the serving size was nearly twice that recommended for (or eaten by) young children. The report made the numbers on vitamin levels look larger by using these large single-serve packages (which have limited distribution through restaurant and food service channels) and by selecting and including a number of cereals in their analysis that are not marketed to, or intended for, or customarily eaten by children,” says Jones.

On the other hand, Jones thinks that a reminder about the judicious use of fortified foods can be important for parents as well as the population in general. It is critical to note, she says, that more is not always better and care must be used in selecting foods. It is not a good idea to eat multiple foods during a day that are highly fortified. For children, colorful, attractive gummy vitamins and other chewable supplements need not only be carefully controlled, but also considered in terms of the total diet. Such supplements may not be needed and should not be overused. Children should also avoid eating adult multi-vitamins and multi-mineral cereals.

Jones suggests that nutrients be consumed through food first, because foods generally contain an array of vitamins and minerals, beneficial phytochemicals and antioxidants – and the chances of exceeding recommended level intakes through eating a varied diet would be extremely rare. Unfortunately, though, most people do not eat the right kinds of foods to provide the right amount of nutrients in our diets, making food fortification necessary. Until the fortification of milk became the norm in the U.S. and Europe, rickets was common. Since the introduction of folate in flour in 1998, there has been a reduction in neural tube defects by 36%.

“I think food fortification is important now and it will continue to be important in the future. For some nutrients, such as vitamin D, it is the only viable strategy. In the future it may become even more important as fish supplies dwindle and other pressures on the food supply occur with the planet's burgeoning population,” adds Jones. “So few of us eat according to USDA MyPlate and the Dietary Guidelines, so until we as a society markedly change our diet, fortified food is a critical strategy to address nutrient gaps.”