Fortified Foods, Friend or Foe?

Eating healthy is important. So is building a healthy relationship with food. And the earlier in life we establish these tenets of good health, the better off we’ll be. But there are circumstances and stages in life that can make it difficult to get all the nutrients we need from food. In decades past, these difficulties have manifested themselves in diseases of micronutrient deficiency. Because of this, the fortification of foods became common, and in some cases necessary. In fact, some of the greatest improvements in public health have resulted from food fortification. It’s a history that often doesn’t get told.  

What are micronutrients? Micronutrients are required to support the vital physiological functions of our body. They include vitamins, minerals and trace elements—all of which help to prevent disease and promote health.

  • Vitamin A — may contribute to maintenance of healthy vision; improves immune function
  • Vitamin C — may prevent infection and boost immune function; slows cellular aging
  • Vitamin D — enhances intestinal absorption of calcium, magnesium and zinc; promotes bone health
  • Vitamin E — reduces inflammation; important for immune and neurological function
  • Calcium — vital for muscle contraction; promotes bone health
  • Magnesium —  helps regulate muscle and nerve function, blood sugar, blood pressure, and the production of protein, bone and DNA
  • Niacin (Vitamin B3) — helps support cell growth; helps regulate metabolism
  • Zinc — aids cellular metabolism; supports normal growth and development during pregnancy; boosts immune function

Why are some foods fortified? Turns out, fortification of foods has taken place in the U.S. since the early 20th century when scientists and healthcare professionals noted that nutritional deficiencies were causing many chronic health problems.  In 1924, iodine was added to salt as a preventative measure against goiter. In the 1930s and 1940s, the fortification of milk and flour became necessary because of concerns over the poor nutritional status of young men enlisting in the military during World War II.  Vitamin D was added to milk to prevent rickets, while thiamine (B1), niacin (B3), riboflavin (B2) and iron were added to flour to address prevalent health conditions of the early 1900s like beriberi and pellagra.

While it may seem like ancient history, the need to fortify foods is not a thing of the past. In the early 1990s, scientists confirmed the role of folic acid deficiency in women who gave birth to children with defects of the brain, spine and spinal cord, otherwise known as neural tube defects (NTD). To combat this, the FDA in 1998 made it mandatory to fortify enriched cereal grain products with folic acid, a synthetic form of folate and a B vitamin. According to the Centers for Disease Control and Prevention (CDC), the number of NTD-affected pregnancies in the U.S. declined by about 25 percent between 1995–1996 and 1999–2000.

Fresh versus fortified: Is one better than the other? Data from the National Health and Nutrient Examination Survey (NHANES) indicate that Americans over the age of 2 don’t get enough key nutrients in their diet. This includes vitamins A, D, E and C, folate, calcium, magnesium, fiber and potassium. For adolescent and premenopausal females, iron consumption is also insufficient.

It’s important to seek nutrients from food first, and eating a well-balanced, healthy diet can provide you with most of the nutrients you need. But some nutrients are harder to come by than others—for reasons such as lack of access, seasonal availability or cost—and that’s where fortified foods come in handy. Fortified foods can help increase our intake of the essential vitamins and minerals we don’t get enough of.

Take vitamin D, for example. The majority of the vitamin D we eat comes from fortified foods because very few foods contain vitamin D naturally. The best natural sources are fatty fish like swordfish, salmon and tuna. Other naturally occurring sources of vitamin D include mushrooms, beef, liver and egg yolks, but these sources contain relatively small quantities. To address low intakes of vitamin D, many common foods like orange juice, milk, yogurt, margarine and ready-to-eat cereals have been fortified. The U.S. and Canada also require infant formula to be fortified with vitamin D.

The U.S. has a long-standing history with fortified foods that have helped to both prevent against disease and promote public health.