Food Fortification – Too Much Of A Good Thing?

A Short History of Fortification

The first widespread use of fortification was in the early 1900’s.  In some areas of the United States, upwards of 60% of the population had enlarged thyroid glands, also known as goiters.  In 1924 officials all over America began iodizing salt and within ten years goiters all but disappeared.

GrainProductsJust before World War II, the FDA established a standard of identity for enriched flour.  A standard of identity is the set of “mandatory, federally-set requirements that determine what a food product must contain in order to be marketed under a certain name in interstate commerce”.  It’s why there is ice cream and also “frozen dessert”, or margarine and butter.  Other products, like pasta, rice, and enriched bread soon had a standard of identity of their own.

In the 1950’s, as part of a public health strategy, manufacturers began to fortify cereals with four nutrients considered most deficient in the diets of the population: thiamin, niacin, riboflavin, and iron.  The government was happy with simple fortification because it involved no extensive campaign to educate the public or induce dietary changes.  To public health officials, fortification meant that people could keep eating as they always had, but still eat better.

Fast-forward to the 1980’s and 1990’s.  Science had evolved, making the synthesis of essential vitamins and minerals cheap.  The government was still grappling with improving the nation’s health.  And, the public was becoming more aware of the role of nutrition in health (remember the reactionary “Where’s the beef?” commercial).  The cheapness of single nutrients, the implicit mandate from health officials, and the market potential for new products combined to give the food industry the impetus to go forth and fortify like never before.

By 1984, 92% of ready-to-eat cereals were fortified. The Nutrition Labeling and Education Act of 1990 allowed some claims about nutrient content and health benefits to be put on their products. The Dietary Supplement Health and Education Act of 1994 allowed structure/function claims (read: more health benefits) opened the door to even more products being promoted with added vitamins and minerals. Add to that the more recent trend of fortifying foods with preventative antioxidants…and you see how you can end up with Froot Loops and Coco Crisps being labeled “Smart Choices“.

calcium-fortified-juice

Too Much of a Good Thing?

The problem is that, without much supporting scientific data, there has been a compelling assumption permeating the food industry and, more worryingly, food and health watchers like the FDA.  The assumption is that there is no such thing as too much vitamin and mineral intake.  And so the proliferation of enriched and fortified foods, with corresponding health claims, has persisted without much serious questioning of benefits and risks.

Iron

Let’s take iron as an example of a mineral that is generally a part of the army of fortification.  There is actually more than double the amount of iron in our foods than what is necessary to maintain good iron-balanced health.  For most of us, this is not too big of a deal.  Our body isn’t very good at absorbing iron to begin with.  Unfortunately, as many as a million Americans suffer from a genetic condition known as hemochromatosis.  Their bodies absorb a little more iron than they actually use.  Without blood loss (the only way to get rid of excess iron), the iron can lead to liver and heart problems, and in some cases can cause death.  While the rates of iron-deficient anemia are at an all time low, the listing of hemochromatosis as a cause of death has increased by 60% from 1979 to 1992.  And, many believe that deaths due to hemochromatosis are still routinely “under-diagnosed, often misdiagnosed, and probably underreported.”

Folic Acid

Like many public campaigns, it is easier to convince people that something is good and right if it is ‘for the children’.  (I’m not saying this is a bad thing, it’s just that sometimes legislation gets too much out of hand this way.)  The FDA required that folic acid be added to enriched grain products beginning January 1998.  This time there was some research.  Marion Nestle, in her book Food Politics, explains the science behind the decision and discusses the pros and cons of folic acid fortification:

Studies had revealed that mothers who consumed adequate amounts of folic acid and other vitamins during early pregnancy reduced the odds that they might bear a child with a neural tube defect by 50% or more. Although the doses used in the studies varied by more than ten-fold, and few studies distinguished between the benefits of folic acid from those of other supplementary vitamins, most (but not all) experts viewed this research as definite evidence of the need for women of childbearing age to consume more of this vitamin. Because risk factors for neural tube defects are poorly understood, and because the fetal neural tube closes before a woman might have any idea that she was pregnant, the FDA chose fortification–rather than advice to eat better diets or take supplements–as the method most likely to raise folic acid intake among women “at risk” of pregnancy.

Unlike the other nutrients used in fortification, which were added to the food supply to prevent deficiencies in large segments of the population, folic acid was expected to prevent about half of the 4,000 cases of neural tube defects that occurred each year, a very small proportion of the 3 million or so babies born the United States annually.  To prevent these few–albeit devastating–cases, fortification would be likely to raise the folic acid intake of 260 million Americans, among them many who were already obtaining adequate amounts of the vitamin from foods.   Indeed, raising folic acid intakes would produce one additional benefit: it would reduce blood levels of homocysteine, a by-product of protein metabolism associated with higher rates of coronary heart disease and stroke. The potential benefits, however, would need to be balance against a possible hazard.  Excessive amounts of folate interfere with the ability to diagnose deficiencies of vitamin B12, a problem noted with increasing frequency among the elderly. Overall, the benefits of fortification were expected to outweigh the risk, but many questions remained unanswered.

folic acid sourcesA recent article from the Economist adds to the list of negative consequences that should be considered when weighing the risks and benefits of folic acid fortification.  The Economist reports on an article published in the Proceedings of the National Academy of Science that warns that the liver (where the folic acid is converted to folate) can only handle at most 1mg of folic acid a day.  That is well above recommended daily dose, which is 0.4mg.  However, the amount of fortification in some cereals can lead Americans to consumer up to 0.8mg  per standard serving.  On top of that, pregnant women are advised to take similar amounts of folic acid from supplements.

Regardless of its source, unmetabolised folic acid has been found in human blood and urine.  The body’s increased exposure to the circulating folic acid is suspected of exacerbating certain cancers.  This concern has led some countries, including the entirety of the European Union, to put programs for grain fortification on hold.  Notwithstanding, the authors of the study stress that folic acid pills are still a good idea during pregnancy, so moms-to-be or aspiring mothers should not give them up.

The Lesson Is Clear

Don’t rely on supplements, enrichments, or fortifications for your daily vitamin and mineral needs unless your nutrient needs are unique.  When asked about the functional differences between a food and a supplement, Marion Nestle writes that whole foods (1) offer the full variety of nutrients—vitamins, minerals, antioxidants, etc–in that food, not just the one nutrient in the supplement; (2) the amounts of the various nutrients are balanced so they don’t interfere with each other’s digestion, absorption, or metabolism; and (3) there is no possibility of harm from taking nutrients from foods.  The exception here is polar bear liver; its level of Vitamin A is actually toxic.

When considering the role of fortification in your diet, Michael Pollan’s mantra can and should be invoked.  As you peruse the grocery aisles or make your list at home, remember to “Eat food. Not too much. Mostly plants.”  Following Pollan’s advice might also help you stave off death at the furry paws of the polar bear and his liver, too.

September 9, 2009  Tags: , , , , , , ,   Posted in: Health, Science & Technology

One Response

  1. Yoda - September 11, 2009

    In nature should our nutrition come…

Leave a Reply