Nutrients in disguise: Why fortified food may be no blessing

Elena Vardanian
26.02.2021
5 min read

Fortifying food is an effective way to prevent nutritional deficiencies and related diseases such as rickets (caused by a lack of vitamin D) and osteoporosis (caused by calcium deficiency), especially among vulnerable groups (elderly, pregnant and children). If that is true then why are some scientists concerned about the possible toxic effects of consuming too much of certain nutrients? 

Fortified and enriched foods 

Fortification and enrichment are both processes that add nutrients to food, but they’re slightly different.

According to the World Health Organization (WHO) and the Food and Agricultural Organization of the United Nations (FAO), fortification is the practice of deliberately increasing the content of an essential micronutrient in a food, whereas enrichment is defined as the addition of micronutrients to a food irrespective of whether the nutrients were originally in the food before processing or not (1).

But you can also meet a slightly different definition: fortification is when a nutrient is added to a food that never contained that nutrient. For example, adding vitamin D to orange juice or milk. Food enrichment, on the other hand, is when nutrients that are lost during processing are added back into a food. For instance, when whole wheat is processed into white flour, Iron and B vitamins may be added back in a synthetic form (2).

Up-stream of vitamin food

White flour became a pioneer of enriched food. Transition from white “better processed” flour to white “nutrient rich” flour started in the 1920's. Innovative kind of flour was a solution to essential nutrients loss which was correlated to the processing of grains. The idea was brought to life only in 1940’s, when food of any kind was scarce, and there was an international effort to improve the health of the wartime populations. Processed flour was chosen for enrichment due to its commonplaceness: flour contributed to the diets of both the well-off and the poor, so it was the ideal candidate for enrichment.

In a lot of cases, food fortification came as a result of a particular public health need. For example, in the early 1900, when every second child in Boston had rickets, the U.S government decided to fortify milk with Vitamin D. Twenty years later, in 1924s, companies began adding iodine to table salt to combat a high incidence of goiters. In 1996 the FDA mandated adding synthetic folic acid to processed grains such as flour, baked goods and cereal in order to combat high incidences of neural tube defects in infants. It appeared to be so effective at reducing this risk that more than 50 countries require folate fortification in certain foods (3). 

Fortified & enriched foods for comers & goers

Children are particularly vulnerable to nutrient deficiencies. Without added vitamins and minerals, many children and teens don’t meet daily nutrient requirements (4). Fortified and enriched foods are important sources of nutrients for kids, especially for iron, zinc, and B vitamins.

Adults also not getting enough calcium, magnesium, dietary fiber, vitamins A, D, E, and C (5). Older adults and pregnant women are especially vulnerable to vitamin deficiencies (6). People with special diets also need to be aware of potential vitamin deficiencies. Vegans, for example, can benefit from foods fortified with vitamin B-12 (almond milk, rice milk, and other protein alternatives).

  • Fortified plant milks are rich with calcium, vitamin D, A and B12;
  • Whole grain cereals fortified with B6, B12, and folic acid;
  • Grains & rice are iron enriched and help with iron deficiency anemia which is the most common nutritional deficiency and the leading cause of anemia in the United States;
  • Eggs are now being fortified—namely with omega-3 fatty acids (DHA and ALA) (7).

Turns & twists of food upgrading

In some cases, fortified or enriched foods are helpful. They can fill in the gaps and increase a particular vitamin and mineral consumption that would otherwise be less than the recommended value.

The review of 48 research papers dedicated to fortified and enriched foods shows that food fortification with micronutrients may reduce anaemia (by 32%), iron deficiency anaemia (by 72%) and micronutrient deficiencies including A and B vitamins. Most of the studies (36 out of 43) targeted children. Less than a half were conducted in developing countries. Luckily, there is no evidence of side effects like death or diseases associated with micronutrients fortification but researchers shows us that quality of the evidence was low to very low, due to limitations in the study methods that could introduce a risk of bias, high heterogeneity (variation in the results from study to study), and small sample sizes (8). But it’s also easy to get too much. Adults may overconsume certain vitamins with enriched or fortified foods, especially if they are also taking supplements.

Some of contra arguments are the following:

  • Pregnant women and older adults can get too much vitamin A. It can cause birth defects, and high levels of vitamin A have been linked to hip fractures in older adults (9). While many women still have low folate intake, foods fortified with folic acid can cause people to get too much, according to the Harvard T.H. Chan School of Public Health.
  • Many younger children are also at risk of overdosing on some added vitamins, according to a report from the Environmental Working Group (EWG) (10). The report showed that many fortified foods currently available contain levels of vitamins that aren’t appropriate for children. Many children may also exceed daily recommended values by eating a variety of fortified foods throughout the day, or by eating more than one serving. Nearly half of children ages 2 to 8 get too much zinc, and 13 percent consume too much vitamin A. These overdoses are potentially dangerous. The EWG recommends that children eat products with no more than 20 to 25 percent of the adult recommended daily value for vitamin A, niacin, and zinc (10).
  • Even though fortification has increased vitamin and mineral consumption in the United States, the benefits of fortification are not limitless. There are still difficulties in its implementation and effectiveness - there haven’t been studies on nutrients other than folic acid that show that fortified foods are improving our health. There are also concerns that fortified and enriched foods may be causing people to get harmful amounts of certain vitamins and minerals and a reluctance to fortify on human rights grounds where consumer choice may be an issue (11).
  • The way your body absorbs individual nutrients added to foods differs from the way it absorbs nutrients that naturally occur in whole foods, consumed alongside all kinds of other complementary nutrients. For example, skim milk that is fortified with vitamin A and D. Technically, milk was made without fat, but A and D are fat-soluble vitamins, which means that you can’t benefit if you eat them without a fat source. What a twist!
  • The quality and quantity of nutrients are also important. Most food companies are using synthetic versions of the micronutrients, which your body may process differently than the natural, food-based versions. Some companies add vitamins into these foods at incredibly high levels — up to 100% of the recommended daily amount into one serving of food. Also, among fortified foods you can easily find highly processed one, this fact offers little room for optimism.
  • WHO agrees, that food fortification also raises production costs through such expenses as initial equipment purchases, equipment maintenance, increased production staff needs and quality control and assurance facilities (1). Low income households and other vulnerable population groups may not have access to fortified foods. Nobody, particularly children under age of five, can not fully rely only on nutrients to satisfy an adequate level of daily requirements.

The Bottom Line

You can’t hide poor nutrition by adding extra vitamins. Desserts made with enriched flours and fortified breakfast cereals coated in sugar aren’t healthy. Best option will be avoiding foods that contain added sugars, have trans fats, or are high in sodium because the typical diet already has a good amount of nutrient-poor processed foods and added sugars. While fortified and enriched foods can certainly add to a healthy diet, they aren’t enough by themselves. Nobody can rely on fortification or enrichment to get all of the nutrients they need. You still need to eat a well-rounded, varied diet that is loaded with vegetables and other whole foods.