Q: What’s the difference between enriched and fortified foods, and how did they get that way?
Starting in the 1920s, the federal government addressed several diseases caused by nutritional deficiencies by encouraging manufacturers to add certain nutrients to specific foods.
The earliest example of adding something to a food product to address a public health issue was adding iodine to table salt.
In the late 1890s, a significant percentage, between 26%-70% of children living in the Great Lakes, Appalachian, and the Pacific Northwest regions, suffered from enlarged thyroid glands due to goiter, a disease caused by iodine deficiency. Called the "Goiter Belt," the soils of these regions contain little or no natural iodine, and livestock in these areas also showed evidence of goiter.
In the 1830s, a French chemist observed that goiter was less prevalent in areas in France that consumed salts that naturally contained iodine. This led to the discovery that iodine could both treat and prevent goiter. Doctors first tried giving iodine as drops given to children. Unfortunately, the dosing was complicated and caused accidental overdoses. A simpler and safer approach was needed. What if they could find a way to add iodine to salt?
In 1922, the Michigan Medical Society set up a committee to implement the addition of a form of iodine called iodide to table salt, working with salt suppliers to create a market for the “iodized” version. By 1924, iodized salt became available at groceries across the country, and over the next decade, the incidence of goiter plummeted.
Today, table salt is still available on your grocery shelf in both iodized and non-iodized versions. Boxes of iodized salt can be identified by the statement, "This salt contains iodide, a necessary nutrient." Curiously, iodine is also present in today’s cow milk and dairy products due to the use of sterilizing agents containing iodine.
Cow’s milk is another food fortified to address a nutritional deficiency. In the 1930s, many children suffered from rickets, a shortage of vitamin D. Rickets will cause bones to become soft, causing leg deformities in children and broken bones in adults. Because most children drank cow’s milk, it was decided to try adding vitamin D to it.
One approach was to add cod liver oil to milk, which made it taste "fishy." Another method was irradiating the milk, converting an inactive form of vitamin D present in the milk into its active form. Eventually, a more straightforward process of adding vitamin D concentrate to milk prevailed, creating today’s “fortified” milk.
In the 1930s and 1940s, nearly 7,000 people died yearly in the United States from pellagra, a niacin deficiency. Both pellagra and beriberi, a lack of thiamine, became common after new techniques in milling stripped off the tough outer covering of wheat, corn, and rice. This process produced white rice from brown rice and a finer wheat flour which became preferred by bakers and consumers for bread and other baked goods.
The outer coverings of grains are good sources of vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), and iron. Removing them from grains during milling contributed to an alarming rise in nutritional deficiency diseases. In 1940, there was a disturbing incidence of poor nutritional status among young men enlisting for service during World War II. In May 1941, President Roosevelt's National Nutrition Conference for Defense recommended that flour and bread be enriched with vitamins B1, B2, B3, and iron. Within 1 year, 75% of white bread in the United States used the new “enriched” flour.
Today, most foods made from grains are made with enriched flour. Breakfast cereals, corn, corn chips, bread, noodles, macaroni, and other pasta contain enriched flour. The B vitamin folic acid (folate) was added to the official description of enriched flour in 1998 due to concerns that inadequate folic acid intake during early pregnancy can cause severe birth defects like spina bifida. In 2016 the FDA approved the addition of folic acid to the corn masa flour used in tortillas, tortilla chips, and tamales.
2 Final Facts About Food Fortification in the United States:
1. It's not universal.
The Food and Drug Administration (FDA) does not require all foods to be fortified. Non-fortified versions can also be sold but cannot be labeled as fortified or enriched.
2. Calcium fortification of food is not standardized.
You will find differing amounts of extra calcium added to calcium-fortified orange juice and several types of milk, such as dairy, almond, and soy. No consensus exists on just how much calcium should be added to food.
Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.
©2023 Louise Achey
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