Q: What’s the difference between enriched and fortified foods?
Starting in the 1920s, the federal government addressed diseases caused by nutritional deficiencies by encouraging food manufacturers to add certain nutrients to specific foods.
The earliest example of adding something to a food product to address a public health issue is adding iodine to table salt.
In the late 1890s, between 26% and 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. Livestock raised in these areas also suffered from goiter.
In the 1830s, a French chemist observed that goiter was less prevalent in areas of France that consumed salt containing iodine. This led to his discovery that iodine prevented and cured goiter. Doctors first tried giving children drops containing iodine, but accidental overdoses created problems. Instead, adding a small amount of iodine in the form of iodide to salt used in food preparation successfully treated and prevented goiter in both children and livestock.
In 1922, the Michigan Medical Society set up a committee to implement adding iodine to table salt. They worked with salt suppliers to create a market for a new, “iodized” formula. By 1924, iodized salt became available at groceries across the state and country. Over the next decade, the incidence of goiter plummeted.
Today, table salt continues to be available in both iodized and non-iodized forms, side-by-side on your grocery shelf. Every box of iodized salt can be identified by the presence of 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 widespread use of sterilizing agents containing iodine.
Cow’s milk is another food that’s been modified to address a nutritional deficiency. In the 1930s, many children suffered from rickets, a disease caused by lack of vitamin D. Rickets causes bones to become soft, creating leg deformities in children and broken bones in adults.
The government decided to add vitamin D to cow’s milk because most children drank it daily. Adding vitamin D as cod liver oil to milk made it taste “fishy.” Irradiating the milk was also tried, which changes the inactive form of vitamin D already present in milk into its active form. Adding concentrated vitamin D to milk ended up the simplest solution, creating today’s “fortified” milk.
In the 1930s and 1940s, nearly 7,000 Americans died every year from pellagra. Pellagra and another nutritional deficiency disease, beriberi, became rampant when new techniques transformed the milling process.
Millers were able to remove the tough outer covering of wheat, corn, and rice. This produced white rice from brown rice and a more refined wheat flour much preferred by bakers and consumers for making bread and other baked goods.
The outer coverings of rice, wheat, and corn are excellent sources of vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), and iron. Removing these vital nutrients from flours and cereals contributed to an alarming rise in pellagra and beriberi. Pellagra is caused by the deficiency of niacin (B3), and beriberi is from a lack of thiamine (B1). In 1940, a disturbing incidence of these nutritional deficiencies was noticed in young men enlisting to serve in World War II.
In May 1941, President Roosevelt’s National Nutrition Conference for Defense recommended that flour and bread have vitamins B1, B2, B3, and iron added to it. Barely one year later, 75% of white bread in the United States used flour “enriched” with those nutrients. Most flours, cereals, corn products, breads, noodles, and macaroni sold today are made with enriched flour.
In response to evidence that inadequate folic acid intake during early pregnancy contributes to severe birth defects like spina bifida, the Food and Drug Administration (FDA) changed the description of enriched flour in 1998 to include the B vitamin folic acid or folate. Folic acid was approved for addition to corn masa flour used in tortillas, tortilla chips and tamales in 2016.
2 Final Facts About Food Fortification in the United States:
1. It’s not mandatory.
The FDA does not require modification of foods. Non-fortified flours and cereals can be sold as long as they are not labeled as fortified or enriched.
2. Calcium fortification is not standardized.
Unlike enriched flour or fortified cow milk, extra calcium can be added to orange juice and several types of milks, such as dairy, almond, and soy.
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Check out her NEW website TheMedicationInsider.com for daily tips on how to take your medicine safely.®2020 Louise Achey
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