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The folly of fortifying food

Reading time: 6 minutes

Fortifying food may be a way to feed micronutrients to the undernourished, but our bodies don’t like it—or the processed foods that are used for the purpose. Bryan Hubbard reports

Like an uncomfortable echo of Marie Antoinette’s ill-starred “Let them eat cake” dietary advisory to France’s starving, Kellogg’s chief executive Gary Pilnick recently suggested that families struggling with their household budgets could eat a bowl of Frosties for dinner.

Plundering a rich seam of management speak, Pilnick told the business news channel CNBC that “the cereal category has always been quite affordable, and it tends to be a great destination when consumers are under pressure.” In other words, let them eat flakes.

Far from retreating from his clunky advice, Pilnick carried on digging. Kellogg’s has discovered that 25 percent of cereal consumption is outside breakfast, he explained, with a lot of people eating cereal for dinner already. “Cereal for dinner is something that is probably more on trend now and [that] we would expect to continue as that consumer is under pressure.”

Pilnick’s corporate team doubled down with their own shovels. They launched an advertising campaign that features Tony the Tiger telling an incredulous US audience, “When I say cereal, you say dinner!” The advert ends with a dejected chicken slinking off, having been told it has the night off.

The campaign has been reinforced on Instagram, where customers are invited to share how they enjoy their own favorite Kellogg’s cereal for dinner and stand the chance of winning a $5,000 payout and a year’s supply of Frosted Flakes, Fruit Loops or Frosted Mini-Wheats.

Pilnick might argue the campaign is far from irresponsible and is getting micronutrients into people who are ill-nourished. Unlike Antoinette’s cakes, Frosted Flakes contain synthetic forms of an array of nutrients:

  • Iron (ferric phosphate)
  • Vitamin B1 (thiamine)
  • Vitamin B2 (riboflavin)
  • Vitamin B3 (niacinamide)
  • Vitamin B6 (pyridoxine hydrochloride)
  • Vitamin B9 (folic acid)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin D3 (cholecalciferol)

It’s a fortified food, and manufacturers have been putting synthetic micronutrients into processed food since the 1920s, when iodine was added to salt to prevent goiter (swollen thyroid gland) in America’s poorest regions. A decade later, vitamin D was added to milk, and manufacturers started including vitamins B1, B2 and B3 and iron in flour, a practice that became mandatory in 1942 and has been adopted by more than 80 countries since.

Around the same time, vitamins A and D were added to margarine, and today soymilk, infant formula, and enriched grains such as pasta and rice are also packed with micronutrients.  Fortifying sugar with vitamin A is standard in countries in Latin America and Africa.

With 60 percent of Americans eating just one serving of fruit or vegetables a day, lacing their food with nutrients might not be such a bad idea—except that Pilnick’s go-to Frosted Flakes dinner contains around 15 g of sugar for every 41-g standard serving, nearly a third of the ingredients.

New pathways

But it isn’t just sugar that our bodies have to process when we eat fortified foods. Overwhelming the body with a sudden rush of synthetic micronutrients creates new biological pathways that can cause heart disease, a new study has discovered.

Food manufacturers add niacin (B3) to their products to help lower cholesterol levels, but researchers from the Cleveland Clinic have discovered the additives are creating the very problem they’re supposed to be preventing.

When we have too much niacin in the body, we make a byproduct called 4PY that helps break down the nutrient—but it also causes vascular inflammation that damages blood vessels and increases the risk of stroke and heart attack.

If niacin is a good thing, we’re having too much of it, the researchers say. They studied the heart health of a group of volunteers and found those who had the highest levels of excess niacin had the highest 4PY activity and, as a result, the highest risk of major heart problems.

Lead researcher Dr Stanley Hazen likened the process to multiple taps pouring water into a bucket. “Once the bucket is full, it begins to spill over, and the body needs to process that spillover and produces other metabolites, including 4PY,” he explained.

Food manufacturers in the US and around 50 other countries are mandated to add niacin to food such as flour, cereals and oats to prevent diseases that are related to nutritional deficiency and to lower levels of “bad” LDL cholesterol. Niacin is also in over-the-counter remedies, so it’s easy to have an excess of the nutrient.1

Doesn’t always work

Despite the dangers, fortification of processed foods has become a global phenomenon.  Fortifying salt and flour is mandatory in more than 130 countries, and 70 percent of homes around the world now consume iodized salt.

But it doesn’t always deliver the desired results. Adding iron to wheat flour, for example, doesn’t reduce levels of anemia or lower rates of iron deficiency compared to unfortified wheat flour, one study discovered.2

Another group of researchers came up with even more concerning results when they measured the impact of iron-fortified flour on a group of Brazilian children under the age of six. Although the children consumed an average of 100 g a day of fortified flour, their rates of anemia actually increased over four years.3

Fortified food can also raise the risk of serious health problems such as cancer. Folic acid (synthetic B9, which differs from naturally occurring folate) has been added to breakfast cereals, bread, pasta and rice since 1998 in the US to prevent birth defects, or neural tube defects, including spina bifida and anencephaly, in which a baby’s brain or skull doesn’t properly form.

But a team of researchers from University College Dublin discovered that folic acid stays in the blood of the mother and baby and can cause tumors to grow or develop. They took blood samples from 20 women just after they gave birth and found 18 had high levels of folic acid that hadn’t been processed. They saw a similar picture in 49 of 50 blood donors.

The synthetic vitamin was “persistently present” in women who’d had a caesarean delivery, meaning “there would be a constant and habitual exposure of existing tumors to folic acid, with the potential for accelerated growth.”4

The poison is in the dose, say researchers from the Sight and Life foundation in Switzerland, which aims to raise the nutritional status of the world’s developing nations. Sticking to the Tolerable Upper Intake Level, as defined by the World Health Organization, should ensure there are no adverse reactions5—but how can that be done when people are consuming synthetic micronutrients from many different food sources?

Why processed food?

There’s no doubt that a poor diet has resulted in serious nutritional deficiencies, especially among poorer people and in developing nations. It’s responsible for 45 percent of all deaths in children under the age of five and for around 7.5 percent of disease around the world.

But while deficiency and malnourishment are major causes of disease, so too are processed foods, and these are responsible for the epidemic of chronic disease in the affluent West. These foods have been linked to heart disease, a number of cancers, osteoarthritis, and even depression.

Adding micronutrients to sugary carbohydrates doesn’t make them healthy options. Besides that, these foods contain emulsifiers and other additives that our gastrointestinal tract does not digest. Instead, additives are creating an imbalance in the microbiome—the billions of bacteria in the human gut—that can lead to disease.

Around 60 percent of foods in the average American diet contain additives and chemicals that the human body has never encountered before and that it isn’t capable of processing efficiently.

The result is that processed food has overtaken heart disease to become the West’s “silent killer,” say researchers at Florida Atlantic University’s Schmidt School of Medicine—and they lay the blame for Americans’ sudden fall in life expectancy on the diet.6

Makers of fortified foods are targeting poorer communities that can’t afford “proper” food—at least that’s the theory. But it’s a myth that healthy food is more expensive, say researchers from the University of South Australia, who compared the cost of eating a Mediterranean diet to the cost of the standard Western processed diet.

People who consume the Mediterranean diet—which includes fresh vegetables and fruits, nuts, seafood and extra virgin olive oil—are spending $28 less every week on their food budget, which works out to annual savings of $1,456 for a family of four.

Despite the lower costs of a healthy diet, just 8 percent of Australians eat the recommended 375 g of vegetables every day, while most get 35 percent of their daily energy from processed food.7

The solution is simple: Channel the millions of dollars spent on fortification and advertising into educating people about the health benefits of eating real fruit and vegetables.

And consign the Frosties to the trash.



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  1. Nat Med, 2024; 30(2): 424–34
  2. Cochrane Database Syst Rev, 2020; 2020(7): CD011302
  3. Public Health Nutr, 2012; 15(10): 1796–801
  4. BMC Public Health, 2009; 9: 295
  5. Nutrients, 2021; 13(4): 1118
  6. Am J Med, 2024; doi: 10.1016/j.amjmed.2024.02.001
  7. Nutrients, 2023; 15(7): 1692
MAY24, 'Who needs real food? Let them eat flakes!'
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