Add calcium and vitamins to foods? The debate over fortification

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Will proposal to fortify foods with calcium and vitamin D help or harm?

Date published: 8/15/2004

ADDING CALCIUM and vitamin D to bread, pasta, cereal and other grains could prevent 27,000 cases of colon cancer and 300,000 broken bones from osteoporosis for a dime per American, say researchers.

But can you overdose on fortified foods? What are the real costs and benefits?

In some ways, the report in this month's American Journal of Clinical Nutrition raises more questions than answers.

It seems clear that Americans aren't getting enough calcium and vitamin D, and that this is causing diseases, but what is the best and safest solution to the problem?

Adding vitamins and minerals to the food supply is nothing new.

The U.S. government began adding iodine to salt in 1924. Since then, it has added vitamins A and D to milk and mandated "enriching" white flour with thiamin, niacin, riboflavin and iron, returning some of the nutrients lost when whole grains are transformed into refined ones.

Today, most Americans don't remember the names of the disfiguring deficiencies we now avoid by eating fortified foods: goiter, rickets, beriberi, pellagra. (Incidentally, whole grains, though they're not fortified, are naturally high in B vitamins.)

Most recently, in 1998, the U.S. mandated adding folate to enriched flour and cereal grains to help prevent birth defects. The following year, rates of a paralyzing defect called spina bifida dropped by 31 percent.

Even though adding folate helped many people, taking in too much folate in a day can mask a serious deficiency of vitamin B12, making it undetectable by blood tests even while people suffer permanent nerve damage.

For this reason, fortifying foods with folate alone was hotly debated; folate is important for pregnant women, while the elderly are more at risk for deficiency of vitamin B12.

Furthermore, young children are at higher risk of overdosing on fortified foods. National food surveys estimate that 20 to 30 percent of children under the age of 8 may exceed the safe upper limits for folic acid by eating fortified cereals, grain products and supplements, according to the American Dietetic Association's position papers.

A researcher at Purdue University says additional calcium and vitamin D won't cause problems.

Date published: 8/15/2004