Fortification has been a public-health triumph, successfully eradicating diseases that were caused by deficiency of a single nutrient. But the modern nutrition landscape is different now, meaning that some kinds of fortification carry concerns.

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ON NUTRITION

When you see that a food is “enriched” or “fortified,” do you know what that means? Fortification is the addition of nutrients or other bioactive compounds (such as flavonoids) to food or supplements. According to the Food and Drug Administration, food fortification is intended to correct nutrient deficiencies in the population, restore nutrients lost when a food is processed, or provide a better nutrient-to-calorie ratio.

In the United States, food fortification started in 1924 with iodized salt because of concerns that people in some parts of the country weren’t getting enough iodine in their diet, causing enlargement of the thyroid gland (goiter). To prevent rickets, vitamin D was added to milk in 1933, then the Enrichment Act of 1942 called for grain products to be fortified with thiamin, riboflavin and iron.

In 1996, the Enrichment Act was expanded to include folic acid, the synthetic form of the B vitamin folate. This was targeted at women of childbearing age, because of the connection between low levels of folic acid around time of conception — which often isn’t preplanned — and increased risk of neural tube defects (birth defects of the brain and spinal cord).

Fortification has been a public-health triumph, reducing neural tube defects and successfully eradicating most diseases that were caused by deficiency of a single nutrient. But the modern nutrition landscape is different today than it was in 1924. Today’s diseases are not ones of nutrient deficiency; they are often diseases related to lifestyle, including caloric excess. That means fortification carries some concerns.

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In 1977, the Food and Drug Administration lowered the standard level for iron enrichment due to concerns about iron toxicity among young men, who, as a group, were getting too much iron in their diets. Excess folic acid could “mask” symptoms of vitamin B-12 deficiency, possibly leading to nerve damage. Excessive intake of supplemental zinc can lower absorption of copper and iron, possibly leading to anemia and other problems.

Many foods are fortified with calcium, and it’s common to take calcium supplements to support bone or cardiovascular health. However, emerging evidence suggests that excess calcium may have the opposite effect, increasing the risk of hip fracture in women, prostate cancer in men, and cardiovascular disease, including heart attacks, in both. Similarly, while antioxidants are essential for good health, excessive amounts may contribute to more oxidation in the body, not less.

Today, we eat more processed foods — and take more dietary supplements — than ever, making it easy to exceed the Tolerable Upper Limit (UL) of many nutrients. The UL is the highest level of daily nutrient intake that is likely to pose no risk. Data from the National Health And Nutrition Examination Survey suggest that many children exceed the UL for several nutrients. So what might this mean for you?

• Remember that more isn’t better. Don’t take supplements casually, and keep in mind that the supplement industry is unregulated.

• Eat fewer processed foods. It’s easy to exceed your needs for certain nutrients with fortified foods while missing out on fiber and the broader array of nutrients found in whole foods. Some food manufacturers add extra nutrients just to make a food appear healthful when it’s really not.

• Plan ahead for pregnancy. If you are a woman who plans to become pregnant at some point, be sure to get 400 micrograms (mcg) of folic acid daily, one way or another.