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In the world of nutrition, fortification refers to adding micronutrients (vitamins and minerals) to a food to increase the micronutrient intake in those who eat the food. There are at least four different types of fortification - two types of fortification I support and two types I oppose.

I support staple food fortification and household level fortification

1. Industrial fortification of staple foods refers to adding micronutrients to staple foods in levels that contribute significant amounts of micronutrients to the diet and can eliminate micronutrient deficiencies as public health problems. The costs are usually very small and are usually absorbed by the consumer. Examples include adding vitamin A to vegetable oils, vitamins A and D to milk and butter, iron and zinc to flours, and iodine to salt. A few may argue that we should be getting these micronutrients through our foods and fortification is somehow unhealthy. Iodine in salt is probably the most easily defended – if the environment is naturally low in iodine it is virtually impossible to get enough iodine through food without iodized salt and the consequences of iodine deficiency are devastating. At the most severe, children born to iodine-deficient mothers are cretins. The level of cretinism was among the highest in the world in Ecuador prior to universal salt iodization. Salt iodization began in the 1970s, and now cretinism has disappeared. For nutrients other than iodine, there are conventional food sources, but there would be no other way to so quickly get universal coverage at very low costs. Conventional food fortification need not otherwise interfere with the food system.

2. Household level fortification is most often in the form of adding micronutrient powders to foods for young children (less than 2 years old). While an infant could get sufficient nutrients from their foods, they often do not and some sort of supplement is needed. Infants are not able to swallow a tablet, so a package of “sprinkles” is added directly to the child’s food prior to eating it. As a short-term solution, I have no problem with it.

I don’t support fortification of processed foods and biofortification

3. There is increasing fortification of processed foods, such as “energy bars”, sweet soft drinks, candies and so on, which is not the same thing as fortification of staple foods. This fortification is not done to meet a public health need, but as a marketing ploy. The increase of “ultraprocessed” foods in our diet is probably responsible for the growing epidemic of obesity and NCDs (see here and here) , and consumption of these foods should be discouraged.

4. Biofortification is the breeding of varieties of staple crops for higher micronutrient content. While I am not a screaming activist, I am still opposed to biofortification and I think it is taking us down the wrong path. My reasons are:

1. For biofortification to be effective, the biofortified varieties needs to displace conventional varieties. For most staple crops there are thousands or tens of thousands of varieties (although usually a few, or a few dozen, varieties of staple crops are commonly grown in most countries). If biofortified crops were only, say, 10% of the total production for a given crop, then there wouldn’t be the near-universal coverage needed to eliminate the deficiency of the nutrient. But if there was widespread adoption it would displace production of all the other non-biofortified varieties and threaten agrobiodiversity.

2. Farmers choose the varieties they grow for many reasons – yield, drought and disease resistance, taste, storage properties, etc etc. Biofortification requires that nutritient content trumps all those considerations . Granted, during development of biofortified varieties, they do also select for other properties that farmers find desirable. And, for some crops there are now multiple biofortified varieties. But for most crops, there are not biofortified varieties that cover the range of concerns that farmers have.

3. Biofortification promotes “nutritionism”, that is, it creates the situation where only a scientist can adequately design a diet and confirm that it is delivering adequate amounts of a nutrient. You can’t tell from looking at a bean that it has high levels of iron – you only know that it does because a lab test indicates it is so. It is disempowering as a household can no longer choose a healthy diet without the input of the experts.

4. It isn’t necessary. Anywhere you can grow anything orange (carrots, papayas, mangos, chicken eggs) you can produce sufficient vitamin A. Small amounts of meat provide adequate iron and zinc, and so on. I would prefer to try a little harder to reduce vitamin and mineral deficiency using conventional methods, before we resort to biofortification.

Biofortification will continue with or without my support. Incredible as it seems, I am not indispensable to their efforts. So I will let them go their way, and I will go mine and pursue improved global nutrition through other means.