Preventive Medicine Column

Dr. David L. Katz

A paper published on-line on January 27in the Journal of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) highlights the importance of nutrient fortification to the diets of our children.  The researchers used data from the National Health and Nutrition Examination Survey to determine the sources of micronutrients in the diets of over 7,000 kids ages 2 to 18, and assessed overall dietary intake in this cohort assembled to represent the population at large.  The basic finding was that nutrient intake levels below the Estimated Average Requirement (one of the thresholds, along with the more familiar Recommended Dietary Allowance, used in the Dietary Reference Intakes developed by the Institute of Medicine) were occasional despite fortification, but would have been very widespread in the absence of it.  The findings pertained to fat-soluble vitamins, water-soluble vitamins, and minerals.

There is, to be sure, an important role for fortification in public health nutrition. But it seems to me the new paper stops short of the finish line in its conclusions, and allows far too readily for a pat on the back of the food companies doing the fortification. The authors fail to note the findings warrant a slap across the face of our culture, accompanied by a hearty: snap out of it!

What does it mean when our sons and daughters would commonly be deficient in a range of vitamins and minerals in the absence of willful additions of these nutrients to their foods?  It means their foods are natively lacking the nutrients.  It means their foods are, all too often, junk.

Prior evidence tells us exactly that.  Research has shown that the percent of total calories derived from what would routinely be regarded as “junk food” has risen to account for as much as 50% of our kids’ total intake.  And even this may allow for favorable distortion, because ready-to-eat cereal is not routinely included in the junk food category.  Personally, however, I am pretty dubious about calling multi-colored marshmallows “part of a complete breakfast.”  Yes, I suppose they are “part” of it all right- I leave you to infer what part.  And these are the very kinds of foods where fortification is playing its salient role.

So the complete story is: we’ve built a food supply for ourselves and our kids increasingly out of nutrient-deficient junk, but make it ok by tossing multiple nutrients into the vat of glow-in-the-dark gloop before the mixing is done.   The prevailing diet of our daughters and sons is comprised of foods so nutrient poor that absent fortification, they would not be getting the nutrition they need from…food.  That we, as a nation of loving parents and grandparents, are willing to go along with this does not reflect well on us.

For one thing, consider that fortified junk food is still junk food.  It isn’t only what a food doesn’t contain (i.e., those nutrients) that makes it dubious; it’s what it does contain.  The addition of vitamins and minerals does nothing to exonerate junk foods of their standard provisions of added sugars, added salt, artificial flavorings, artificial colorings, inflammatory fats, high glycemic starches, and willfully irresistible calories.

Consider, as well, the irony: we recently got a bumper crop of high-profile commentaries in both scientific and pop culture publications telling us all to dump our worthless nutrient supplements. This was hyperbolic nonsense to begin with- but that much more so in light of this new study.  Within weeks of learning we should dump our supplements, we learn that without fortification- essentially, nutrient supplements mixed into the big vats of Big Food- our kids would be suffering widespread nutrient deficiencies.  So, is the memo here that those same nutrients accompanied by the junk that often serves as their delivery vehicle are good, but the nutrients on their own are somehow bad?  Personally, I’ll take nutrients on their own and leave out the glow-in-the-dark marshmallows, thank you very much.

But then again, I will take foods that are endowed by nature with nutrients as my first choice. Real food. Nutrients, nutrition, and food are supposed to go together.  Food is supposed to be sustenance.  That we have propagated a food supply that is otherwise says something about our cultural priorities.  And while it’s true we can rely on fortification to prevent overt nutrient deficiencies, we need only look around to see what reliance on nutrient-fortified junk has wrought: epidemic childhood obesity, epidemic diabetes, and worse.   Optimal dietary patterns, comprised of real foods naturally rich in both the nutrients we measure routinely and those we don’t, are associated with optimal health outcomes. Nutrient fortified junk food, however, is the nutritional equivalent of lipstick on a pig.

If all genuine efforts in support of true food and the truth about food continue to suffer the fate of pearls before swine, we certainly know the result: a diet of lipstick on a pig, for breakfast, lunch, and dinner.




Dr. David L. Katz