Eat Beat

Fortified Foods: Too much of a good thing?

by Althea Zanecosky

You’re in the grocery store shopping for a carton of orange juice. There’s “regular” OJ and then a selection of others that are fortified: one with calcium and vitamin D, one with fiber, and another with Omega 3s. OJ is just one of the many fortified food decisions parents face at the grocery store. Which fortified food choices have value?

Already Fortified
Some of our foods are routinely fortified as a useful way to prevent diseases that come from nutritional deficiencies.

Almost 100 years ago, medical researchers announced that iodine could prevent goiter, widespread at that time. Adding iodine to salt decreased goiter incidence by 90 percent.

In the 1930s, researchers discovered that our bodies couldn’t absorb the calcium in milk without the presence of vitamin D. Ever since, milk has been fortified with vitamin D.

In recent years health statistics showed an increase in babies being born with neural tube defects (NTDs). Research showed a link between NTDs and the mother's intake of folate. So in 1998, the government required that folate be added to certain grain products. According to recent studies, the folate fortification program has decreased the rate of NTDs by 19 percent, a much better result than scientists predicted.

Ways To Add Nutrients
Many kids are picky eaters. According to the USDA, protein, calcium, iron, and vitamins A and C are the nutrients most lacking in American children’s diets. If you and your health care provider have established that your child is not eating enough foods from MyPyramid and may be low in these nutrients, you have a few choices:

1. Daily multi-vitamin. A daily multi-vitamin for kids, one that contains 100 percent of each listed nutrient, is recommended by many pediatric health experts.

2. Fortified foods. You can buy foods fortified with nutrients you think your child isn’t getting through normal daily eating. However, be aware that kids often get extra vitamins already if they're eating fortified grains (especially breads and cereals), juices and snack items. So read food package labels and make sure you know what is in the foods your kids eat regularly. If a child routinely eats several fortified foods daily, and also takes a multi-vitamin, he could be at risk for overdoing it with some vitamins and minerals.

Dietitian’s Tips

Pass on foods that aren’t inherently healthy before being fortified.

Replace fortified snacks and drinks with foods that really do contain adequate nutrition. For example, next time your child is thirsty and wants (vitamin C-fortified) apple juice, give him a glass of water for the thirst and an apple for the taste instead. Stop buying packaged, processed foods and replace them with fresh produce options.

Do We Need More?
2005 Dietary Guidelines for Americans encourage children to eat foods from five food groups in the USDA’s MyPyramid (www.MyPyramid.gov): whole grains, fruits, vegetables, meat and other protein choices, and low-fat milk products. These nutrient-dense foods help ensure that kids are getting a healthy diet.

The idea of fortification is to help Americans get all the nutrients they need from food. But beyond iodine, vitamin D, and folate, a typical diet from the USDA-recommended food groups should provide adequate amounts of the other nutrients needed daily.
Follow this diet and additional fortified foods are probably unnecessary.

Calcium Tally
While dairy foods provide about 75 percent of the calcium in our food supply, the store shelves are full of kid-friendly foods with added calcium. Before buying calcium-fortified foods, parents should tally their kids’ calcium intake to determine whether more is needed.

Calcium requirements:
Ages 1-3: 500 milligrams/day
Ages 4-8: 800 milligrams/day
Ages 9-18: 1,300 milligrams/day

Watch for Vitamin Overdose
Your child’s body is not able to absorb too many extra nutrients. The idea of fortified foods is to fill a gap, to bring a person up to the recommended intake. Going well beyond the recommended levels of certain nutrients can be harmful.

Iron. If your child is not picky and not tired (anemic), she’s probably getting enough iron from fortified grains and meat. A child will become constipated and have black colored stools when the iron level is getting too high. If that happens discuss your child’s diet with her doctor. If your child is a picky eater and older than age 1, ask her doctor about multi-vitamins with iron before trying them.

Vitamin C. Many juices are fortified with vitamin C. If your child drinks a lot of juice, he probably doesn’t need a multi-vitamin. Some kids get diarrhea or other digestive upsets from too much vitamin C. If your child develops persistent digestive problems, try substituting other drinks for those fortified with vitamin C and check with your doctor.
To learn the daily recommended intakes of vitamins and minerals for boys or girls at different ages, visit www.iom.edu/Object.File/Master/21/372/0.pdf

Althea Zanecosky is a Philadelphia registered dietitian and national spokesperson for the American Dietetic Association.