Are fortified foods poisoning our children?

Most of us assume that when it comes to vitamins in food, more is better. But a recent study has found that eating too much food fortified with additional vitamins and nutrients can actually harm our health. This morning, Environmental Working Group (EWG) released a report that cautions against the purchase of fortified foods, particularly for parents feeding such foods to children under the age of eight.

"With some vitamins, there's a limit to what's healthy for you, but it's very hard to ever reach that limit. With others, there's really no limit,” explains Renee Sharp, research director for EWG and a co-author of the report. However, she says, with some vitamins, “the window between what's good for you and what's potentially toxic is actually quite narrow". For children, zinc, niacin and vitamin A are particularly problematic, as excessive doses can contribute to liver damage and skeletal abnormalities.

Sharp says that EWG never intended to look at fortified foods, but in the course of pulling together its soon-to-be released food database, she and her colleagues realized that, with certain nutrients, humans need to ensure they're consuming enough while not getting too much.

It's a complicated problem. "We realized we couldn't just look at the composition of foods,” Sharp says. “We had to look at the quantity that people consume, too, especially where kids are concerned.”

A solution that became a problem

Fortified foods were originated intended to treat nutritional deficiencies, particularly in children. "For more than half a century, vitamins and minerals have been added to fortify foods in many countries and have played a critical role in helping to eliminate many formerly common diseases, such as pellagra and neural tube defects due to folic acid deficiencies," says Kris Charles, spokesperson for Kellogg, one of the largest manufacturers of fortified foods in the United States.

These foods can still be useful in certain contexts. For example, a spokesman from Oxfam notes that, when delivering food aid, nonprofits will test children to determine their nutrient deficiencies, then provide fortified foods that help to address them. However, in most of the developed world, fortified foods have outlived their usefulness. In fact, children covered by the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children, have unusually high levels of nutrients because they are receiving so many fortified foods.

"We were trying to solve a problem, and we've gone a long way toward solving that problem, but we've created another problem in the process," Sharp says. "It's time to stop and take stock."

According to EWG, part of the problem is that the Food and Drug Administration (FDA) has not updated its recommended daily allowances of vitamins and nutrients since 1968. Meanwhile, the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, which provides much of the research upon which the US bases health policy, has long since changed its recommendations. For years, the IOM has urged the FDA to change its allowances to reflect current science on what humans need for optimal health.

The difference between adults and children

Another concern, the IOM notes, is that the FDA's vitamin and nutrient recommendations for children are unclear. Currently, the recommended daily values are for adults only, which means a product that meets the daily recommendation for niacin, for example, is overdosing a child. The FDA is currently updating its guidelines, a process that is still open for public comment until 1 August, but the agency is not including an update to daily recommended values in its revisions.

"We are not trying to be alarmists and say 'your kid is going to die because you're feeding him or her fortified foods,'" Sharp says. "But it's a concerning issue, and we believe it's one that could be easily solved by a combination of dual labeling [with recommendations for both children and adults] and basing those labels on current science."

According to Kellogg, however, alarm is exactly the point of the EWG report. "Kellogg is concerned that the EWG report could needlessly alarm parents looking to make the right nutrition choices for their children," Charles says. "The report ignores a great deal of the nutrition science and consumption data showing that, without fortification of foods such as ready–to-eat cereals, many children would not get enough vitamins and minerals in their diets."

Charles adds that less than 2% of the cereals assessed by EWG made the organization's "Top 23 List" of cereals containing more than the IOM limits for one or more nutrients. Moreover, he says, the vast majority of those cereals are geared toward adults, not children.

EWG's report also includes 27 snack bars with more than 50% of the IOM's recommended daily value of one or more nutrients, and 114 cereals that contain 33% or more of the IOM's recommended value of a nutrient or vitamin, which Sharp says is important to track because, when combined with one or two other products, those foods could potentially be harmful.

Prenatal dangers

Although the EWG report focuses on children, over-consumption of fortified foods could be problematic for pregnant women and the elderly as well. Pregnant women, for example, need to take care not to consume too much vitamin A, particularly "preformed vitamin A", the form of the vitamin commonly found in supplements and fortified foods. On its website, the National Institutes of Health cautions that "Getting too much preformed vitamin A (usually from supplements or certain medicines) can cause dizziness, nausea, headaches, coma, and even death. High intakes of preformed vitamin A in pregnant women can also cause birth defects in their babies."

The goal of the report, according to Sharp, is not just to encourage the FDA to re-think labeling, but also to draw attention to the role that marketing plays in the consumption of these foods. "One of the big drivers of the fortified foods market is not health needs, but marketing," she says. "And it works. People see claims like 'added nutrients' and they perceive those foods as healthier.” The solution, she argues, may be to increase regulation of marketing: “We'd like to see some restrictions around how nutritious a food has to be in order to be marketed as such."

Ultimately, if fortified foods are to continue filling the need that they were created for without overdosing the public on certain nutrients, Sharp says we may need something of a sea change. "It may be time to shift our thinking on vitamins from 'make sure you get enough,' to 'make sure you get the right amount,'" she says.

Amy Westervelt is an Oakland, California-based freelance reporter who covers the environment, business and health

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