Foods With Something Extra

Functional, enriched, and fortified foods offer health bonuses

By Kathleen Zelman, MPH, RD/LD
WebMD Weight Loss Clinic - Feature

Reviewed By Brunilda Nazario, MD

Fooling Mother Nature can sometimes be a good thing. In the world of nutrition, improving upon nature has proven to offer health benefits. Through the power of technology, we can add nutrients where they are not found naturally.

People who had trouble getting enough calcium in their diets rejoiced when calcium found its way into non-dairy foods, just to name one example. But it goes way beyond calcium. Fortifying food with essential nutrients has had a huge impact on public health, improving our existing food supply and significantly reducing certain diseases in this country.

Many food manufacturers are now working furiously to introduce their own version of a fortified or "functional food" into the marketplace. Functional foods go beyond basic nutrition, adding nutrients that may offer protection against disease or other health benefits. This is the fastest-growing segment of the food industry, with sales already in the range of $10 billion to $20 billion a year -- roughly 5% of the food dollar.

Where It All Began

Long ago, researchers discovered that our bodies didn't use the calcium in milk well without the presence of vitamin D. Milk has been fortified with vitamin D ever since.

In response to public health issues, the government has required fortification of many other foods. For example, grains, bread and rice are routinely enriched with B vitamins and iron.

The idea is to help Americans get all the nutrients they need from food. And it works! One of the most successful fortification programs involves folate, a B vitamin.

In the mid-1990s, government health statistics showed an increase in babies being born with neural tube defects (NTDs), improper development of the spinal cord and brain. Research showed a link between NTDs and the mothers? dietary intake of folate. So in 1998, the government began requiring that folate be added to certain grain products.

According to a recent study published in the journal Obstetrics and Gynecology, the folate fortification program has decreased the rate of NTDs by 19% -- a much better result than scientists predicted.

Enrichment vs. Supplements

So why not just take a supplement? Remember that the popularity of vitamin and mineral supplements has only gained momentum in the last 20 years or so.

And health care professionals have always relied on our nations' food supply to provide us with all the nutrients we need for good health. The only exceptions are during pregnancy, breastfeeding, and infancy, when it is virtually impossible to meet nutritional needs with food alone.

In general, a varied diet should provide all the nutrients needed for good health -- especially in light of all the foods that have added nutrients. But if your diet isn't always optimal diet, a daily multivitamin/multimineral supplement may be a good idea.

Food as Medicine

Fortified foods have taken on an entirely new role with the addition of cholesterol-binding stanols and sterols to margarines and, more recently, to orange juice. These functional foods are specifically aimed at consumers who are trying to lower their blood cholesterol levels.

Think of these foods as over-the-counter "medications" that allow certain people to manage high cholesterol without medication. (Of course, managing your cholesterol level should only be done under the supervision of your doctor.)

When these fortified margarines were first introduced to the market, they were expensive and you needed to eat a sizeable portion to get the cholesterol-lowering benefit. Welcome the newcomer: Minute Maid's fortified orange juice is priced the same as the rest of their juices -- and the recommended portion is reasonable.

Have We Gone Too Far?

Many nutritionists think we have crossed the line with some of the enriched, fortified, and functional foods. They maintain that fortification is no longer a public-health strategy, but an excuse to make junk food appear nutritious.

Their arguments often center on candy-like cereals that have been enriched with vitamins and minerals from A to Z. In their opinion, these super-fortified foods should not masquerade as nutritious.

But cereal manufacturers defend the practice and insist that while their products might be heavy on the sugar, a bowl of cereal with low-fat milk meets one-third of most people's dietary requirements. It is also a matter of supply and demand. Clearly these products sell, and, let's face it, manufacturers are in the business of selling product.