Answers to Consumers' Frequently Asked Questions

Q: How will fortification benefit me?

Wheat and maize flours and rice are most commonly fortified with iron, folic acid, and other B vitamins. Iron improves your capacity for physical activity and productivity. Iron also facilitates children’s physical and mental development and improves the health of pregnant women. When iron deficiency causes severe anemia, it contributes to maternal deaths.

Folic acid (vitamin B9) is needed for the health production of cells. It reduces the prevalence of neural tube defects such as spina bifida and anencephaly. These birth defects are permanently disabling or fatal. Severe vitamin B9 deficiency also leads to anemia.

Other vitamins and minerals frequently used in fortification and their role in health include:

Niacin (vitamin B3) prevents the skin disease known as pellagra. Riboflavin (vitamin B2) helps with metabolism of fats, carbohydrates and proteins. Note: Riboflavin cannot be added to rice as the orange color is too bright and will change the color of fortified rice. Thiamin (vitamin B1) prevents the nervous system disease called beriberi. Vitamin B12 maintains functions of the brain and nervous system. Vitamin D helps bodies absorb calcium which improves bone health. Vitamin A deficiency is the leading cause of childhood blindness. It also diminishes an individual’s ability to fight infections. Zinc helps children develop, strengthens immune systems and lessens complications from diarrhea.

Q: Will fortification harm me?

It is highly unlikely that anyone will get an excess amount of vitamins and minerals from fortified foods. Studies and research in countries with long histories of fortification have established overwhelming evidence of the protective effect of fortification.

A study published in 2004 found that the “prevalence of excessive micronutrient intakes in current European diets is non-existent or extremely low, even for consumers choosing higher amounts of fortified foods. Diet-based models indicate that future increases in the proportion of foods fortified at levels between 10 and 50% RDA (recommended daily allowance) would not be expected to lead to excessive intakes for the majority of vitamins and minerals.”

In the United States, most wheat flour and many breakfast cereals are fortified with folic acid. Also, vitamin supplements containing folic acid are widely available. Yet a population-based study found that less than 3% of U.S. adults exceeded the recommended upper level of folic acid. None reached that level by eating fortified foods; they only exceeded the level if they consumed high-dose supplements.

Q: Will fortification add to the cost of my flour, noodles, bread, rice, etc.?

The ongoing cost to fortify wheat and maize flour with quality iron, zinc, folic acid and other B vitamins ranges from US $1.50 to US $3 per metric ton of flour. If the miller passes that cost to the consumer, it amounts to only pennies per pound of flour. Reports from different countries all say the cost is less than 50 cents per person per year.

When Uzbekistan launched a flour fortification program in 2005, the cost was 120 Sums (around 10 US cents) per person, per year. The total cost of adding mandatory nutrients to flour in the United States is $0.07 per person per year. The retail cost of rice may increase 1-4% depending on the fortification method used.

Q: What kind and what levels of vitamins and minerals are in my rice and flour products?

Each country sets its own fortification standard, so this answer varies by country. The country standard is determined by the prevalence of vitamin and mineral deficiency in that country and the people’s typical eating habits. Global and some regional recommendations are available to help countries set standards. When FFI knows the country standard, the kind and levels of each nutrient are included in the country profile.

Q: What if I prefer unfortified flour or rice?

Countries which require fortification usually allow exceptions for certain types of whole wheat flour or perhaps brown or parboiled rice. If you prefer unfortified food, read the labels and choose these products.

Q: Why not just take supplements?

Supplements can provide protective health benefits when taken consistently as directed. People tend to forget to take supplements, however. They are costly for some consumers, and they carry slight risks of toxicity if taken in excess. Fortification, on the other hand, does not depend on personal behavior changes, and people are unlikely to consume too many vitamins and minerals from fortified foods alone.

With folic acid, for example, women need adequate levels of folic acid prior to conception and early in the pregnancy. If the pregnancy is unplanned, the woman may not be taking folic acid supplements to prevent neural tube birth defects. By the time she learns she is pregnant, it is typically too late for folic acid supplements protect against neural tube defects.

Also, supplement use is more prevalent among groups with higher education and income, and hence less likely to reach poorer population than a fortification program.

In a survey of 1,240 pregnant women in Quebec hospitals, 70% of respondents were aware of the preventive role of folic acid, but only 25 % had taken the recommended dose of supplements during the periconception period.
In a study conducted in Colorado, 53 % of mothers with a neural tube defect affected pregnancies did not know about the recommendation to consume 400 micrograms of folic acid.
In a study to evaluate the uptake of folic acid among 301 Northampton women in 2001, only 43 % women reported taking folic acid before pregnancy and 67 % consumed supplements with folic acid in the first trimester of pregnancy. Also, women under age of 21 and women from lower social classes were found to less likely to take folic acid supplements than women over the age of 21.

Q: Why not just eat a balanced diet?

Meeting nutrient requirements through the food alone is not a practical solution in many parts of the world for several reasons—economic, geographic, social and cultural.

Iron deficiency, for example, is one of the most widely prevalent nutrient deficiencies. The best source of iron is meat, fish, and poultry, but people’s ability to absorb iron from these sources is inhibited by other components in food. Also, many people do not eat meat for cultural reasons, personal beliefs or because meat is too expensive.

Vitamin B9 is present in small quantities in many foods. But women would have to consume an unrealistic amount of these foods to get the dietary equivalent of 400 micrograms of folic acid a day, which is the amount recommended to reduce the risk of a pregnancy affected by a neural tube defect. To get the dietary equivalent of 400 micrograms of folic acid a day, a person would need to consume one of the following:

4 slices of fried beef liver
44½ medium ripe tomatoes
14½ cups of raw broccoli
17½ cups of orange juice
19½ cups of raw green beans
5½ cups of black beans
200 medium red apples

Q: Does fortification change the appearance or taste of food?

Appropriately fortified rice resembles natural rice grains and has been shown to be indistinguishable from natural rice in appearance, taste and texture. When cooked, fortified rice has the same appearance, texture, and taste as cooked, unfortified rice.

Global recommendations for flour fortification are based on levels that will not affect the flour’s taste, smell, or appearance. Some people fear that iron could cause sensory problems at the levels recommended if flour consumption is less than 150 grams per capita per day. However a study of 15 kinds of noodles and breads commonly eaten in Asia showed that the foods would be acceptable to consumers if the food were made with fortified flour. The study included foods fortified with recommended iron levels for groups that eat less than 150 grams per capita per day.

Q: Will there be nutrient losses when fortified rice is rinsed before cooking?

Rice fortified with coating and extrusion technologies can be rinsed with minimal nutrient losses, depending on the types of nutrients added. Vitamins and minerals used in extrusion are evenly distributed and adequately sealed, resulting in high retention of most of the nutrients. Greater losses occur with coating and powder techniques, but limited data are available.

Q: Can fortified rice be cooked in the same way as unfortified rice?

Yes, fortified rice can be cooked in exactly the same way as unfortified rice.