#FFI20: RJ Berry
Retired Epidemiologist at National Center on Birth Defects & Developmental Disabilities at US Centers for Disease Control & Prevention
FFI: How did you become interested in nutrition?
Berry: It has been a long, winding career path for me to work in nutrition. I first studied nutrition when I was a medical student. While I was in medical school, I had an opportunity to spend an elective year at a research institute in Papua New Guinea, where I worked on several nutrition projects. After working at the United States Centers for Disease Control and Prevention (CDC), on folic acid, nutrition became my primary focus.
FFI: What inspired you to become involved with food fortification?
Berry: After I started working at CDC in 1981, I quickly became immersed in CDC’s efforts to study the prevention of neural tube defects (NTDs). In the late 1970s, studies in the United Kingdom suggested that a woman’s risk of having an NTD-affected pregnancy might be decreased by taking folic acid early in pregnancy. Dr. Godfrey Oakley, who had established birth defects surveillance at CDC in the 1960s, saw the potential for eventually preventing these severe birth defects by promoting food fortification with folic acid. After CDC’s work in China, which I led, showed that 400 mcg of folic acid alone prevented the first occurrence of NTDs, the work to promote the fortification of food with folic acid accelerated worldwide.
FFI: How did your work prioritize fortification?
In 1992, the United States (US) Public Health Service adopted the recommendation for 400 mcg of folic acid daily for women planning pregnancy. After this recommendation, the Food and Drug Administration (FDA), CDC, National Institutes of Health (NIH), and other organizations began working to establish folic acid fortification in the US. Mandatory fortification of fortified cereal grain products with folic acid was approved by FDA in 1996 and was fully implemented in the US in 1998. CDC works closely with international organizations and countries to promote folic acid fortification.
FFI: What health outcomes do you expect fortification to improve globally?
Berry: Reduction of NTDs, mostly spina bifida and anencephaly, will be the main health outcomes. It is important to provide folic acid to women before they become pregnant to prevent NTDs.
FFI: In your experience, what are the main components to a successful fortification program?
Berry: I think the most important component is the promotion of strong partnerships among national programs, international nutrition organizations, industry, and the local population. Another important component is the provision of the best science to all partners. Finally, having local champions to promote fortification is an important component.
FFI: What are the greatest challenges you have encountered in planning or implementing fortification programs? And how did you address those challenges?
Berry: The most important problem is the positing of potential adverse effects of folic acid that are not supported by strong evidence. Observational data from the 1940s and 1950s, during the time when both folic acid and vitamin B12 were discovered, were used in 1998 to establish upper intake levels that were based on the concern that folic acid caused neurological damage in adults with vitamin B12 deficiency. I published a review that provided a detailed description of the historical evidence, which did not support the earlier concern that folic acid harmed adults with vitamin B12 deficiency. Other early concerns were that maternal use of folic acid during pregnancy increased the occurrence of twinning and miscarriages. We published two articles using data from our work in China showing that these concerns about increases in twinning and miscarriages were unfounded.
FFI: What can we do as a society to continue strengthening fortification efforts?
Berry: The work of FFI and other organizations promotes evidence-based decisions and encourages partnerships among industry, the population, and national governments. We must make decisions based on strong evidence and avoid making decisions based on the opinions of experts.
FFI: If you were not working in nutrition, what do you think you would be doing?
Berry: I probably would have been one of the early people working in computer sciences. I took my first programming class in 1965 and was captivated by writing programs. I decided to not pursue computers as a career and went to medical school instead. However, at every point of my career, I have used computers and was able to contribute to my work environments by using and understanding them.
FFI: Is there anything else you would like to share?
Berry: One of the things that helped me throughout my career was the fact that I worked in a place with good people, at all levels. There wasn’t a lot of angst; people worked together well and oftentimes we were learning to do new things. It was a place where you could thrive. When I was working in China, I used to see people who feared upcoming site visits from their superiors. I never felt that fear; I was always very happy and eager to see visitors from CDC, because I knew we were doing great work.
This interview is part of the #FFI20 Champions campaign, a celebration of fortification heroes who have helped build a smarter, stronger, and healthier world by strengthening fortification programs over the past 20 years. To read interviews with other champions, visit the #FFI20 Champions campaign homepage.